Burden Of Smoking Research Articles

Burden of smoking on quality of life in patients with chronic obstructive pulmonary disease

The objective of this study was to assess the impact of smoking on health-related quality of life, Work Productivity and Activity Impairment (WPAI) in chronic obstructive pulmonary disease (COPD) patients. Respondents of the 2009/2010 US National Health and Wellness Survey (NHWS), aged ≥40 years, with COPD, chronic bronchitis or emphysema, were included in the study. Current and former (had not smoked for ≥11 years) smokers were compared. Physical component summary (PCS) and mental component summary (MCS) scores from the Short Form-12 version 2 (SF-12v2), health utilities (SF-6D) and WPAI were evaluated. Differences between current (n = 1685) and former (n = 1932) smokers were revealed: MCS (44.80, 46.73; p < 0.01); PCS (35.12, 35.79; p < 0.1); SF-6D (0.63, 0.65; p < 0.05). WPAI: presenteeism (23%, 18%; p < 0.05); work impairment (25%, 21%; p < 0.05); activity impairment (52%, 49%; p < 0.01). In conclusion, COPD patients who smoke have poorer health-related quality of life, impaired productivity and higher healthcare costs than former smokers.

Cigarette smoking is a modifiable risk factor for Barrett's oesophagus.

Cigarette smoking has been associated with an increased risk of oesophageal adenocarcinoma (OAC). However, the impact of smoking and more importantly smoking cessation on Barrett's oesophagus (BO) is unclear. The aim of the study is to evaluate the association between cigarette smoking and presence of BO in a large prospective cohort of patients with gastro-oesophageal reflux disease (GORD). Patients presenting to the endoscopy unit for upper endoscopy completed a validated GORD questionnaire and information on demographics (age, gender, and ethnicity), cigarette smoking [status (current/past), amount (pack years) and duration of smoking cessation], clinical data [medication history, body mass index (BMI), and family history] and endoscopic findings [BO and hiatal hernia] were recorded. Cigarette smokers (current and past) and nonsmokers were compared using Fisher's Exact test for categorical variables and Mann-Whitney test for continuous variables. Effects of cigarette smoking and smoking cessation on BO risk was assessed by stepwise logistic regression analysis. A total of 1056 patients were included in the analysis [mean age: 57.2 ± 12.7years, Caucasian 880 (83.3%), male 985 (93.3%), and mean BMI 29.6 (SD: ± 5.6)]. 827 (78.3%) were smokers and 229 (21.6%) were nonsmokers. 474 subjects (44.9%) had a previous history of smoking. Anytime smokers were more likely to have BO (adjusted OR: 3.3; 95 CI: 1.7-6.3; p < 0.01). Higher smoking burden (pack years) was associated with higher risk of BO in this GORD cohort (p for trend < 0.01). Duration of smoking cessation was inversely associated with risk of BO (p for trend: 0.01). This study shows that smokers with reflux symptoms have about threefold higher risk of BO compared with nonsmokers, whereas discontinuing smoking is associated with a significant reduced risk. Smoking cessation appears to be a viable option to reduce BO risk in patients with reflux disease.

Impact of tobacco control on adult per capita cigarette consumption in the United States.

We assessed the impact of tobacco control on adult per capita cigarette consumption in the United States from 1964 to 2011. We used logit regression to model the diffusion of smoking from 1900 to 2011. We also projected hypothetical cigarette consumption after 1963 in the absence of tobacco control. Model predictors included historical events such as wars, specific tobacco control interventions, and other influences. Per capita consumption increased rapidly through 1963, consistent with S-shaped (sigmoid) diffusion. The course reversed beginning in 1964, the year of publication of the first surgeon general's report on smoking and health. Subsequent tobacco control policy interventions significantly reduced consumption. Had the tobacco control movement never occurred, per capita consumption would have been nearly 5 times higher than it actually was in 2011. Tobacco control has been one of the most successful public health endeavors of the past half century. Still, the remaining burden of smoking in the United States augurs hundreds of thousands of deaths annually for decades to come. Reinvigorating the tobacco control movement will require novel interventions as well as stronger application of existing evidence-based policies.

A systematic review of peer-support programs for smoking cessation in disadvantaged groups.

The burden of smoking is borne most by those who are socially disadvantaged and the social gradient in smoking contributes substantially to the health gap between the rich and poor. A number of factors contribute to higher tobacco use among socially disadvantaged populations including social (e.g., low social support for quitting), psychological (e.g., low self-efficacy) and physical factors (e.g., greater nicotine dependence). Current evidence for the effectiveness of peer or partner support interventions in enhancing the success of quit attempts in the general population is equivocal, largely due to study design and lack of a theoretical framework in this research. We conducted a systematic review of peer support interventions for smoking cessation in disadvantaged groups. The eight studies which met the inclusion criteria showed that interventions that improve social support for smoking cessation may be of greater importance to disadvantaged groups who experience fewer opportunities to access such support informally. Peer-support programs are emerging as highly effective and empowering ways for people to manage health issues in a socially supportive context. We discuss the potential for peer-support programs to address the high prevalence of smoking in vulnerable populations and also to build capacity in their communities.

Sex Differences in Smoking-related Risk of Vascular Disease and All-cause Mortality

Tobacco exposure is one of world’s leading causes of death and illness and traditionally affected more men than women. However, the twenty first century burden of smoking might become disproportionally larger in women than in men for two reasons. First, as the smoking epidemic reached its peak decades earlier in men than in women, previous studies on female smoking-related hazards are highly likely have underestimated the full eventual impact of smoking on mortality in women because of the lengthy time lag between smoking uptake and disease onset in middle and old age. Second, findings from large contemporary studies suggest that the full health hazards of prolonged smoking are at least as great as, and potentially even greater, among women who smoke compared with men who smoke. Moreover, quitting smoking is equally beneficial in men and women all across the world. Future studies that attempt to identify the potential mechanisms responsible for the greater risk observed in women compared with men who smoke are warranted. Clinically, physicians and health professionals should be encouraged to further increase their efforts at promoting smoking cessation in men and women.

Smoking Burden in the Philippines

...

Adverse effects of smoking on serum cholesterol levels

Smoking is a major public health problem and is associated with significant morbidity and mortality. Many studies have reported derangement of serum cholesterol levels in smokers, adding to the suffering.The present study was carried out to compare serum cholesterol levels between smokers and non-smokers. Serum samples from 100 chronic smokers and equal number of non-smokers were collected and cholesterol levels were measured. Majority of non-smokers (72%) had serum cholesterol level ranging between 150-200mg% as compared to smokers (27%). Significant higher levels (>250mg%) were found in smokers (40%) as compared to non-smokers (6%). Increased duration and burden of smoking were significantly associated with deranged cholesterol levels (p≤0.05). Vigorous nationwide campaigns should be carried out to educate the society of ill effects of smoking.

The Impact of Tumor Necrosis Factor α Inhibitors on Radiographic Progression in Ankylosing Spondylitis

To study the effect of tumor necrosis factor α (TNFα) inhibitors on progressive spinal damage in patients with ankylosing spondylitis (AS). All AS patients meeting the modified New York criteria who had been monitored prospectively and had at least 2 sets of spinal radiographs a minimum of 1.5 years apart were included in the study (n=334). The patients received standard therapy, which included nonsteroidal antiinflammatory drugs and TNFα inhibitors. Radiographic severity was assessed by the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Patients with a rate of AS progression that was ≥1 mSASSS unit/year were considered progressors. Univariable and multivariable regression analyses were done. Propensity score matching and sensitivity analysis were performed. A zero-inflated negative binomial (ZINB) model was used to analyze the effect of TNFα inhibitors on the change in the mSASSS with varying followup periods. Potential confounders, such as disease activity (as assessed by the Bath Ankylosing Spondylitis Disease Activity Index), the erythrocyte sedimentation rate, C-reactive protein level, HLA-B27 positivity, sex, age at onset, smoking burden (number of pack-years), and baseline damage, were included in the model. TNFα inhibitor treatment was associated with a 50% reduction in the odds of progression, with an odds ratio (OR) of 0.52 (95% confidence interval [95% CI] 0.30-0.88, P=0.02). Patients with a delay of >10 years in starting therapy were more likely to experience progression as compared to those who started earlier (OR 2.4 [95% CI 1.09-5.3], P=0.03). In the ZINB model, the use of TNFα inhibitors significantly reduced disease progression when the gap between radiographs was >3.9 years. The protective effect of TNFα inhibitors was stronger after propensity score matching. Treatment with TNFα inhibitors appears to reduce radiographic progression in AS patients, especially with early initiation and with longer duration of followup.

Smoking in young women in Scotland and future burden of hospital admission and death: a nested cohort study

Many women smoke, yet few longitudinal studies have examined the non-fatal burden of smoking in women. To investigate smoking in young women, and hospital admission and death in Scotland; and to compare mortality risk with elsewhere in the UK. Nested cohort study: Royal College of General Practitioners' Oral Contraception Study, UK. A total of 4121 women categorised by smoking habits and living in Scotland at recruitment (1968-1969) were followed until March 2009. Cox regression was used to investigate smoking and survival time; mortality from cancer, circulatory, or respiratory disease, and all other causes; and hospitalisation for any reason, and for specific reasons. The number and type of hospital admissions and bed-days were examined by smoking status. Life tables and Cox regression were used to compare the mortality risk of women living in Scotland with that of women living elsewhere. All-cause mortality was increased in women who smoked <15 cigarettes daily (adjusted hazard ratio = 1.99, 95% confidence interval [CI] = 1.74 to 2.27) and those who smoked ≥15 cigarettes daily (adjusted HR = 2.81, 95% CI = 2.47 to 3.20). Smoking any amount increased death from cancer, circulatory, respiratory, and other causes. Increased risk estimates were seen in one or both smoking groups for hospitalisation for any cause, and for several specific causes. More smokers than non-smokers were admitted to hospital, for four or more reasons, and had a longer total stay. The median survival age among smokers was lower in Scotland than elsewhere. Higher adjusted hazard ratios for mortality were found among smokers in Scotland. This study provides a powerful reminder of the burden of smoking in young women. In the UK, harmful effects appear to be worse in smokers in Scotland.

Prevalence and Risk Factors of Asymptomatic Peripheral Arterial Disease in Patients with COPD in Taiwan

AimChronic obstructive pulmonary disease (COPD) is an independent risk factor for cardiovascular morbidity and mortality. The aim of this study was to determine the prevalence of asymptomatic peripheral arterial disease (PAD) and the associated risk factors for patients with COPD.MethodsThis prospective cross-sectional study enrolled 427 COPD patients (mean age: 70.0 years) without PAD symptoms consecutively. Demographic data, lung function and cardiovascular risk factors were recorded. The ankle-brachial index (ABI) was used to detect PAD (ABI<0.90).ResultsThe overall prevalence of asymptomatic PAD in the COPD patients was 8% (2.5% in the younger participants (<65 years of age, n = 118) and 10% in the elderly participants (≥65 years of age, n = 309). The COPD patients with asymptomatic PAD had a significantly higher rate of hyperlipidemia (47.1% vs. 10.4%) and hypertension (79.4% vs. 45.8%) than those without asymptomatic PAD (p<0.05). There was no significant difference in lung function (forced vital capacity and forced expiratory volume in one second) between the two groups. In multivariate logistic regression, hyperlipidemia was the strongest independent factor for PAD (odds ratio (OR): 6.89, p<0.005), followed by old age (OR: 4.80), hypertension (OR: 3.39) and smoking burden (pack-years, OR: 1.02).ConclusionsThe prevalence of asymptomatic PAD among COPD patients in Taiwan is lower than in Western countries. Hyperlipidemia, old age, hypertension, and smoking burden were the associated cardiovascular risk factors. However, there was no association between lung function and PAD in the COPD patients.

A pilot study of Screening, Brief Intervention, and Referral for Treatment (SBIRT) in non-treatment seeking smokers with HIV

IntroductionPLHIV have higher rates of smoking and lower motivation to quit smoking; thus to impact smoking rates, cessation interventions need to be acceptable to a wider range of PLHIV smokers as well as feasible to implement in a busy clinical setting. The purpose of this study was to evaluate the acceptability, feasibility, and effects of a Screening, Brief Intervention, and Referral for Treatment (SBIRT) model in an HIV/AIDS clinic among a sample of PLHIV. MethodsPLHIV smokers (N=40) were randomized at baseline, irrespective of their self-reported discrete smoking cessation motivation status, to receive either 8-weeks of combination nicotine replacement therapy (NRT) in conjunction with brief counseling (SBIRT framework) (n=23) or usual care (n=17). Smoking outcome measures included cigarettes smoked per day, nicotine dependence, smoking urge, and smoking withdrawal symptoms. ResultsThe SBIRT intervention appeared to be acceptable and feasible, and produced medium to large reductions in cigarettes smoked per day, physical nicotine dependence, smoking urge, and smoking withdrawal symptoms, even for smokers not ready to quit within 6months. ConclusionsFindings provide preliminary support for the integration of an SBIRT model in an HIV/AIDS clinic setting to screen and provide active treatment to all smokers, regardless of readiness to quit smoking. Given the high prevalence and incredible health burden of continued smoking in this population, identifying brief and effective interventions that are easily translated into clinical practice represents an enormous challenge that if met, will yield significant improvements to overall patient outcomes.

The impact of smoking in adolescence on early adult anxiety symptoms and the relationship between infant vulnerability factors for anxiety and early adult anxiety symptoms: the TOPP Study.

Cigarette smoking is increased in people with trait anxiety and anxiety disorders, however no longitudinal data exist illuminating whether smoking in adolescence can influence the developmental trajectory of anxiety symptoms from early vulnerability in infancy to adult anxiety expression. Using The Tracing Opportunities and Problems in Childhood and Adolescence (TOPP) Study, a community-based cohort of children and adolescents from Norway who were observed from the age of 18months to age 18–19years, we explored the relationship between adolescent smoking, early vulnerability for anxiety in infancy (e.g. shyness, internalizing behaviors, emotional temperaments) and reported early adult anxiety.Structural equation modeling demonstrated that adolescent active smoking was positively associated with increased early adulthood anxiety (β = 0.17, p<0.05), after controlling for maternal education (proxy for socioeconomic status). Adolescent anxiety did not predict early adult smoking. Adolescent active smoking was a significant effect modifier in the relationship between some infant vulnerability factors and later anxiety; smoking during adolescence moderated the relationship between infant internalizing behaviors (total sample: active smokers: β = 0.85,p<0.01, non-active smokers: ns) and highly emotional temperament (total sample: active smokers: β = 0.55,p<0.01,non-active smokers: ns), but not shyness, and anxiety in early adulthood. The results support a model where smoking acts as an exogenous risk factor in the development of anxiety, and smoking may alter the developmental trajectory of anxiety from infant vulnerability to early adult anxiety symptom expression. Although alternative non-mutually exclusive models may explain these findings, the results suggest that adolescent smoking may be a risk factor for adult anxiety, potentially by influencing anxiety developmental trajectories. Given the known adverse health effects of cigarette smoking and significant health burden imposed by anxiety disorders, this study supports the importance of smoking prevention and cessation programs targeting children and adolescence.

Electrocardiographic Changes Associated with Smoking and Smoking Cessation: Outcomes from a Randomized Controlled Trial

IntroductionCardiovascular disease (CVD) can be detected and quantified by analysis of the electrocardiogram (ECG); however the effects of smoking and smoking cessation on the ECG have not been characterized.MethodsStandard 12-lead ECGs were performed at baseline and 3 years after subjects enrolled in a prospective, randomized, placebo-controlled clinical trial of smoking cessation pharmacotherapies. ECGs were interpreted using the Minnesota Code ECG Classification. The effects of (i) smoking burden on the prevalence of ECG findings at baseline, and (ii) smoking and smoking cessation on ECG changes after 3 years were investigated by multivariable and multinomial regression analyses.ResultsAt baseline, 532 smokers were (mean [SD]) 43.3 (11.5) years old, smoked 20.6 (7.9) cigarettes/day, with a smoking burden of 26.7 (18.6) pack-years. Major and minor ECG criteria were identified in 87 (16.4%) and 131 (24.6%) of subjects, respectively. After adjusting for demographic data and known CVD risk factors, higher pack-years was associated with major ECG abnormalities (p = 0.02), but current cigarettes/day (p = 0.23) was not. After 3 years, 42.9% of subjects were abstinent from smoking. New major and minor ECG criteria were observed in 7.2% and 15.6% of subjects respectively, but in similar numbers of abstinent subjects and continuing smokers (p>0.2 for both). Continuing smokers showed significant reduction in current smoking (–8.4 [8.8] cigarettes/day, p<0.001) compared to baseline.ConclusionsIn conclusion, major ECG abnormalities are independently associated with lifetime smoking burden. After 3 years, smoking cessation was not associated with a decrease in ECG abnormalities, although cigarettes smoked/day decreased among continuing smokers.

Serum osteopontin in giant cell arteritis: A biomarker associated with sistemic inflammatory response and relapsing course

Quality-adjusted life-years (QALYs) use a single number to provide an assessment of the overall health burden of diseases associated both with mortality and morbidity. This study examined the trend and geographic variation of the burden of smoking by calculating smoking-related QALYs lost from 1993 to 2008 for the US adults and individual states.Population health-related quality of life scores were estimated from the 1993 to 2008 Behavioral Risk Factor Surveillance System. The smoking-related QALYs lost are the sum of QALYs lost due to morbidity and future QALYs lost in expected life years due to premature deaths (mortality).From 1993 to 2008, the percent of US adults who smoked declined from 22.7% to 18.5%, but the smoking-related QALYs lost were relatively stable at 0.0438 QALYs lost per population. Although smoking contributed more QALYs lost for men (0.0535) than for women (0.0339), smoking-related QALYs lost decreased by 2.5% for men but increased by 12.6% for women. Kentucky, Oklahoma, Mississippi, West Virginia, and Tennessee had the most smoking-related QALYs lost wheras Utah, California, Connecticut, Minnesota, and Hawaii had the least QALYs lost. The state tobacco tax rate was strongly and negatively associated with both the percent smoked (r = −0.60) and QALYs lost (r = −0.54), as well as the percentage change in both.This analysis quantified the overall burden of smoking for the nation and individual states from 1993 to 2008. Such data might assist in providing specified quantitative targets for the Healthy People 2020 smoking-related health objectives and for tracking changes on a yearly basis.

A Prospective Study of Tobacco Smoking and Mortality in Bangladesh

BackgroundLimited data are available on smoking-related mortality in low-income countries, where both chronic disease burden and prevalence of smoking are increasing.MethodsUsing data on 20, 033 individuals in the Health Effects of Arsenic Longitudinal Study (HEALS) in Bangladesh, we prospectively evaluated the association between tobacco smoking and all-cause, cancer, and cardiovascular disease mortality during ∼7.6 years of follow-up.Cox proportional hazards models were used to estimate hazard ratios (HRs) and their 95% confidence intervals (CIs) for deaths from all-cause, cancer, CVD, ischemic heart disease (IHD), and stroke, in relation to status, duration, and intensity of cigarette/bidi and hookah smoking.ResultsAmong men, cigarette/bidi smoking was positively associated with all-cause (HR 1.40, 95% CI 1.06 1.86) and cancer mortality (HR 2.91, 1.24 6.80), and there was a dose-response relationship between increasing intensity of cigarette/bidi consumption and increasing mortality. An elevated risk of death from ischemic heart disease (HR 1.87, 1.08 3.24) was associated with current cigarette/bidi smoking. Among women, the corresponding HRs were 1.65 (95% CI 1.16 2.36) for all-cause mortality and 2.69 (95% CI 1.20 6.01) for ischemic heart disease mortality. Similar associations were observed for hookah smoking. There was a trend towards reduced risk for the mortality outcomes with older age at onset of cigarette/bidi smoking and increasing years since quitting cigarette/bibi smoking among men. We estimated that cigarette/bidi smoking accounted for about 25.0% of deaths in men and 7.6% in women.ConclusionsTobacco smoking was responsible for substantial proportion of premature deaths in the Bangladeshi population, especially among men. Stringent measures of tobacco control and cessation are needed to reduce tobacco-related deaths in Bangladesh.

Smoking-related knowledge, attitudes, and behaviours among Alaska Native people: a population-based study

BackgroundSeveral studies have shown that Alaska Native people have higher smoking prevalence than non-Natives. However, no population-based studies have explored whether smoking-related knowledge, attitudes, and behaviours also differ among Alaska Native people and non-Natives.ObjectiveWe compared current smoking prevalence and smoking-related knowledge, attitudes, and behaviour of Alaska Native adults living in the state of Alaska with non-Natives.MethodsWe used Alaska Behavioral Risk Factor Surveillance System data for 1996 to 2010 to compare smoking prevalence, consumption, and cessation- and second-hand smoke-related knowledge, attitudes, and behaviours among self-identified Alaska Native people and non-Natives.ResultsCurrent smoking prevalence was 41% (95% CI: 37.9%–44.4%) among Alaska Native people compared with 17.1% (95% CI: 15.9%–18.4%) among non-Natives. Among current every day smokers, Alaska Natives were much more likely to smoke less than 10 cigarettes per day (OR=5.0, 95% CI: 2.6–9.6) than non-Natives. Compared with non-Native smokers, Alaska Native smokers were as likely to have made a past year quit attempt (OR=1.4, 95% CI: 0.9–2.1), but the attempt was less likely to be successful (OR=0.5, 95% CI: 0.2–0.9). Among current smokers, Alaska Natives were more likely to believe second-hand smoke (SHS) was very harmful (OR=4.5, 95% CI: 2.8–7.2), to believe that smoking should not be allowed in indoor work areas (OR=1.9, 95% CI: 1.1–3.1) or in restaurants (OR=4.2, 95% CI: 2.5–6.9), to have a home smoking ban (OR=2.5, 95% CI: 1.6–3.9), and to have no home exposure to SHS in the past 30 days (OR=2.3, 95% CI: 1.5–3.6) than non-Natives.ConclusionAlthough a disparity in current smoking exists, Alaska Native people have smoking-related knowledge, attitudes, and behaviours that are encouraging for reducing the burden of smoking in this population. Programs should support efforts to promote cessation, prevent relapse, and establish smoke-free environments.

Revisiting the Hispanic mortality advantage in the United States: The role of smoking

More than three decades of health disparities research in the United States has consistently found lower adult mortality risks among Hispanics than their non-Hispanic white counterparts, despite lower socioeconomic status among Hispanics. Explanations for the “Hispanic Paradox” include selective migration and cultural factors, though neither has received convincing support. This paper uses a large nationally representative survey of health and smoking behavior to examine whether smoking can explain life expectancy advantage of Hispanics over US-born non-Hispanics whites, with special attention to individuals of Mexican origin. It tests the selective migration hypothesis using data on smoking among Mexico-to-US migrants in Mexico and the United States. Both US-born and foreign-born Mexican-Americans exhibit a life expectancy advantage vis-à-vis whites. All other Hispanics only show a longevity advantage among the foreign-born, while those born in the United States are disadvantaged relative to whites. Smoking-attributable mortality explains the majority of the advantage for Mexican-Americans, with more than 60% of the gap deriving from lower rates of smoking among Mexican-Americans. There is no evidence of selective migration with respect to smoking; Mexicans who migrate to the US smoke at similar rates to Mexicans who remain in Mexico, with both groups smoking substantially less than non-Hispanic whites in the US. The results suggest that more research is needed to effectively explain the low burden of smoking among Mexican-Americans in the United States.

Effects of aging and smoking on carotid intima–media thickness in HIV-infection

To investigate the effects of aging and smoking on carotid intima-media thickness (cIMT) among patients with and without HIV. Data from a community sample of HIV-infected and HIV-uninfected participants were analyzed. Carotid intima-media thickness was measured via carotid ultrasound and smoking history was obtained via patient interview. Data on 166 male and female participants with stable HIV-infection and 152 healthy HIV-uninfected participants were analyzed. Among the HIV-infected and HIV-uninfected participants, a significant association was observed between age and cIMT [r = 0.51, P < 0.0001 (HIV), r = 0.39, P < 0.0001, (non-HIV)], and between smoking burden and cIMT [r = 0.42, P < 0.0001 (HIV), r = 0.24, P = 0.003 (non-HIV)]. In multivariate regression modeling among all participants (HIV and non-HIV), a significant three-way interaction was observed between age, smoking burden, and HIV status with respect to cIMT (P < 0.010), controlling for sex, race, and traditional cardiovascular disease (CVD) risk factors, such that increased cIMT was associated with increased smoking burden and age to a greater degree among HIV-infected vs. HIV-uninfected participants. Among HIV-infected participants a significant interaction between smoking burden and age with respect to cIMT was seen (P = 0.027) controlling for race, sex, CVD risk factors, immunological function, and antiretroviral therapy use. A significant interaction between HIV, age, and smoking on cIMT was observed, suggesting that HIV-infection modifies the relationship of age and smoking on cIMT in this population. These findings emphasize the need to encourage smoking cessation in this population, due to its deleterious effect on subclinical atherosclerosis in older HIV-infected patients.

Indoor Air Quality in Central Appalachia Homes Impacted by Wood and Coal Use.

Though the high prevalence of biomass fuel use in the developing world is widely known, the use of burning biomass for cooking and heating in the developed world is under-recognized. Combustion materials including coal and wood are also used for heating in some areas of the United States. We conducted a pilot study to assess the feasibility of conducting indoor environmental monitoring in rural Appalachia. We sought to explore the type of biomass being used for home heating and its impact upon indoor air quality in non-heating and heating seasons. Residential indoor air monitoring for particulate matter (PM) and nitrogen dioxide (NO2) was conducted in Lee County, Virginia. Homes had evidence of poor indoor air quality with high concentrations of indoor PM and a large burden of cigarette smoking. Further characterization of indoor combustion material use in this region to determine the health impacts associated with such exposures is warranted.

Declining Rates of Tobacco Use in the Japanese Medical Profession, 1965^|^ndash;2009

BackgroundAlthough there has been a downward trend in smoking rates among medical doctors in recent years, rates have been higher among Japanese doctors when compared internationally.MethodsWe extensively reviewed all published English- and Japanese-language articles that reported the smoking rates of Japanese doctors.ResultsA total of 36 articles were examined, most of which had been conducted as postal surveys, usually by a national, prefectural, or local medical association. Sample sizes ranged from 17 to 11 773, and response rates ranged from 33% to 91%. National surveys conducted between 1965 and 2009 suggest that there has been a statistically significant (P < 0.0001) decline in smoking rates among Japanese doctors (from around 68% to 16% among males and from 19% to 5% among females).ConclusionsOverall, the published data reveal a significant decline in smoking rates among Japanese doctors since 1965, especially among men. Although less than one-fifth of Japanese male doctors now smoke, more work needs to be done in tobacco control to help further reduce the burden of smoking, especially in medical schools.