Rates Of Heavy Smoking Research Articles

Investigating the role of uric acid and uric acid-to-creatinine ratio as a predictive factor of chronic obstructive pulmonary disease exacerbation in 2019.

Serum uric acid has been suggested as an independent marker of oxidative metabolism in chronic obstructive pulmonary disease (COPD), a disease with significant social, health, and economic burden. Therefore, we aimed to investigate the role of this factor in COPD exacerbation. We investigated 20- to 70-year-old patients who were admitted due to COPD exacerbation (acute phase) or presented to the pulmonary clinic for follow-up (non-acute phase). Correlation of uric acid and uric acid-to-creatinine ratio (UCR) with multiple factors and their predictive performance for more exacerbations and acute phase of COPD was investigated (receiver operating characteristic [ROC] analysis). Overall, 63 patients were enrolled in this study, of whom 79.4% were men. Acute-phase group encompassed 79.4% of the population with a greater rate of heavy smoking and average exacerbation in a year (p-value = 0.009 and <0.001). The mean of uric acid and UCR was 5.6 (SD, 2.35) and 4.4 (SD, 1.9) in the total population, respectively, and were significantly higher in the acute phase and patients with frequent exacerbations (FE ≥ 3 exacerbations a year), p-value <0.05. The area under the curve (AUC) of ROC analysis showed a high performance of uric acid and UCR for predicting acute phase (0.84 [95%CI, 0.73-0.96] and 0.86 [0.74-0.98]), FE (0.72 [0.60-0.85] and 0.75 [0.63-0.87]), and FE among acute-phase patients (AUC, 0.63 [0.46-0.79] and 0.66 [0.50-0.81], respectively). Uric acid and UCR could be invaluable predictors of frequent exacerbation and the acute phase of COPD. Therefore, they might be applicable in evaluating the severity and progress of the disease.

Trends and socioeconomic factors in smoking and alcohol consumption among Chinese people: evidence from the 2008\u20132018 National Health Service Surveys in Jiangsu Province

BackgroundSmoking and excessive drinking are risk factors for many diseases. With the rapid economic development in China, it is important to identify trends in smoking and alcohol consumption and socioeconomic factors that contribute to these behaviors to ensure the health of the population.Methodswe analyzed pooled cross-sectional data from the fourth, fifth, and sixth National Health Service Surveys conducted in Jiangsu Province in 2008, 2013, and 2018, respectively. The study population was those over 15 years old in three surveys. Trends in smoking and alcohol use were analyzed with descriptive statistics, and bivariate and multinomial logistic regression was used to identify contributing factors.ResultsAmong total sample, smoking rate was 23.95%, in which the incidence of light, moderate and heavy smoking was 5.75, 4.63 and 13.56%, respectively; drinking rate was 23.29%, in which non-excessive drinking and excessive drinking were 19.80 and 3.49%, respectively, “smoking and drinking” rate was 13.41%. From 2008 to 2018, overall and light-to-moderate smoking rates first increased and then decreased while heavy smoking rate declined; alcohol consumption increased while excessive drinking increased before decreasing; and the incidence of “smoking and drinking” has been rising continuously. The trend of smoking and drinking rates in urban area was similar to rural area, however there was significant difference between urban and rural area. Socioeconomic factors, demographic, health-related and year variables were significant influencing factors of smoking and drinking.ConclusionOur research can provide important evidences for tobacco and alcohol control in China and other similar developing countries. Preventive measures such as education and support services along with stricter regulations for tobacco and alcohol use are needed to improve public health in China.

Abstract PS7-80: Family history (FH) of breast cancer (BC) and associated risk-factors and screening: Analysis of an internet-based risk assessment tool

Abstract BackgroundBreast cancer (BC) is the most common cancer in women worldwide, and a leading cause of death. There are well established risk-factors for BC: Lifestyle factors include smoking, drinking alcohol, obesity, and low physical activity, and biologic factors may include increased exposure to estrogen and specific genetic mutations. The impact of having a family history (FH) of BC on associated risk factors is poorly understood. Results from previous literature suggest that those with FH of BC are more likely to adopt screening behaviors, but do not differ in risk-related behaviors. Because women with a FH of BC have an increased risk of developing BC themselves, we sought to better understand the co-present modifiable risk and screening behaviors associated with both BC and other common cancers. MethodsAn Internet based tool designed to provide personalized information on cancer risk was designed by healthcare providers and made publicly available in 2009 (OncoLink.org). Data from female responders in a convenience sample frame were analyzed as part of this study. All procedures were approved by IRB. Differences between respondents with v. without FH of BC were analyzed using chi-square test. Results15,712 female responses were analyzed; 10,800 (68.7%) had a FH of any cancer, 4578 (29.1%) BC. Median age was 26 (IQR 19-38); 84.4% of respondents were between 18-45; 76.7% were white, 88.3% pre-menopausal, 83.5% from North America, and 76% completed some college. Respondents had an average of 1.88 listed cancers in their FH with 15.89% reporting more than 4 cancers in FH. 248 (1.58%) and 202 (1.29%) reported a FH of BRCA1 and BRCA2, respectively. 3939 reported a FH of just one cancer, with 815 reporting just a FH of BC. Among those with FH of just BC, 20.74% were the respondent’s mother, 2.1% sister, and 50.3% grandmother. Those with a FH of BC were more likely to be current smokers and to have a history of secondhand smoke exposure (Table). There was no difference in rates of heavy smoking (1+ packs per day) (Table). Those with a FH of BC were more likely to be current drinkers, but not more likely to be heavy drinkers (7+ per week) (Table). Median BMI in those with FH of BC was higher than in those without; those with FH of BC were also more likely to be overweight or obese, and to exercise less than once per week (Table). Those with FH of BC were more likely to have had menarche before age 12 or to have taken OCPs, but showed no difference in menopause after 50, or rate of taking HRT for 2+ years (Table). They were also more likely to have performed a self-breast exam or to have received one in clinic (Table). Those with a FH of BC were not more likely to engage in common preventive and screening behaviors for cervical cancer, including being vaccinated against HPV or receiving regular pap screening (Table).ConclusionsOur results suggest many with FH of BC have both modifiable and non-modifiable risk factors that increase risk for development of cancer. We found that a FH of BC was associated with increased rates of smoking, drinking, obesity, and sedentary lifestyle when compared to those without FH. Importantly, our results lend further support to previous findings that these individuals are more engaged with BC-related screening behaviors. However, we found that FH of BC did not impact rates of screening for cervical cancer. Future work should explore targeted interventions to reduce risk-increasing behaviors among those with FH of BC. Total Pos FH BC Neg FH BCN%N%N%RRARChi-Square p-valueBehavioral Risk FactorsAny Smoking-Related Risk965161.4%291163.6%674060.5%1.053.1%&amp;lt; 0.001Current Smoker171510.9%53911.8%117610.6%1.111.2%0.031+ Packs Per Day (among smokers)36320.8%12422.9%23919.9%1.153.0%0.15Ever Smoke527333.6%157634.4%369733.2%1.041.2%0.14Ever Quit361623.0%105323.0%256323.0%1.000.0%0.98Secondhand Smoke Exposure516532.9%164135.8%352431.7%1.134.2%&amp;lt; 0.001Currently Drinks Alcohol787950.1%240852.6%547149.1%1.073.5%&amp;lt; 0.0017+ Drinks Per Week124315.6%38816.0%85515.5%1.030.5%0.78Overweight (BMI 25-30)335526.8%100928.3%234626.1%1.082.1%0.02Obese (BMI 30+)317025.7%101028.3%216024.6%1.153.7%&amp;lt; 0.001Diet Risk1121871.4%335773.3%786170.6%1.042.7%&amp;lt; 0.001Exercise &amp;lt;1x per week608438.7%189141.3%419337.7%1.103.6%&amp;lt; 0.001Exercise 5+ Times Per Week214013.6%56812.4%157214.1%0.88-1.7%0.004UV Exposure Risk570436.3%178138.9%392335.2%1.103.7%&amp;lt; 0.001Tanning Salon455029.0%142331.1%312728.1%1.113.0%&amp;lt; 0.001Estrogen Risk FactorsAge Menarche Before age 12489932.4%154034.8%335931.4%1.113.4%&amp;lt; 0.001Age Menopause After 50 (if menopausal)82844.9%24142.4%58746.0%0.92-3.6%0.15Age First Gave Birth &amp;gt; 30 (if gave birth)131020.3%39920.7%91120.1%1.030.7%0.55Taken 2+ Years of HRT (postmenopausal)37420.3%12622.2%24819.5%1.142.7%0.18Ever Taken OCPs1060267.5%320269.9%740066.5%1.053.5%&amp;lt; 0.001Preventive and Screening BehaviorsPrevious Tamoxifen Use1220.8%581.3%640.6%2.200.7%&amp;lt; 0.001Ever Performed Self Breast Exam1056167.2%314268.6%741966.6%1.032.0%0.02Ever Had Clinical Breast Exam928659.1%284562.1%644157.8%1.074.3%&amp;lt; 0.001Received HPV Vaccine (those &amp;lt;35 yo)428838.4%120738.5%308138.3%1.010.2%0.84Regular Pap Screening (25-65 yo)704682.1%218282.7%486481.9%1.010.9%0.33 Citation Format: Ryan O'Keefe, Michael LaRiviere, Carolyn Vachani, Margaret Hampshire, Christina Bach, Karen Arnold-Korzeniowski, Marisa Healy, James Metz, Christine Hill-Kayser. Family history (FH) of breast cancer (BC) and associated risk-factors and screening: Analysis of an internet-based risk assessment tool [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-80.

Impact of shift work on sleep and quality of life in industrial workers: A cross sectional study

Introduction: Shift work is associated with impaired sleep patterns, poor quality of life (QOL), and several medical conditions. Shift work disrupts the sleep-wake cycle and biological rhythms. Poor sleep quality and disruption of the normal circadian cycle are likely to cause cardiovascular disorders, obesity, diabetes mellitus, anxiety, depression, lethargy, and fatigue. It is also associated with diminished vigilance and work performance. Aim: The aim of the study is to evaluate the impact of shift work on quality of sleep and QOL in industrial workers. Methodology: This is a cross-sectional, comparative study conducted on 147 rotating shift work employees and 132 regular nonshift day workers in various industries. Semi-structured pro forma was used for sociodemographic data. Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale were used to assess the quality of sleep. The WHO-5 Well-Being Index and WHOQOL-BREF were used to assess the QOL. Appropriate statistical methods were used to analyze the data. Results: Compared with nonshift day workers, those work for variable shifts exhibited higher rates of heavy smoking and increased caffeine consumption. Variable shift workers reported persistent sleep disturbance, poor sleep quality, and daytime sleepiness compared to fixed day shift workers (P Conclusion: Shift work has a significant negative impact on quality of sleep and QOL and results in poor functioning and disturbances in mental and physical health of the individual. Hence, attention must be paid to the strategies that can improve the quality of sleep and QOL.

Impact of Menthol Smoking on Nicotine Dependence for Diverse Racial/Ethnic Groups of Daily Smokers.

Introduction: The aims of this study were to evaluate whether menthol smoking and race/ethnicity are associated with nicotine dependence in daily smokers. Methods: The study used two subsamples of U.S. daily smokers who responded to the 2010–2011 Tobacco Use Supplement to the Current Population Survey. The larger subsample consisted of 18,849 non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic (HISP) smokers. The smaller subsample consisted of 1112 non-Hispanic American Indian/Alaska Native (AIAN), non-Hispanic Asian (ASIAN), non-Hispanic Hawaiian/Pacific Islander (HPI), and non-Hispanic Multiracial (MULT) smokers. Results: For larger (smaller) groups the rates were 45% (33%) for heavy smoking (16+ cig/day), 59% (51%) for smoking within 30 min of awakening (Sw30), and 14% (14%) for night-smoking. Overall, the highest prevalence of menthol smoking corresponded to NHB and HPI (≥65%), followed by MULT and HISP (31%–37%), and then by AIAN, NHW, and ASIAN (22%–27%) smokers. For larger racial/ethnic groups, menthol smoking was negatively associated with heavy smoking, not associated with Sw30, and positively associated with night-smoking. For smaller groups, menthol smoking was not associated with any measure, but the rates of heavy smoking, Sw30, and night-smoking varied across the groups. Conclusions: The diverse associations between menthol smoking and nicotine dependence maybe due to distinction among the nicotine dependence measures, i.e., individually, each measure assesses a specific smoking behavior. Menthol smoking may be associated with promoting smoking behaviors.

Gender Differences among Smokers Living with HIV.

Tobacco use has emerged as a leading cause of death among persons living with HIV (PLWH) who smoke cigarettes. In contrast to the general population where smoking prevalence in men exceeds that in women, large surveys have shown similar smoking rates among male and female PLWH. There are important behavioral and biological differences between male and female smokers, but little is known about the relationships between tobacco use and gender in PLWH. Herein, the authors present a detailed examination of gender differences in smokers living with HIV (N = 267; 54% male, 46% female) recruited in 2 tobacco treatment trials. The authors found higher rates of heavy smoking and other substance use in men. Women were more likely to have used pharmacotherapy during quit attempts. Asthma rates were markedly higher in female smokers. There were no significant differences in a range of psychobehavioral domains or in cessation rates between male and female smokers living with HIV.

Heavy smoking rate trends and related factors in Korean occupational groups: analysis of KNHANES 2007–2012 data

ObjectivesThe present study was designed to investigate the smoking and heavy smoking trends and identify possible related factors among Korean male workers from 2007 to 2012 by occupational groups.MethodsThe data...

Heaviness of smoking among employed men and women in Poland.

At least 50% of smokers die prematurely. Those who smoke heavily are at an increased health risk. The purpose of the current report was to evaluate socio-demographic correlates of heavy smoking among employed men and women. Data derive from the representative, household study - the Global Adult Tobacco Survey conducted in Poland over the years 2008-2010. Of 14 000 households selected for the survey, 7840 sampled individuals completed the interviews. Among 1189 daily smokers, the rate of heavy smokers was 63.5% in males and 43% in employed females (p < 0.001). The study showed that age and age at the smoking onset were significantly associated with heavy smoking among both genders. Among males and females the heavy smoking rate was the highest in the subjects that started smoking at the age between 14-17 years compared to those who started smoking at the age ≥ 21 years (odds ratio (OR) = 3.3, 95% confidence interval (CI): 2-5.5, p < 0.001 and OR = 2.7, 95% CI: 1.4-5.3, p < 0.0001, respectively). The men with house rules that prohibited smoking with some exceptions were 2.4 times more likely to be heavy smokers in comparison with those having rules which completely prohibited it (p < 0.01). The men working in workplaces where smoking was prohibited in all indoor areas were at lower odds of heavy smoking relative to those working in areas where smoking was allowed everywhere (OR = 0.5, 95% CI: 0.3-0.9, p < 0.05). Among the men, there was also an association between job features and heavy smoking, which was not observed among the women. These findings should be taken into account while developing tobacco control measures addressed to economically active population.

Smoking behavior among the Chinese employed floating population aged 18-59 in 2012

To understand the prevalence of cigarette smoking among employed floating population in China and to provide evidence for developing prevention and control measures targeted at cigarette smoking among them. On the basis of the Disease Surveillance Points (DSPs)System and employed distribution among floating population, the China Non- communicable and Chronic Disease Risk Factor Surveillance in 2012 sampled from 170 DSPs, multi-stage stratified equal-sized cluster sampling method was used and stratified by six occupational groups. Cigarette smoking related information among the employed floating population was collected by face-to-face interviews. The analytical method accounted for the complex sampling design. There were 48 699 subjects, aged 18-59 years old, eligible and included in this analysis among the surveyed employed floating population. Among them, the prevalence of current smoking was 32.5% (95%CI: 32.0%-33.0%). A significantly higher percentage of men 55.3% (95%CI:54.6%-56.0%)relative to women 1.9% (95% CI:1.7%-2.1%)reported current smoking(χ(2) = 2.6, P = 0.103 7). Among men, differences in current smoking rates remained similar across age groups (χ(2) = 2.6, P = 0.103 7), but the current smoking rate tended to be lower with higher education(χ(2) = 140.7, P < 0.000 1). The current smoking rate in men was the highest(58.6% , 95% CI:57.3%-60.0%)in the floating population working in the construction industry. The prevalent of daily cigarette smoking was 27.9% (95% CI: 27.4%-28.4%), with a significantly higher proportion among men 47.8% (95% CI:47.1%-48.5%) than among women 1.3% (95%CI:1.1%-1.4%). Among daily smokers, the mean number of cigarettes smoked was 15.6(95%CI:15.5-15.8)per day(men:15.7 per day; women: 10.3 per day). The number was higher in men 15.7(95% CI:15.6-15.9)than in women 10.3(95% CI:9.3-11.3). Among daily smoking men, the daily consumed cigarettes number increased with the age increased (t = 34.89, P < 0.000 1), whereas the daily consumed cigarettes number decreased with the increase of education level (t = -14.63, P < 0.000 1). The daily consumed cigarettes number in men was the highest (18.2, 95%CI:17.9-18.6)in the floating population working in the construction industry. There were 47.1% of the daily smokers who smoked more than 20 cigarettes per day in the floating population aged 18-59, with a higher percentage among men (47.6%) than women (21.9%). The percentage in men increased with age and education level and the heavy smoking rate was the highest in the construction industry (60.4%). Among current smokers, the percentage of attempting to quit was 10.3% (95%CI: 9.7%-10.8%). A higher proportion of women 14.8% (95% CI:11.1%-18.5%), compared to men 10.1% (95% CI:9.6%-10.7%), reported attempting to quit. The rate of attempting to quit among current smokers increased with age. No significant difference in prevalence of attempting to quit by education level or occupation was seen. The percent of successfully quitting smoking was 6.1% (95%CI:5.7%-6.5%). The proportion was higher in women 7.2% (95%CI:4.6%-9.8%)than in men 6.1% (95%CI:5.7%-6.5%). The percentage of quitting smoking successfully increased with age (χ(2) = 269.0, P < 0.000 1). The percent of people who exposed to secondhand smoking was 68.7% (95%CI: 68.1%-69.3%). The percent was higher among men 76.4% (95%CI:75.5%-77.3%) than in women 64.0% (95%CI:63.2%-64.9%). Smoking was more common among men in the employed floating population aged 18-59 years old, especially in the construction industry. Low percent was seen among those who attempting to quit, and the ones who successfully quit were very few.

Tightening tobacco restrictions on teens may impact adult smoking

States with more stringent limits on teens purchasing tobacco have lower adult smoking rates, especially among women, according to a study by researchers at the Washington University School of Medicine in St. Louis, Missouri.1 Investigators also found that, compared with states that have fewer restrictions, the stricter states also tended to have fewer adult heavy smokers. Researchers evaluated data from an ongoing National Cancer Institute survey that monitors smoking behavior in all 50 states. They reviewed data from 1998 to 2007 on 105,519 people aged 18 to 34 years. They considered whether people had ever smoked, were currently smoking, and, if they did smoke, whether they smoked more than 10 cigarettes per day. Researchers also examined the specific smoking restrictions that were in place when the participants were aged 17 years. Although it has been illegal for many years in most states to sell cigarettes to people aged younger than 18 years, few provisions are in place to prevent such sales, according to the study's first author, Richard Grucza, PhD, associate professor of psychiatry at Washington University. Dr. Grucza and his colleagues focused on 9 smoking-related policies and found that in states with enforcement policies, 17-year-olds not only had more difficulty purchasing cigarettes but were less likely to smoke in their 20s or 30s. They estimated that if all states had such policies in place, the prevalence of smoking could be reduced by approximately 14%, whereas the rates of heavy smoking would decline by 29%. The most effective restrictions were those on cigarette vending machines, in which the machines were either eliminated or housed in locations inaccessible to people aged younger than 18 years; identification requirements for purchasing cigarettes; restrictions on repackaging cigarettes so that 5 or 10 can be sold at a time versus an entire 20-pack; and prohibiting the distribution of free cigarettes at public events. Many of the more restrictive policies have been in place nationally since the FDA started regulating cigarettes in 2009, which may lead to a decline in future adult smoking rates, Dr. Grucza notes. He and his colleagues found that restrictive policies on youth access had a big impact on women but did not make much of difference with regard to smoking rates in men. They theorized that underage women in the past have had an easier time getting alcohol and tobacco and that new policies such as checking identification may have made it more difficult for underage women to buy cigarettes. The last year of available data on states for the study was 2006. At that time, only 4 states required a photo identification and only 20 had any kind of identification requirements. As more states around the country adopt stricter policies, smoking rates are likely to decline, Dr. Grucza says.

Knowledge, attitude and practice of university students towards smoking in Irbid, Jordan

The purpose of this cross sectional study was to explore university students' knowledge, attitude and practice towards smoking and to compare these factors between smokers and non-smokers. A sample of 2793 students was randomly selected to complete a self-administered questionnaire about knowledge, attitude and practice of smoking at three universities in Irbid, Jordan. The Majority of the smoking students (75.2%) knew the adverse effects of smoking. Rates of non-smoking students who knew the adverse effects of smoking were significantly higher than that of students who smoke. A high rate of students showed an opposing attitude towards the assumption that smoking females would have more friends (89.6%), have stronger personality (93.4%), and be more attractive (90.6%) than non-smoking females. Similar higher rates of negative attitude were also observed towards the smoking male. About 50% of smokers have a misguided belief that smoking helps them concentrate while studying and 37.7% believe that smoking helps in avoiding obesity. Students that started smoking before enrollment in a university had a significantly higher rate of heavy smoking as compared to those who started smoking after being enrolled. Students smoke not because they lack the knowledge about the risk of smoking but due to misguided beliefs and attitudes. Key words: Attitude, knowledge, practice, smoking, students, university.

Determinants of heavy smoking: Results from the global adult tobacco survey in Poland (2009–2010)

The aim of current analysis was to identify socio-demographic correlates of heavy smoking. Global Adult Tobacco Survey (GATS), a nationally representative household study was implemented in Poland between 2009 and 2010. We used data on representative sample of 1915 adults, age 25 years and older. The Odds Ratios (OR) and 95% Confidence Intervals (CI) for heavy smoking to the broad number of variables including age, age at smoking onset, education, occupational classification, living conditions, place of residence, place of residence at age about 14 years, awareness of smoking health consequences were tested in logistic regression model. Among daily smokers the rate of heavy smokers was 63% in males and 45% in females (p < 0.001). The present study indicated that three characteristics: age, early age at smoking onset and lack of awareness of smoking health consequences were significantly associated with heavy smoking among both genders. Significantly higher risk of heavy smoking was observed among the 50-59 years of age population compared to the youngest group. The heavy smoking rate was highest among males who started smoking under age 14 years (OR = 3.1; 95% CI: 1.4-6.7; p < 0.001) and females that started smoking at age 14-17 years (OR = 2.3; 95% CI: 1.5-3.5; p < 0.0001) compared to those who started smoking at age 21 years or older. Heavy smoking was significantly correlated to lack of awareness of adverse health consequences of smoking (OR = 1.5; 95% CI: 1.1-2.03; p < 0.01 and OR = 1.5; 95% CI: 1.0-2.2; p < 0.01 for men and women, respectively) compared to aware respondents. These outcomes should be taken into account while developing tobacco control measures. Among other things, educational interventions to increase knowledge of adverse tobacco health effects should be widely implemented.

Trends in Cigarette Use Behaviors Among Adolescents by Region in Korea

ObjectivesUnderstanding recent trends in cigarette smoking among adolescents is important in order to develop strategies to prevent cigarette smoking. The aim of this study was to compare recent trends in cigarette smoking for adolescents living in rural areas, small towns and metropolitan cities in Korea.MethodsThe raw data from the Korea Youth Risk Behavior Web-based Survey (KYRBWS) from 2005 to 2009 were used. Data were analyzed by using the method of complex survey data analysis considering complex sampling design. Logistic regression models were used to evaluate significant linear time trends in cigarette smoking. The indicators of cigarette use behaviors were 'current smoking rate', 'frequent smoking rate', 'heavy smoking rate' and 'smoking experience rate before 13 years of age'. All analyses were conducted according to gender.ResultsStatistically significant increasing trends in current smoking rate and frequent smoking rate were observed and borderline significant increasing trends in heavy smoking rate were shown among rural boys. Among metropolitan city boys, statistically significant increasing trends were also seen for frequent smoking. Statistically significant decreasing trends in current smoking rate were observed among small town and metropolitan city girls. Smoking experience rate before 13 years of age for rural girls decreased significantly.ConclusionsCigarette smoking prevalence among adolescents in the rural areas has increased in the last five years especially among boys. Our findings suggest that anti-tobacco program for adolescents should be conducted primarily for those in rural areas.

Attention-deficit/hyperactivity disorder in perspective

Attention-deficit/hyperactivity disorder (ADHD) is not only one of the most frequent child neuropsychiatric disorder [9], but also one of the most investigated conditions in child and adolescent mental health [7]. Interest in the nosology of ADHD is renewed owing to the preliminary ADHD criteria recently presented by the ADHD and Disruptive Behavior Disorder working group for DSM-V of the American Psychiatric Association. Among several aspects considered for review in the criteria [10], two are directly or indirectly addressed by papers in this issue of our journal. DSM-IV criteria exclude ADHD diagnosis in the presence of pervasive development disorders (PDD). A recent body of literature challenges this notion, documenting high comorbidity between the two disorders (see, for instance, [11]). Ghanizadeh [2] performed exploratory and confirmatory factor analyses on DSM-IV ADHD and autistic spectrum disorder (ASD) symptoms from validated scales in a community sample of 1600 school-age children. His findings suggest that the high rate of co-morbidity between ADHD and ASD is probably not due to the overlapping diagnostic criteria of ADHD and ASD. One of the main drives for the revision of the DSM-IV criteria for mental disorders was the promise of a new frame in psychiatric nosology by the incorporation of a more pathophysiological approach resulting in a potential presence of biological markers as part of the diagnostic criteria [3]. Theoretically, ADHD would be a potential candidate to be a ‘‘prime star’’ for this revolution in the classificatory system! The high heritability of the disorder is well established, and large amounts of new data have documented the neurobiological basis of ADHD [5, 13]. However, after more than a decade of intense research on ADHD molecular genetics, neuropsychology and neuroimaging, we are still missing clear biological markers with sufficient sensitivity and specificity to be incorporated in the classificatory system [10]. In addition, the role of environmental risk factors or correlates in the pathophysiology of this heterogenic disorder is not completely understood. Two papers in this issue might help to enlarge our knowledge on potential environmental factors associated with ADHD. Motlagh et al. [8] found that mothers of children with ADHD reported both higher rates of heavy smoking and higher levels of severe psychological stress during pregnancy than mothers of unaffected control children. Documenting the role of comorbidity in the heterogeneity of the disorder, findings were less robust when ADHD was comorbid with Tourette syndrome. However, caution should be exercised when interpreting findings that suggest a role of smoking during pregnancy in the etiology of ADHD, since several other studies found neither an association nor an impact of maternal smoking during pregnancy in attentional control (see for instance, [1, 12]). Li et al. [6] assessed a nationwide population-based cohort sample including all 1,015,912 singletons born in Denmark from 1987 to 2001 to assess the role of prenatal maternal exposure to bereavement in ADHD. They found that boys born to mothers who lost a child or spouse in the 6 months before pregnancy or during pregnancy had significantly increased risk for ADHD. Finally, Jepsen et al. [4] assessed some neuropsychological aspects of executive functioning and attention in two groups of early-onset patients with psychosis and in L. A. Rohde (&) ADHD Outpatient Program, Department of Psychiatry, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2350, 2nd Floor, Room 2201, Porto Alegre, Brazil e-mail: lrohde@terra.com.br

Severe psychosocial stress and heavy cigarette smoking during pregnancy: an examination of the pre- and perinatal risk factors associated with ADHD and Tourette syndrome

Attention-deficit/hyperactivity disorder (ADHD) is frequently diagnosed in children with Tourette syndrome (TS). The basis for this co-occurrence is uncertain. This study aimed to determine if specific pre- and perinatal risk factors, including heavy maternal smoking and severe psychosocial stress during pregnancy, were associated with one or both disorders, or neither. We compared maternal report data on pre- and perinatal risk factors on 222 children between the ages of 7 and 18 years including 45 individuals with TS alone, 52 individuals with ADHD alone, 60 individuals with condition of comorbid TS + ADHD, and 65 unaffected control children. Pre- and perinatal histories as well as psychiatric assessments were performed using standardized questionnaires and semi-structured interviews with the mothers and children. Logistic regression was used to determine the odds ratio for each variable of interest. Compared to the mothers of unaffected control children, the mothers of children with ADHD alone reported higher rates of heavy smoking (>10 cigarettes per day) during pregnancy and higher levels of severe psychosocial stress during pregnancy (OR = 13.5, p < 0.01 and OR = 6.8, p < 0.002, respectively). The TS + ADHD and the TS alone patients also had higher rates heavy maternal smoking and high levels of psychosocial stress compared to the control children, but these differences failed to reach statistical significance (heavy smoking: OR = 8.5, p < 0.052, OR = 4.6, p < 0.19, respectively; severe psychosocial stress: OR = 3.1, p < 0.07, OR = 2.6, p < 0.11, respectively). Heavy maternal smoking and severe levels psychosocial stress during pregnancy were independently associated with a diagnosis of ADHD. TS patients also had higher rates of these risk factors, but the ORs failed to reach statistical significance. Efforts are needed to reduce the frequency of these risk factors in high-risk populations. Future studies, using genetically sensitive designs, are also needed to sort out the causal pathways.

Correlates of heavy smoking among alcohol-using methadone maintenance clients.

This cross-sectional study examines predictors of heavy smoking among 256 male and female methadone maintenance therapy (MMT) clients from five MMT clinics in the Los Angeles area. The authors find that women report lower rates of heavy smoking than men (47% vs. 54%, respectively), in concordance with current literature pointing to gender differences in smoking behaviors. In particular, men who report heavy drinking, fair or poor health, and recent heroin use are more likely to report heavy smoking compared with men not reporting these factors. Women who report recent heroin use, a lifetime history of sex trade, and who have been ill enough to require a blood transfusion also have greater odds of reporting heavy cigarette smoking. Findings from this study may aid not only in designing gender-based smoking cessation programs for MMT clients but also in addressing the gender-based issues related to smoking in such a population.

Detrimental Effects of Variable Work Shifts on Quality of Sleep, General Health and Work Performance

Objectives: The aim of this study was to explore the detrimental effects of working a varying pattern of 8-hour shifts on quality of sleep, general health and work performance. Subjects and Methods: The Arabic version of the Pittsburgh Sleep Quality Index (PSQI)and 2 self-administered questionnaires were used to assess quality of sleep, work performance and general health in a sample of 200 males on a schedule of varying 8-hour shifts at the Kuwait Oil Company. A matched sample of an equal number of workers on a fixed daytime shift as a control group was enrolled in the study. Results: Compared with men working on a straight daytime shift schedule, those working on 8-hour variable shifts exhibited higher rates of heavy smoking (p < 0.003), coffee/tea consumption (p < 0.0001), constipation (p < 0.002), job stress (p < 0.0001) and poor sexual performance (p < 0.0001). Variable-shift workers reported persistent sleep disturbances in 3 dimensions of the global score of the PSQI (p < 0.0001). They also had significantly more complaints of fatigue (p < 0.005), poor level of work performance (p < 0.005) and loss of concentration (p < 0.005). Shift workers were significantly more prone to making errors and having accidents at work, and were more likely to report absence from work than the controls (p < 0.0001 and p < 0.005, respectively). Conclusion: These results suggest that the majority of workers on an 8-hour variable-shift schedule experienced various health problems, poor quality of sleep and an increased risk for errors and accidents at work as compared with those workers on a straight daytime shift schedule. There is a need to compare potential benefits of an alternative work shift schedule.

Correlates of Severity of Smoking Among Persons with Severe Mental Illness

Individuals with schizophrenia and severe mental illness smoke cigarettes at rates that well exceed the general population. Little is known about the correlates and sequelae of increased smoking severity on persons with severe mental illness. A total of 304 smokers from six community mental health centers were assessed for smoking history, psychiatric symptoms, co-occurring disorders, subjective quality of life, and expired carbon monoxide (CO). Statistical analyses identified correlates of smoking severity, as assessed by number of cigarettes smoked per week. The average number of cigarettes smoked per week was 136+/-83. Increased smoking was associated with higher levels of expired CO and being Caucasian, and with a greater likelihood of a current diagnosis of hypertension and oral/gum disease. Greater smoking severity was also associated with greater perceived stress, poorer overall subjective quality of life, and lower satisfaction with finances, health, leisure activities, and social relationships. This study confirms high rates of heavy smoking among persons with severe mental illness. The association of increased quantity of cigarettes smoked with being Caucasian is consistent with previous reports in mentally ill and non-mentally ill populations. The linkage of heavy smoking with poorer quality of life and co-occurring medical disorders suggests the importance of smoking reduction and cessation strategies to reduce smoking and decrease patients' total pack years of smoking.

Socioeconomic status and maternal cigarette smoking before, during and after a pregnancy.

Research suggests that cigarette use declines when women find out they are pregnant, increasing again after the birth. Pregnancy may provide many women with a substantial impetus to stopping smoking. Also, rates of smoking cessation and reduction may be class-related, with the highest socioeconomic-status groups manifesting higher rates of reduction. Using data from the Mater Hospital--University of Queensland Study of Pregnancy, we report family income related to rates of smoking before, during and after a pregnancy. Before becoming pregnant, 45.9 per cent of women in the sample were smokers. This declined to 34.7 per cent of women at their first clinic visit. Rates of heavy smoking (20 or more cigarettes per day) had returned to earlier levels by the six-month (after birth) follow-up. Women in the lowest family-income group had the highest rates of cigarette use before, during and after their pregnancy. Of the lowest family-income group, 8.4 per cent were heavy smokers before, during and after their pregnancy, compared with 2.8 per cent of women in the highest family-income group. Smoking cessation rates were highest in the highest family-income group (those who smoked least), but relapse rates after the birth were similar for all income groups. Arresting rates of smoking relapse by pregnant women should be seen as a major public health priority.

Prevalence and correlates of heavy smoking in Vietnam veterans with chronic posttraumatic stress disorder

A study was conducted to investigate smoking patterns in 445 Vietnam veterans with and without posttraumatic stress disorder (PTSD). Combat veterans with PTSD reported similar occurrence of smoking (53%) compared to combat veterans without PTSD (45%). For those who smoked, combat veterans with PTSD reported a significantly higher rate of heavy smoking (≥25 cigarettes daily): 28% of combat veterans without PTSD were heavy smokers and 48% of combat veterans with PTSD were heavy smokers. PTSD diagnosis and heavy smoking status were independently and differentially related to motives for smoking. In combat veterans with PTSD, heavy smoking status was positively related to total health complaints, lifetime health complaints, health complaints in the past year, negative health behaviors, total PTSD symptoms, DSM-IV C cluster (avoidance and numbing) and D cluster (hyperarousal) PTSD symptoms. Heavy smoking status was also associated with fewer positive health behaviors.