Heavy Tobacco Use Research Articles

An Unusual Case of Intraluminally Growing Esophageal Tumor

Question: A 78-year-old man presented with a 2-month history of progressive dysphagia to solids. His past medical history revealed heavy tobacco use and chronic obstructive pulmonary disease. He denied any recent history of weight loss or a history of food impaction. On presentation, there were no palpable lymph nodes or liver enlargement. Laboratory data were not pertinent except for slight elevation of SCC to 3.6 ng/mL. A barium esophagogram revealed a 5-cm filling defect in the esophagus 20 cm distal to the incisors. Upper GI endoscopy demonstrated a large, elastic, circumferential mass almost entirely occupying the lumen in the upper esophagus, but the endoscope easily passed the lesion (Figure A). What is your diagnosis? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. Pathologic findings obtained from biopsy specimens revealed spindle-shaped cells as well as moderately differentiated squamous cell carcinomas in the same view, and there was a transitional zone (Figure B, arrow) between the sarcomatous (above the arrow) and the carcinomatous components (below the arrow). Computed tomography showed regional lymph node metastasis, but no distant metastasis. Immunohistochemical staining for cytokeratin AE1/AE3 antibodies were positive in the spindle-shaped cells (Figure C), which confirmed the diagnosis of carcinosarcoma of the esophagus (cT3N1M0, stage III). This patient was not a candidate for esophagectomy because of his age and advanced lung disease, so he was treated with chemoradiation with remarkable response (Figure D).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Carcinosarcoma of the esophagus is an uncommon malignancy of the esophagus with both carcinomatous and sarcomatous components, and it represents only 1%–2% of all esophageal neoplasms. There were 2 major proposed explanations for the pathogenesis of carcinosarcomas: The metaplastic and the collision concepts. The metaplastic concept is that individual elements might be derived from a single common ancestor cell (so-called carcinosarcoma), whereas the collision concept is that 2 individual stem cells may independently and simultaneously undergo malignant transformation (true carcinosarcoma).1Iwaya T. Maesawa C. Uesugi N. et al.True carcinosarcoma of the esophagus.Dis Esophagus. 2006; 19: 48-52Crossref PubMed Scopus (17) Google Scholar Recent studies have supported the metaplastic concept of carcinosarcoma. Therefore, most esophageal carcinosarcomas are diagnosed as a so-called carcinosarcoma. This tumor often presents as a bulky intraluminal polypoid lesion, and thus often causes symptoms of dysphagia.2Madan A.K. Long A.E. Weldon C.B. et al.Esophageal carcinosarcoma.J Gastrointest Surg. 2001; 5: 414-417Crossref PubMed Scopus (48) Google Scholar Esophageal carcinosarcomas are usually treated according to same protocol as other esophageal cancers. This case highlights that esophageal carcinosarcoma should be considered in the differential diagnosis of esophageal tumors growing intraluminally.

Comparison of outcomes of patients with hepatocellular carcinoma (HCC) over 2 consecutive decades for a VA population.

e14536 Background: Hepatocellular carcinoma (HCC) incidence is increasing in the United States. We compared the outcome of HCC patients (pts) over two consecutive decades for a VA population. Methods: In an IRB-approved protocol, we reviewed the records of pts with diagnosis (dx) of HCC seen at a VA Medical Center from 1/1/1990 to 12/31/2009. Demographics, Vietnam era (V) status, stage, alpha-fetoprotein (AFP) level at dx, hepatitis B (HBV) and C (HCV), heavy alcohol use (E), tobacco use (T), BMI, diabetes (DM), ferritin (F) level, and treatment modalities were reviewed. Cox survival regression analysis and tests of proportions were performed. Results: All were men. There were 42 pts were from the first decade (d1) (1990 to 1999) and 72 pts from the 2nd decade (d1) (2000 to2009). The median (M) age at dx was 62.25 yo (35-87) for the whole population (W). Comparison of two decades is shown in the table. For the second decade, more variables were analyzed: M BMI of 70 pts was 25.3 (16.9-42.4). 34 pts (47.2%) were Caucasian, 33 pts (45.8%) African American, and 5 pts (7%) others. 25pts (34.7%) has DM, 57 (79%) E use, and 61 (84.7%) T use. Two pts (2.78%) received transplant, 4 (5.56%) resection, 16 (22%) local therapy (L), and 11 pts (15.3%) systemic therapy. In univariate survival analysis, age (p<0.004), stage (p<0.0001), AFP (p<0.0017), F (p<0.002), and V (p<0.0001) were significant predictors of survival. In multivariate survival analyses that included stage, AFP, F, and V for W, stage (p<0.019), AFP (p<0.0008), and F (p<0.035) were significant predictors. Conclusions: The incidence of hepatocellular carcinoma increased at this medical center. Pts were diagnosed at an earlier stage and survival improved in 2nd decade. Stage, AFP, and ferritin levels were independent predictors of survival. First decade Second decade P value No. of pts 42 72 % HCC/total new cancer 0.58% (42/7,187) 1.07% (72/6,726) P <0.0015 Age (yrs) 64.5 (38-82) 60.0 (35-87) NS Median stage 4 3 P <0.0001 Survival (days) 107.0 (0-2557) 182.5 (3-2,214) P <0.0001 AFP ng/ml 238.4 (0.60-2,603,000) 116.4 (1.1-379,567) NS Ferritin (F) ng/dl 113.1 (19-886) 301.5 (15-2,866) NS HBV 1/32 (3.13%) 6/66 (11%) NS HCV 10/17 (37.0%) 49/69 (71%) NS Vietnam era 9/42 (21.43%) 48/72 (66.7%) P <0.0001

Distribution of Human Papillomavirus Genotypes in Sardinian Patients with Oral Squamous Cell Carcinoma~!2010-03-01~!2010-05-10~!2010-07-13~!

Human papillomaviruses (HPVs) seem to play an important role in the pathogenesis of gynecological carcinomas and in head and neck carcinomas. The aim of this study was to detect and genotype HPVs in fresh oral squamous cell carcinoma (OSCC) from a Sardinian population, and to determine whether HPV presence was significantly associated with the development of OSCC.The oral mucosa tissues were obtained from 120 samples (68 OSCC and 52 control samples) taken from a Sardinian population seen at the Dental Clinic of the Department of Surgery and Odontostomatological Sciences, University of Cagliari (Italy) and the “ Ospedale SS Trinità”, Cagliari (A.S.L. 8) between 2007 and 2008. PCR was used for the detection of HPV DNA and the genotype was determined by DNA sequencing. The frequency of HPV infection was evaluated in relation to age, sex, smoking and alcohol use. Statistical analysis was performed using the SPSS 11.5 software.The results showed the presence of HPV-DNA in 60.3% of OSCC with HPV-16 (51.2%) being the most frequent genotype. In these Sardinian OSCC patients, HPV-DNA was detected more in males (65.8%) than in females (34.1%) while controls show a 0% of HPV presence. HPV positive was highly associated with OSCC among subjects with a history of heavy tobacco and alcohol use and among those with no such history.A greater frequency of high risk HPV presence was observed in patients with OSCC compared to health control patients. In addition these results suggested that oral HPV presence could be associated in OSCC subjects. Our results need more analyses to detect the HPV-DNA integration into tumoral cells.

A Retrospective Study Of Cannabis Use-Associated Psychopathology In A Southern Nigeria Treatment Facility

Hospital records of patients seen between 1999 and 2002 were carefully examined. A questionnaire was used to extract relevant information from the case records and clinical diagnosis was made using the ICD-10. Cases that had evidence of pre-existing psychiatric disorder, family history of mental illness or heavy use of alcohol and/or tobacco were excluded. Out of 6,556 patients that were seen for the first time, 849 were drug-related cases and 601 of these were primarily cannabis users. A substantial number (83%) of these were young and presented with severe psychopathologies. About 90% and 47% were diagnosed with psychotic disorders and dependence syndrome, respectively. It is concluded that cannabis use is associated with severe psychopathologies and constituted over 70% of demand for treatment. Key words: Cannabis, Psychopathologies, Retrospective Study, Nigeria.

In utero tobacco exposure: The effects of heavy and very heavy smoking on the rate of SGA infants in the Federal State of Saarland, Germany

Objective To assess the effects of heavy and very heavy smoking on the rate of small for gestational age (SGA) infants, and to assess socio-economic and regional differences in smoking patterns in pregnant women in Germany. Study design The Neonatal and Perinatal database of the federal state of Saarland, Germany was used to perform a population-based analysis of preterm (>32 weeks of gestation) and term (>36 weeks of gestation) newborns in 2004–2006. The rate of SGA babies dependent on the amount of tobacco exposure among self-identified smokers and non-smokers were assessed, and distinct maternal risk factors for smoking were evaluated. Our data were compared with the German National Perinatal database. Results 14,593 paired data sets (peripartum/perinatal) were included in this study. The overall rate of smoking during pregnancy was 11.8% with a high percentage of pregnant women smoking 11–20 cigarettes/day (heavy smoker; 4.0%), and >20 cigarettes/day (very heavy smoker; 0.6%). Self-identified heavy tobacco use signifcantly increased the risk for SGA infants ( p < 0.01) in women without uteroplacental insufficiency. Risk factors for smoking included ethnicity (German/Caucasian), socio-economic parameters (single vs. non-single households, status of employment) and age. Smoking pattern and the rate of SGA babies in our cohort differed substantially from the national average. Conclusions Although the overall rate of smoking appears comparable to previously published data, heavy and very heavy smoking was high in our cohort. Heavy smoking was disproportionately associated with SGA. Preventative measures and strategies should take into consideration socio-economic risk factors as well as regional differences, and should be targeted at distinct subgroups that are especially prone to smoking during pregnancy.

The natural history of chronic hepatitis B virus infection #

Chronic hepatitis B virus (HBV) infection has a complicated course. Three phases are identified: an immune tolerant phase with high HBV DNA and normal alanine aminotransferase (ALT) levels associated with minimal liver disease; an immune active phase with high HBV DNA and elevated ALT levels with active liver inflammation; and an inactive phase with HBV DNA levels < 2000 IU/mL and normal ALT levels with minimal inflammation and fibrosis on liver biopsy. Affected persons can move progressively from one phase to the next and may revert backward. The primary adverse outcomes of chronic HBV infection are hepatocellular carcinoma (HCC) and cirrhosis. Published natural history studies were reviewed and ranked by the strength of evidence regarding the study design. Factors with the highest evidence of risk for development of HCC or cirrhosis from population-based prospective cohort studies include male sex, family history of HCC, HBV DNA level above 2000 IU/mL in persons above age 40, HBV genotypes C and F, and basal core promoter mutation. Those with the next highest level of evidence include aflatoxin exposure, and heavy alcohol and tobacco use. Improved methods to identify persons at highest risk of developing HCC or cirrhosis are needed to allow intervention earlier with antiviral therapy in appropriate patients. Future studies should include prospective follow-up of established population-based cohorts as well as new cohorts recruited from multiple centers stratified by HBV genotypes/subgenotypes and clinical phase to determine the incidence of the various HBV phases, HCC, and cirrhosis. Also, nested case-control studies assessing immunological and host genetic factors among persons with active and inactive disease phases, HCC, and cirrhosis could be conducted using these types of cohorts.

Smoking is a major risk factor for wound dehiscence after midline abdominal incision; case–control study

The incidence of acute fascial wound dehiscence (AFWD) after major abdominal operations is as high as 3%. AFWD is associated with mortality rates of 15-20%. Male gender, advanced age and numerous systemic factors including malignancy hypoproteinemia and steroid use have been associated with increased risk. The aim of the present study was to investigate the association between smoking prevalence and AFWD. Middlemore Hospital records were retrieved from the 1997-2006 period for patients who had undergone midline abdominal surgery and developed AFWD. A return to the operating theatre for closure of the fascial dehiscence was required for study group inclusion. Each patient in the study group was matched to two control patients who had been admitted in the same year for surgery and who had a similar initial surgical intervention. Conditional logistic regression was used to calculate odds ratios with 95% confidence intervals, representing the risk of developing fascial wound dehiscence in smokers compared with the non-smoking group. There were 52 patients (32 male, 20 female) and 104 controls (64 male, 40 female). Median age for both groups was 63 years. A history of heavy tobacco use (> or =20 pack-years) was more prevalent in those who had AFWD (46%) compared with the control group (16%; P = 0.0002; odds ratio 3.7). Smoking is associated with an increased incidence of acute fascial wound dehiscence following laparotomy. It is not known whether smoking is a causal or a surrogate factor.

Intrahepatic Cholangiocarcinoma

Despite data suggesting a rising worldwide incidence, intrahepatic cholangiocarcinoma (IHC) remains an uncommon disease. This study analyzes changes in IHC frequency, demographics, and treatment outcome in a consecutive and single institutional cohort. Consecutive patients with confirmed IHC seen and treated over a 16-year period were included. The trend in IHC frequency over the study period was compared with that of hilar cholangiocarcinoma patients (HCCA) seen during the same time. Demographics and patient disposition, histopathologic, treatment, recurrence, and survival data were analyzed; changes in these variables over time were assessed. From December 1990 through July 2006, 594 patients were evaluated (IHC = 270, HCCA = 324). Over the study period, the average annual increase in new IHC patients was 14.2% (P < 0.001). Relative to HCCA, the proportional increase in IHC was nearly 3-fold, and new IHC patients have outnumbered those with HCCA by 2:1 over the last 3 years. Conditions associated with IHC were rarely seen, with only 7 patients having a history of sclerosing cholangitis and/or inflammatory bowel disease and none with hepatolithiasis or biliary parasitic disease; however, heavy tobacco use (27%) and diabetes mellitus (16.4%) were particularly prevalent. The majority of patients were not candidates for resection, most commonly because of advanced hepatic disease. After resection (n = 82), median disease-specific survival was 36 months; recurrence was observed in 62.2% of patients at a median follow-up of 26 months, with the liver remnant involved most frequently (62.7%). Multiple hepatic tumors (P < 0.001), regional nodal involvement (P = 0.012), and large tumor size (P = 0.016) independently predicted poor recurrence-free survival. Most patients (n = 115, 73.7%) with unresectable disease were treated with chemotherapy, either systemic alone (n = 75) or combined with regional hepatic arterial floxuridine (FUDR) (n = 28). Compared with the first 10 years of the study (1990-2000), the last 6 years saw an overall improvement in disease-specific survival for all patients (22 vs. 12 months, P = 0.002), which was particularly notable for patients with unresectable disease (15 vs. 6 months, P = 0.003). At Memorial Sloan-Kettering Cancer Center, IHC incidence has increased dramatically in the last 16 years. Resection offers the best opportunity for long-term survival but is possible in the minority, and patients with large, node-positive or multifocal IHC seem to derive little benefit. Establishing and maintaining control of the intrahepatic disease remains the biggest problem for all IHC patients. The recent increase in survival seems largely because of improved nonoperative therapy for unresectable disease.

Postoperative Delirium

Postoperative Delirium

Line Region Hypomethylation Is Associated with Lifestyle and Differs by Human Papillomavirus Status in Head and Neck Squamous Cell Carcinomas

Genomic hypomethylation is a hallmark of essentially all cancers, but the degree of this hypomethylation differs among individual tumors. Little work has explored what leads to these differences and or asked whether they are clinically meaningful. In this study of head and neck squamous cell carcinoma, we assessed hypomethylation in tumors using a semiquantitative fragment analysis approach to determine the relative methylation status of the line retroviral element LRE1 (Line-1.2). Because this is an established marker of genomic methylation status, we examined the relationship between the relative methylation, patient demographics, and other risk factors for head and neck squamous cell carcinoma. We determined relative methylation status for 303 patients, 193 of which had complete data for all variables of interest. Using a generalized linear model, we found that patient body mass index was significantly positively associated with tumor LRE1 methylation level. Smoking duration, particularly in tumors lacking human papillomavirus (HPV) DNA, was significantly negatively associated with relative methylation level. Having previously assessed relative methylation in blood-derived DNA, we compared tumor with the blood DNA methylation level and observed these to be independent. Finally, the lower LRE1 methylation in patients whose tumors were HPV DNA negative was associated with poorer patient survival (hazard ratio, 1.6; 95% confidence interval, 1.0-2.6). These findings suggest that HPV-associated tumors differ molecularly from those arising after heavy tobacco use and that this epigenetic alteration may affect survival in HPV-negative patients already exhibiting a more aggressive disease.

Distinct Risk Factor Profiles for Human Papillomavirus Type 16–Positive and Human Papillomavirus Type 16–Negative Head and Neck Cancers

High-risk types of human papillomavirus (HPV), including HPV-16, cause a subgroup of head and neck squamous cell carcinomas (HNSCCs). We examined whether the risk factors for HPV-16-positive HNSCCs are similar to those for HPV-16-negative HNSCCs in a hospital-based case-control study. Case subjects (n = 240) diagnosed with HNSCC at the Johns Hopkins Hospital from 2000 through 2006 were stratified by tumor HPV-16 status as determined by in situ hybridization. Two control subjects (n = 322) without cancer were individually matched by age and sex to each HPV-16-positive and HPV-16-negative case subject. Data on risk behaviors were obtained by use of audio computer-assisted self-interview technology. Multivariable conditional logistic regression models were used to estimate the odds ratios (ORs) for HPV-16-positive HNSCC and HPV-16-negative HNSCC associated with risk factors. All statistical tests were two-sided. HPV-16 was detected in 92 of 240 case subjects. HPV-16-positive HNSCC was independently associated with several measures of sexual behavior and exposure to marijuana but not with cumulative measures of tobacco smoking, alcohol drinking, or poor oral hygiene. Associations increased in strength with increasing number of oral sex partners (P(trend) = .01) and with increasing intensity (joints per month, P(trend) = .007), duration (in years, P(trend) = .01), and cumulative joint-years (P(trend) = .003) of marijuana use. By contrast, HPV-16-negative HNSCC was associated with measures of tobacco smoking, alcohol drinking, and poor oral hygiene but not with any measure of sexual behavior or marijuana use. Associations increased in strength with increasing intensity (cigarettes per day), duration, and cumulative pack-years of tobacco smoking (for all, P(trend) < .001), increasing years of heavy alcohol drinking (> or = 15 years of 14 drinks per week; P(trend) = .03), and increasing number of lost teeth (P(trend) = .001). Compared with subjects who neither smoked tobacco nor drank alcohol, those with heavy use of tobacco (> or = 20 pack-years) and alcohol had an increased risk of HPV-16-negative HNSCC (OR = 4.8, 95% confidence interval [CI] = 1.8 to 12) but not of HPV-16-positive HNSCC (OR = 0.67, 95% CI = 0.29 to 1.9). HPV-16-positive HNSCCs and HPV-16-negative HNSCCs have different risk factor profiles, indicating that they should be considered to be distinct cancers.

Health-risk behaviour in Croatia

To identify the health-risk behaviour of various homogeneous clusters of individuals. The study was conducted in 13 of the 20 Croatian counties and in Zagreb, the Croatian capital. In the first stage, general practices were selected in each county. The second-stage sample was created by drawing a random subsample of 10% of the patients registered at each selected general practice. The sample was divided into seven homogenous clusters using statistical methodology, combining multiple factor analysis with a hybrid clustering method. Seven homogeneous clusters were identified, three composed of males and four composed of females, based on statistically significant differences between selected characteristics (P<0.001). Although, in general, self-assessed health declined with age, significant variations were observed within specific age intervals. Higher levels of self-assessed health were associated with higher levels of education and/or socio-economic status. Many individuals, especially females, who self-reported poor health were heavy consumers of sleeping pills. Males and females reported different health-risk behaviours related to lifestyle, diet and use of the healthcare system. Heavy alcohol and tobacco use, unhealthy diet, risky physical activity and non-use of the healthcare system influenced self-assessed health in males. Females were slightly less satisfied with their health than males of the same age and educational level. Even highly educated females who took preventive healthcare tests and ate a healthy diet reported a less satisfactory self-assessed level of health than expected. Sociodemographic characteristics, life style, self-assessed health and use of the healthcare system were used in the identification of seven homogeneous population clusters. A comprehensive analysis of these clusters suggests health-related prevention and intervention efforts geared towards specific populations.

Evaluation, Staging, and Surgical Management of Tongue Cancer

Cancer of the oral cavity and oropharynx continues to be a public health concern throughout the United States and abroad. The identification of numerous carcinogens, aside from the historically well accepted heavy use of tobacco and alcohol, has contributed to changing demographics of cancer in this region. In fact, the incidence of oral cavity cancers, and tongue cancer in particular, is increasing. The American Cancer Society estimates a total of 34,360 cancers of the oral cavity and pharynx during 2007, including an estimated 9,800 tongue cancers.

HIV Infection Is Associated with an Increased Risk for Lung Cancer, Independent of Smoking

Human immunodeficiency virus (HIV)-infected persons have an elevated risk for lung cancer, but whether the increase reflects solely their heavy tobacco use remains an open question. The Acquired Immunodeficiency Syndrome (AIDS) Link to the Intravenous Experience Study has prospectively observed a cohort of injection drug users in Baltimore, Maryland, since 1988, using biannual collection of clinical, laboratory, and behavioral data. Lung cancer deaths were identified through linkage with the National Death Index. Cox proportional hazards regression was used to examine the effect of HIV infection on lung cancer risk, controlling for smoking status, drug use, and clinical variables. Among 2086 AIDS Link to the Intravenous Experience Study participants observed for 19,835 person-years, 27 lung cancer deaths were identified; 14 of the deaths were among HIV-infected persons. All but 1 (96%) of the patients with lung cancer were smokers, smoking a mean of 1.2 packs per day. Lung cancer mortality increased during the highly active antiretroviral therapy era, compared with the pre-highly active antiretroviral therapy period (mortality rate ratio, 4.7; 95% confidence interval, 1.7-16). After adjusting for age, sex, smoking status, and calendar period, HIV infection was associated with increased lung cancer risk (hazard ratio, 3.6; 95% confidence interval, 1.6-7.9). Preexisting lung disease, particularly noninfectious diseases and asthma, displayed trends for increased lung cancer risk. Illicit drug use was not associated with increased lung cancer risk. Among HIV-infected persons, smoking remained the major risk factor; CD4 cell count and HIV load were not strongly associated with increased lung cancer risk, and trends for increased risk with use of highly active antiretroviral therapy were not significant. HIV infection is associated with significantly increased risk for developing lung cancer, independent of smoking status.

Case–Control Study of Human Papillomavirus and Oropharyngeal Cancer

Substantial molecular evidence suggests a role for human papillomavirus (HPV) in the pathogenesis of oropharyngeal squamous-cell carcinoma, but epidemiologic data have been inconsistent. We performed a hospital-based, case-control study of 100 patients with newly diagnosed oropharyngeal cancer and 200 control patients without cancer to evaluate associations between HPV infection and oropharyngeal cancer. Multivariate logistic-regression models were used for case-control comparisons. A high lifetime number of vaginal-sex partners (26 or more) was associated with oropharyngeal cancer (odds ratio, 3.1; 95% confidence interval [CI], 1.5 to 6.5), as was a high lifetime number of oral-sex partners (6 or more) (odds ratio, 3.4; 95% CI, 1.3 to 8.8). The degree of association increased with the number of vaginal-sex and oral-sex partners (P values for trend, 0.002 and 0.009, respectively). Oropharyngeal cancer was significantly associated with oral HPV type 16 (HPV-16) infection (odds ratio, 14.6; 95% CI, 6.3 to 36.6), oral infection with any of 37 types of HPV (odds ratio, 12.3; 95% CI, 5.4 to 26.4), and seropositivity for the HPV-16 L1 capsid protein (odds ratio, 32.2; 95% CI, 14.6 to 71.3). HPV-16 DNA was detected in 72% (95% CI, 62 to 81) of 100 paraffin-embedded tumor specimens, and 64% of patients with cancer were seropositive for the HPV-16 oncoprotein E6, E7, or both. HPV-16 L1 seropositivity was highly associated with oropharyngeal cancer among subjects with a history of heavy tobacco and alcohol use (odds ratio, 19.4; 95% CI, 3.3 to 113.9) and among those without such a history (odds ratio, 33.6; 95% CI, 13.3 to 84.8). The association was similarly increased among subjects with oral HPV-16 infection, regardless of their tobacco and alcohol use. By contrast, tobacco and alcohol use increased the association with oropharyngeal cancer primarily among subjects without exposure to HPV-16. Oral HPV infection is strongly associated with oropharyngeal cancer among subjects with or without the established risk factors of tobacco and alcohol use.

Decrease in tobacco use among Brazilian students: A possible consequence of the ban on cigarette advertising?

In 2000, cigarette advertising was banned from the Brazilian media [LEI N° 10.167, de 27 de dezembro de dezembro. (2000). http://www.planalto.gov.br/ccivil_03/Leis/L10167.htm]. Nevertheless, not enough surveys have been carried out to measure the impact of the prohibition. The objective of the present survey was to compare the use of tobacco by primary and secondary school students in 1997 and 2004, that is, before and after the ban on tobacco advertising in Brazil. Two surveys were conducted (in 1997 and 2004) using the same methodology, with a target population of primary (from the fifth grade on) and secondary public schools in ten different Brazilian capitals. The sampling was done by conglomerates, stratified, and obtained in two stages. In total, 15,501 students were surveyed in 1997, and 21,712 in 2004. The questionnaire was adapted from an instrument developed by WHO, anonymous, self-administered, and applied collectively in the classroom. In a comparison of the two surveys (1997 and 2004) tobacco lifetime use (used any psychotropic drug at least once in their life) decreased significantly in seven out of ten capitals surveyed. The 11–12 year old age group experienced the largest decrease in tobacco lifetime use. There was a decrease in lifetime use for males in nine capitals, and in eight capitals for females. A decrease was also observed in heavy tobacco use also in eight capitals. In conclusion there was a significant decrease in tobacco consumption among the surveyed students, suggesting that the decrease is related to changes in public policy in Brazil over the surveyed period.

Assessment of Alcohol and Other Drug Use Behaviors in Health Professions Students

Alcohol and other drug (AOD) use behaviors of health professions students (HPS) were assessed by surveying both university-based HPS and other nursing programs in a Midwestern state in 1999. Response was 2,646 (56.4%) of surveyed students. Family history of alcohol-related and drug-related problems were reported by 39.8% and 13.9%, respectively, with 42.6% of respondents reporting one or both. Among nursing respondents, 48.1%, 19.2%, and 51.1%, respectively, reported family problems with alcohol, drugs, or one or both. Past-year alcohol use was comparable to undergraduate college students (UCS) nationally (83%); heavy drinking, tobacco, and recreational drug use by HPS were lower. Past year drug use was highest among medical students. Marijuana was the predominant illicit drug; medical students and males most often reported use. Health professions educational systems should proactively address student AOD prevention, education, and assistance needs.

A comparative survey on alcohol and tobacco use in urban and rural populations in the Huaihua District of Hunan Province, China

Modern Chinese society is comprised primarily of two subgroups—urban and rural subpopulations. However, comparative data regarding alcohol and tobacco use between urban and rural subgroups in China is sparse. An epidemiological survey was conducted in the Huaihua District of Hunan Province of China, and 3,543 urban and 4,294 rural dwellers aged 15–65 years were interviewed. The drinking rates were higher in the urban area (45.9%) than in the rural area (39.6%), whereas the smoking rates were higher in the rural area (35.9%) than in the urban area (28.7%). Rural respondents were more likely to report heavy drinking (Adjusted odds ratio [OR] = 1.77) and heavy smoking (Adjusted OR = 2.46) than urban populations. Specifically, rural males had higher odds of heavy alcohol and tobacco use than urban males, whereas more urban females were more likely to drink and smoke than rural counterparts. The findings suggest that the status of alcohol and tobacco use varies in the urban and rural area. The heavy alcohol and tobacco consumption among rural populations underscores the need to develop and implement culturally appropriate public health intervention and awareness arising programs especially in rural China.

Head and neck cancer associated with herpes simplex virus 1 and 2 and other risk factors

We investigated whether herpes simplex viruses, HSV-1 and HSV-2, are cofactors of head and neck cancer (HNC) in association with tobacco, alcohol, or HPV-16 infection. The study included 164 HNC cases and 295 controls. Serologic tests were used to distinguish HSV-1 and HSV-2. Antibodies to anti-VLP HPV-16 and HPV-16 E6 and E7 were evaluated by ELISA. After adjusting for age, tobacco, alcohol use, and number of sexual partners, risk of cancer was not significantly increased in those with HSV-1 [adjusted odds ratio (OR)=0.7] or HSV-2 (OR=0.8) compared to HSV-negative patients. Although heavy use of tobacco, alcohol and HPV-16 infection was associated with an increased risk of HNC, the adjusted risk among those infected with HSV-1 or HSV-2 lowered the odds compared to those who were not infected. Heavy smokers (OR=1.7) and heavy drinkers infected with HSV-1 (OR=4.2) or HSV-2 (smokers: OR=1.6; drinkers: OR=3.2) had lower odds compared to seronegative HSV-1 heavy users (smokers: OR=2.5; drinkers: OR=5.5) or HSV-2 (smokers: OR=1.9; drinkers: OR=6.2). Those seropositive to HPV-16 E6 and/or E7 but not HSV-1 (OR=27.4) or HSV-2 (OR=18.0) had higher risk of HNC compared to those infected with HSV-1 (OR=16.7) or HSV-2 (not estimable). These findings suggest that seropositivity to HSV-1 and HSV-2, although not independent risk factors for HNC, may modify the risk of HNC associated with exposure to tobacco, alcohol, or HPV-HR.

Usefulness of Salivary trans-3'-Hydroxycotinine Concentration and trans-3'-Hydroxycotinine/Cotinine Ratio as Biomarkers of Cigarette Smoke in Pregnant Women

Nicotine is rapidly and extensively metabolized in humans and negatively impacts the developing fetus. The concentrations of nicotine, cotinine, trans-3'-hydroxycotinine (hydroxycotinine), and norcotinine in pregnant smokers' oral fluid were evaluated to determine usefulness as biomarkers of cigarette smoking. Sixteen participants were divided into two groups: eight light smokers (LS) who smoked < or =10 cigarettes/day and eight heavy smokers (HS) who smoked > or =20 cigarettes/day. Oral fluid specimens (n=415) were collected throughout pregnancy and analyzed with solid-phase extraction followed by gas chromatography-mass spectrometry-electron impact selected ion monitoring. Median concentrations of nicotine, cotinine, and hydroxycotinine in oral fluid of LS ranged from 241.1 to 622.0, 80.6 to 387.5, and 14.4 to 117.7 ng/mL and for HS 146.5-1372.2, 66.0-245.8, and 38.3-184.4 ng/mL, respectively. Salivary cotinine and hydroxycotinine concentrations were significantly correlated in LS (r = 0.55, p < 0.01) and HS (r = 0.74, p < 0.01). Ratios of hydroxycotinine/cotinine in oral fluid from pregnant women averaged 0.30 +/- 0.18 (range, 0.07-1.05) for LS and 0.68 +/- 0.25 (range, 0.29-1.83) for HS. Based on these preliminary data, the best ratio to differentiate light from heavy pregnant smokers was 0.41. Salivary hydroxycotinine and cotinine concentrations are both good biomarkers of cigarette smoking. Determining the hydroxycotinine/cotinine ratio may differentiate light from heavy tobacco use and help predict increased fetal tobacco exposure.