Heavy Cigarette Smoking Research Articles

The relationship between serum trace element changes and visual function in heavy smokers.

The aim of this prospective study was to evaluate serum manganese (Mn), zinc (Zn) and copper (Cu) levels and visual functions including visual acuity, colour vision, pattern visual evoked potentials (PVEPs), and contrast sensitivity in heavy smokers and to compare these with the equivalent levels and functions in non-smokers. Data were recorded in 24 healthy, chronic and heavy cigarette smokers and 16 healthy, non-smoking control subjects. Serum Zn, Cu and Mn concentrations in all subjects were measured by atomic absorption spectrophotometry. Both study and control subjects had normal visual acuity and colour vision. Pattern visual evoked potentials were normal in all study and control subjects. Contrast sensitivity was significantly reduced in heavy smokers compared to non-smokers (p < 0.023), despite the fact that central vision and PVEP responses were not affected. Mean serum Mn and Zn levels were significantly lower in smokers than in non-smokers (p < 0.0001 and p < 0.005, respectively). Reduced contrast sensitivity values associated with low levels of serum Mn and Zn, which function as cofactors of superoxide dismutase in erythrocyte and other nucleated cells, suggest a possible role of trace elements in smoking-induced early retinal toxicity.

Teenage alcoholic beverage preferences: Risks and responses

The preferences of 2641 teenagers for beer wine or spirits were assessed and compared to other variables examined in the UK part of the European School survey project on alcohol and other drugs (ESPAD). Preference assessment was indirect, relying on the frequencies of consumption of the different beverages in the past month. Wine was less commonly preferred than either beer or spirits. Girls were more likely than boys to prefer wine or spirits and less likely to prefer beer. Teenagers who had most frequently consumed either beer or spirits were more likely than those who preferred wine to be heavy drinkers, cigarette smokers and users of illicit drugs. They were also more frequently truants from school and less likely to have consumed their last alcoholic drink in a low-risk setting. These results are discussed in the light of available evidence on the health promotion designed to reduce high-risk drinking.

IL-1 gene polymorphism and smoking as risk factors for peri-implant bone loss in a well-maintained population.

The aim of the present study was (i) to investigate the relation between specific interleukin-1 (IL-1) gene polymorphisms and peri-implant bone loss at osseointegrated ITI(R) dental implants and (ii) to explore the association between these allelic variants of the IL-1 gene complex and peri-implant mucosal inflammation, in both smoking and non-smoking individuals. A sample of 90 consecutive Caucasian patients (aged 33-88 years), treated with at least one ITI-implant participated in this retrospective investigation. Standardized periapical radiographs were taken after prosthetic rehabilitation (133.6 days, SD 136.9 days) and at the time of the re-examination, on average 5.6 years (SD 2.5 years) thereafter. The radiographs were analyzed by a calibrated examiner for changes in peri-implant bone levels. The examiner was blind with respect to clinical parameters and IL-1 status. The distance between the implant shoulder and the first visible bone-implant contact (DIB) at the respective time points were measured using a computerized method. The absolute bone level difference during the years of service (ABL) and the annual bone loss (DeltaBL/year) were calculated for all the implants. Percentages of full mouth bleeding on probing (BOP), as well as of BOP calculated separately for teeth and implants, were determined for all visits and averaged for the entire observation period. Out of the total patient sample, there were 14 heavy smokers (= 20 cigarettes/day), 14 moderate smokers (5-19 cigarettes/day), 23 previous smokers (smoking cessation > 5 years) and 39 non-smokers. Twenty-eight (31.11%) patients were IL-1 genotype positive. Upon stratification for smoking status, significant differences were found for the variables ABL (P < 0.04, U-test) and DeltaBL/year (P < 0.04, U-test) between non-smokers and heavy smokers for the IL-1 genotype positive group but not for the IL-1 genotype negative group. Moreover, significant differences in ABL (P < 0.04, U-test) and DeltaBL/year (P < 0.04, U-test) were identified between former smokers and heavy smokers for the IL-1 genotype positive group. The differences in inflammatory parameters (BOP) did not reach statistical significance. This study suggests that in heavy cigarette smokers, carriage of a functionally significant IL-1 gene complex polymorphism is associated with an increased risk for peri-implant bone loss following prosthetic reconstruction and during the supportive periodontal care phase of the treatment.

Retinoic acid receptor beta and telomerase catalytic subunit expression in bronchial epithelium of heavy smokers.

Expression of retinoic acid receptor beta (RAR beta) and telomerase catalytic subunit (human telomerase reverse transcriptase [hTERT]) was analyzed in 285 bronchial biopsy specimens from 53 heavy cigarette smokers and four former smokers by using in situ hybridization. Of the 191 biopsy specimens that were positive for RAR beta, 69% expressed hTERT, whereas only 54% of the 94 RAR beta negative biopsy specimens expressed hTERT (P =.014). Because hTERT expression in bronchial tissue has been previously associated with increased risk of lung cancer, the association between RAR beta and hTERT expression suggests that RAR beta expression may be an indicator of increased risk of lung cancer in heavy smokers.

The relationship between employment and substance use among students aged 12 to 17

Purpose The full text of this article is available on JAH Online at http://www.elsevier.com/locate/jahonline. To examine the association between employment status and substance use among students aged 12 to 17 years. Methods Secondary analysis of data from the 1995 and 1996 National Household Surveys on Drug Abuse was conducted. The survey is a primary source of data on licit and illicit drug use among noninstitutionalized Americans aged 12 years or older. Participants are interviewed at their places of residence. Multiple logistic regression procedures yielded estimated associations. Results About one in six adolescents reported both going to school and holding a job. Approximately one-fourth of students smoked cigarettes, and one-third consumed alcohol in the past year. An estimated 1.6% of students were current heavy cigarette smokers, and 2.6% were current heavy alcohol users. One-year prevalence estimates of any illicit drug use and heavy illicit drug use were 16.7% and 1.8%, respectively. Among students employed full time, prevalence estimates increased to 9.7% for heavy cigarette smoking, 13.1% for heavy alcohol use, 38.1% for any illicit drug use, and 5.0% for heavy illicit drug use. Logistic regression analyses supported relatively high rates of cigarette use, alcohol use, illicit drug use, and heavy substance use among working students. Mental health problems, especially externalizing behavioral syndromes, were found to coexist with the use and heavy use of substances. The observed associations varied somewhat by gender. Conclusions The workplace may be an appropriate venue for establishing substance use prevention and early intervention programs focused on younger workers, including adolescents who work part time.

VIII. Special Considerations for Different Population Groups

Therapeutic recommendations in this report are based heavily on evidence from controlled clinical trials. Nonetheless, randomized clinical trials have not been carried out to address all therapeutic questions pertaining to all age groups, both sexes, and different racial/ethnic groups. Consequently, ATP III recommendations for various groups often must be made by combining what has been learned from clinical trials with other lines of evidence such as epidemiological findings. Fortunately, a large number of clinical trials have produced a very large set of consistent results that allow for considerable confidence in projections of benefits and drawbacks of cholesterol-lowering therapy in groups that have not been subject to clinical trials. In the discussion to follow, the ATP III panel has crafted its recommendations for different population groups from general evidence statements and general recommendations developed in previous sections. No attempt will be made to grade the category and strength of evidence for all recommendations made in this section. Men of middle-age (35-65 years) are at increasing risk for CHD as they progressively age. Up to one-third of all new CHD events and about one-fourth of all CHD deaths occur in middle-aged men.1017 Most of the excess risk for CHD morbidity and mortality in middle-aged men can be explained by the major risk factors—cholesterol disorders, hypertension, and cigarette smoking.10,11 Men are predisposed to abdominal obesity, which makes them particularly susceptible to the metabolic syndrome. Consequently, metabolic risk factors (elevated cholesterol and triglycerides, low HDL cholesterol, and elevated blood pressure) appear earlier in men than women. Table VIII.1-1 summarizes factors to consider when applying ATP III guidelines to middle-aged men. View this table: Table VIII.1-1. Special Considerations for Cholesterol Management in Middle-Aged Men CHD is a major cause of death in women as well as men and it ultimately kills as many women as men.1017 However, …

IV. General Approach to Treatment—Goals and Thresholds

The basic principle that guides cholesterol-lowering intervention is that the intensity of treatment is directly related to the degree of risk for CHD events. Both short-term (10-year) risk and long-term risk must be considered for treatment decisions. Persons with existing CHD (or a CHD risk equivalent) are at the highest risk; for this reason, they have the lowest goal level for LDL cholesterol and receive the most intensive treatment. For persons without CHD, classification and treatment goals are based on the category of risk, of which there are two—multiple (2+) risk factors other than LDL, and 0-1 risk factor. Persons with 2+ risk factors have an LDL goal that is not quite as low as that for persons with CHD (or CHD risk equivalents). ATP III differs from ATP II in that it distinguishes three subcategories of risk among persons with multiple (2+) risk factors: 10-year risk for hard CHD >20 percent, 10-20 percent, and <10 percent. Among the group with multiple risk factors, those at highest risk receive the most intensive LDL-lowering therapy, and those with the lowest risk receive the least intensive therapy. For persons with 0-1 risk factor, LDL goal levels are not as low as for persons with multiple risk factors, and intensive LDL-lowering therapy is not required unless LDL cholesterol levels are very high. ATP III recommends that LDL cholesterol be the primary target of therapy. The LDL cholesterol goals for each risk category are shown in Table IV.1-1. View this table: Table IV.1-1. LDL Cholesterol Goals for Three Risk Levels Persons with CHD or CHD risk equivalent have an LDL cholesterol goal of 20 percent per 10 years) who has an LDL cholesterol goal …

Lung cancer screening with low-dose CT

Screening for lung cancer is hoped to reduce mortality from this common tumour, which is characterised by a dismal overall survival, relatively well defined risk groups (mainly heavy cigarette smokers and workers exposed to asbestos) and a lack of early symptoms. In the past studies using sputum cytology and chest radiography have failed to demonstrate any reduction in lung cancer mortality through screening. One of the reasons is probably the relatively poor sensitivity of both these tests in early tumours. Low radiation dose computed tomography (CT) has been shown to have a much higher sensitivity for small pulmonary nodules, which are believed to be the most common presentation of early lung cancer. As, however, small pulmonary nodules are common and most are not malignant, non-invasive diagnostic algorithms are required to correctly classify the detected lesions and avoid invasive procedures in benign nodules. Nodule density, size and the demonstration of growth at follow-up have been shown to be useful in this respect and may in the future be supplemented by contrast-enhanced CT and positron emission tomography. Based on these diagnostic algorithms preliminary studies of low-dose CT in heavy smokers have demonstrated a high proportion of asymptomatic, early, resectable cancers with good survival. As, however, several biases could explain these findings in the absence of the ultimate goal of cancer screening, i.e. mortality reduction, most researchers believe that randomised controlled trials including several 10 000 subjects are required to demonstrate a possible mortality reduction. Only then general recommendations to screen individuals at risk of lung cancer with low-dose CT should be made. It can be hoped that international cooperation will succeed in providing results as early as possible.

Heavy and light cigarette smokers have similar dysfunction of endothelial vasoregulatory activity: An in vivo and in vitro correlation

ObjectivesThe goal of this study was to investigate the dose-dependent effects of active cigarette smoking on endothelial nitric oxide (NO) and endothelin-1 (ET-1) biosynthesis. BackgroundLimited studies have suggested that active cigarette smoking may be associated with a dose-dependent reduction of endothelium-dependent vasodilation (EDV). The underlying biochemical changes that cause this dose-specific effect, such as changes in the endothelial NO biosynthetic pathway and ET-1 production, have not been examined. MethodsFlow- and nitroglycerin-mediated reactivity of the brachial artery were measured in eight nonsmokers, seven light smokers (≤1 pack/week) and eight heavy smokers (≥1 pack/day), and their sera were added to confluent (∼85%) monolayers of human umbilical endothelial cells (HUVECs) for 12 h. Basal and substance P-stimulated NO and basal ET-1 production were measured. The HUVECs used for measuring basal NO production were lysed, and both endothelial NO synthase (eNOS) protein expression and eNOS activity were determined. ResultsSerum cotinine level and pack-years of smoking were significantly lower in light smokers compared with heavy smokers (p < 0.006 and p < 0.004, respectively). There were no significant differences between heavy smokers and light smokers in EDV (p = 0.52), basal- (p = 0.70) and stimulated-NO production (p = 0.95), eNOS protein (p = 0.40) and eNOS activity (p = 0.63). Compared with nonsmokers, all the parameters were significantly altered in both of the smokers’ groups. No differences were found in nitroglycerin-mediated vasodilation and in vitro ET-1 production among the three groups. ConclusionsThese results indicate light smoking may have similar detrimental effects on EDV and NO biosynthetic pathway as does heavy smoking. These data may have important implications concerning the amount of active cigarette exposure that imparts cardiovascular risk.

Predictors of fatigue in healthy young adults: moderating effects of cigarette smoking and gender.

Fatigue is a common complaint of patients seen in primary care. Factors that contribute to fatigue in a patient population include poor health status, psychological stress, poor nutrition, and pregnancy. Less well understood are factors that contribute to fatigue among healthy, nonpregnant individuals. Within the framework of the theory of unpleasant symptoms, 40 healthy young smoking and nonsmoking adults between the ages of 18 and 35 were evaluated to determine self-report level of fatigue and contributing physiological, psychological, and situational factors. Results indicate that while self-report of fatigue did not vary in this population based on gender, subjects who were moderate to heavy cigarette smokers were significantly more fatigued than were nonsmokers (F = 10.24, df = 1, 38, P < 0.01), with the effect being specific to male smokers. Self-report of fatigue did not correlate with body mass index, baseline inflammatory or immune status, or blood pressure. Positive psychological and situational predictors of fatigue included depression (r = 0.556, P < 0.001), state anxiety (r = 0.569, P < 0.001), sleep quality (r = -0.399, P < 0.05), and sleep quantity (r = -0.411, P < 0.05). These results suggest that psychological and situational factors are key contributors to fatigue in young adults and that smoking is a risk factor for fatigue in men.

Diagnostic value of liver biopsy in patients with chronic hepatitis C infection

Results: All heavy smokers presented with facial flushing, warm palms, fullness in the head, dizziness, lethargy, generalized parathesia, pruritus, arthralgia. All smokers had haemoglobin level > 16 g/dl and haematocrit >55 compared to 12/84 (14.3%) in group 2. Serum iron was raised in 12/38 (31.6%) in group 1 compared to 8/84 (9.5%) in group 2. Hyperuricemia was reported in 18/38 (47.4%) in group 1 compared to 6/84 (7%) in group 2. Repeated phlebotomy corrected both symptoms and laboratory derangement. SVR was higher 7/62 (11.3%) in non-smokers compared to smokers 2/32 (6.3%) but didn't reach statistical significance (p = 0.06). Conclusion: Heavy cigarette smoking induces polycythemia with multiple adverse clinical and laboratory manifestations correctable by therapeutic phlebotomy. Smokers tend to have lower SVR and should refrain from smoking before starting IFN-alpha therapy.

Heavy and light cigarette smokers have a similar dysfunction in NO biosynthesis: an in vivo and in vitro correlation

Heavy and light cigarette smokers have a similar dysfunction in NO biosynthesis: an in vivo and in vitro correlation

Trends in lifestyle coronary risk factors in the Danish MONICA population 1982–1992

Myocardial infarction incidence rate declined 3–5% per year during 1982–1992 in the Danish study population of the WHO MONICA Project. We examined whether smoking habits, alcohol intake, dietary habits and physical activity levels changed in the population during the same period. Data from 6695 men and women of ages 30, 40, 50 and 60 y, examined in 1982–4, in 1986–7, and in 1991–2, were analysed to estimate trends. A summary healthy eating index and six scores derived by factor analysis were used to analyse food frequency data. The percentage of smokers declined 1.6% per year in men, and 1.0% per year in 30-, 40- and 50-y-old women, but increased 0.9% per year in 60-y-old women. The percentages of heavy cigarette smoking men and women nevertheless remained constant and close to 30%. Total alcohol intake declined among 30-y-olds, but appeared constant in other age groups. However, among 60-y-old men and among women over 30, the percentage of wine-drinkers rose from 6–11% in 1982–4 to 9–18% in 1991–2. Only 60-y-old men became more physically active at work and only 30-y-old women more so in leisure times. The percentage of individuals with a low healthy eating index decreased and the percentage with a high index increased. More importantly, dietary factor scores showed trends suggesting that very profound and potentially beneficial changes in dietary habits occurred. Lifestyle in the DAN-MONICA population changed in several ways that may have contributed to the declining incidence of myocardial infarction during the 1980s. Public Health (2002) 116, 81–88

Contraception and unexplained abdominal pain

ObjectiveTo test the hypothesis that hospital referral for unexplained abdominal pain might occur less frequently in oral contraceptive (OC) users and more frequently in intrauterine device (IUD) users than in...

MR detection of microhemorrhages in neurologically healthy adults.

T2*-weighted gradient-echo (GE) magnetic resonance images frequently demonstrate small hypointense lesions in patients with systemic hypertension and spontaneous hematomas. These lesions have been suspected to represent subclinical microhemorrhages. We examined the incidence of these lesions in neurologically healthy adults, and the factors associated with them. Axial T2*-weighted GE images (TR = 1,000 ms, TE = 30 ms, flip angle = 20 degrees) were obtained in addition to conventional T1- and T2-weighted spin echo images in 450 neurologically healthy Japanese adults (289 men and 161 women; age 52.9 +/- 7.7 years, range 24-84). The overall incidence of small hypointense lesions was 3.1% (14/450), and these lesions were closely related to systemic hypertension (P < 0.0001) and heavy cigarette smoking (>20 cigarettes per day; P=0.003). Although the incidence of hypointense lesions was lower in neurologically healthy adults than in the reported incidence in patients with a hemorrhagic history, the presence of these lesions was related to the risk factors for primary intracerebral hemorrhage even in the neurologically healthy adults.

Cigarettes, alcohol, drugs and self-esteem: a comparison of 15-16-year-olds from France and the UK

This paper compares samples of 15-16-year-olds from the UK and France on their use of the Rosenberg Self-esteem Scale (Rosenberg 1965) and on the relationships between total self-esteem and substance use. On all 10 of the scale items French students used the extreme ratings to a far greater extent than did UK students. However, the means and standard deviations obtained on adding up the 10 item scores were similar. In both countries, boys showed higher self-esteem than girls and heavy cigarette smoking was associated with low self-esteem. There were no other significant relationships between self-esteem and substance use for the French children, but there were several such, particularly for girls, in the UK.

Respiratory bronchiolitis-associated interstitial lung disease: radiologic features with clinical and pathologic correlation.

The purpose of this work was to describe the radiographic and CT findings in patients with respiratory bronchiolitis-associated interstitial lung disease (RB-ILD) and to correlate them with clinical, physiologic, and pathologic features. RB-ILD was proved pathologically in all 21 patients. Sixteen (76%) patients were current smokers, and five (24%) patients were ex-smokers. The mean cigarette consumption was 38.7 pack-years. Chest radiographs and CT scans were semiquantitatively analyzed and correlated with clinical findings, physiologic measures, and a pathologic score of disease extent. The major radiographic findings were bronchial wall thickening in 16 patients (76%) and ground-glass opacity in 12 patients (57%). The predominant initial CT findings were central bronchial wall thickening (proximal to subsegmental bronchi) in 19 patients (90%), peripheral bronchial wall thickening (distal to subsegmental bronchi) in 18 patients (86%), centrilobular nodules in 15 patients (71%), and ground-glass opacity in 14 patients (67%), None of these CT findings had a significant zonal predominance. Other findings were upper lung predominant centrilobular emphysema (57%) and patchy areas of hypoattenuation (38%) with a lower lung predominance. Radiologic findings were similar in both current and ex-smokers. The amount of ground-glass opacity correlated inversely with arterial oxygen saturation ( r = -0.67, p = 0.04), and the areas of hypoattenuation correlated with alveolar-arterial oxygen gradient ( r = 0.56, p = 0.04). The extent of centrilobular nodules correlated with the extent of macrophages in respiratory bronchioles ( r = 0.53, p = 0.03) and with chronic inflammation of respiratory bronchioles ( r = 0.57, p = 0.02). The extent of ground-glass opacity correlated with the amount of macrophage accumulation in the alveoli and alveolar ducts ( r = 0.56, p < 0.01 and r = 0.54, p = 0.04, respectively). At follow-up CT after steroid treatment and smoking cessation, in nine patients, the extent of bronchial wall thickening, centrilobular nodules, and ground-glass opacity had decreased, but the areas of hypoattenuation had increased (p < 0.05). The CT findings of RB-ILD are centrilobular nodules, ground-glass opacity, and air trapping. These radiologic features, in patients with a history of heavy cigarette smoking, may differentiate RB-ILD from other interstitial lung diseases.

Molecular analysis of p53 and K-ras in lung carcinomas of coal miners.

Thirty-three cases of non-small cell lung cancers (NSCLC) from the archives of National Coal Workers' Autopsy Study were studied for mutational alterations in p53 and K-ras using PCR-SSCP, DNA sequencing and PCR-oligonucleotide probe hybridization techniques. Mutations of the p53 were observed in 4 smokers (19%) and one in a never smoker (8%). Two polymorphisms in smokers were detected at codon 213, a common site for sequence variation. Among the smokers the p53 mutations were in the heavy smokers. In never smokers there was only a single p53 mutation and two K-ras mutations. In never smokers the frequency of K-ras mutations was similar (17%) in smokers, but one never smoker had two K-ras mutations. Mutations of p53 were more frequent in adenocarcinomas (27%) and they were AT-->GC transitions. Four of 11 (36%) adenocarcinomas were found to have K-ras codon 12 mutations, and one adenocarcinoma had two K-ras mutations. There were two large cell undifferentiated carcinomas with p53 mutation and one with a K-ras mutation. Two of the 16 squamous cell carcinomas were positive for p53 mutation, while no K-ras mutations were found in this group. The results of these preliminary studies indicate a moderately different mutational spectrum of p53 and K-ras in coal miners independent of cigarette smoking. The mutational spectrum observed in this study of coal miners with heavy cigarette smoking history suggest a protective effect of coal mine dust in preventing abnormal mutations induced by chemical carcinogens in cigarette smoke or reactive oxygen species. These limited preliminary studies provide insight into the possibility of accurately measuring changes in etiologic markers to unravel the uncertainties of cancer in coal miners.

Growth and pubertal milestones during adolescence in offspring prenatally exposed to cigarettes and marihuana

Weight, height, head circumference, and pubertal milestones were examined in one hundred fifty-two 13- to 16-year-old adolescents for whom prenatal exposure to marihuana and cigarettes had been ascertained. The subjects were from a low-risk, predominantly middle-class sample participating in an ongoing, longitudinal study and whose growth has been monitored since birth. The weight of the 13- to 16-year-old children of heavy cigarette smokers, after statistical adjustment, did not differ from control subjects but they had a significantly higher Ponderal Index (PI). These observations continued those noted when these subjects were 9 to 12 years of age. Among the male offspring of cigarette smokers, pubertal milestones occurred at an earlier age than among male adolescents born to nonsmokers. Active smoking by the offspring did not moderate these findings. Maternal marihuana use was not associated with any growth measurement or the timing of pubertal milestones.

The epidemiology and clinical management of chronic obstructive pulmonary disease in Singapore.

The epidemiology and clinical management of chronic obstructive pulmonary disease in Singapore.