Lifetime Cigarette Consumption Research Articles

The impact of cumulative smoking volume and length of smoking cessation on brachial artery reactivity

Cigarette smoking has been shown to cause endothelial abnormalities. Though the endothelium has shown the ability to recover function after smoking cessation, it is unclear how the intensity of lifetime cigarette consumption and the length of smoking cessation influence this recovery.

Associations between potential causal factors and colorectal cancer risk: A systematic review and meta-analysis of Mendelian randomization studies.

To summarize the associations between potential causal factors and colorectal cancer (CRC) risk based on existing Mendelian randomization studies. This systematic review and meta-analysis involved a literature search in Embase and Medline. All published articles using Mendelian randomization to explore potential causal factors of CRC were included. Studies that reported Mendelian randomization estimates of standard deviation changes in exposures were included in the meta-analysis. Subgroup analyses based on sex and anatomical sites were performed. One hundred and ninety studies presented in 51 articles were included in systematic review, and 114 studies conducted in 32 articles were included in the meta-analysis. Adult body mass index, waist circumference, waist hip ratio, body height, body fat percentage, arm fat ratio, childhood obesity, lifetime cigarette consumption, short sleep, coffee consumption, and blood levels of vitamin B12 , arachidonic acid, stearic acid, and insulin-like growth factor binding protein 3 were positively associated with CRC risk. Conversely, acceleration-vector-magnitude physical activity, milk consumption, and blood levels of adiponectin, linoleic acid, α-linolenic acid, oleic acid, palmitoleic acid, interleukin-6 receptor subunit-α, and tumor necrosis factor were inversely associated with CRC risk. Most obesity-related anthropometric characteristics, several unhealthy lifestyles, and blood levels of some micronutrients, fatty acids, and diabetes-related biomarkers were positively associated with CRC risk. In contrast, some lifestyles and blood levels of some fatty acids and inflammatory biomarkers were inversely associated with CRC risk. Future studies with more valid genetic variants are needed for factors with discrepancies between Mendelian randomization and epidemiological studies.

Common Side Effects and Metabolic Syndrome due to Clozapine: Relationship with the Clinical Variables and Disability.

Common side effects of clozapine may affect the treatment process negatively. In this study, we aimed to assess the common side effects and the prevalence of metabolic syndrome in schizophrenia patients treated with clozapine, and to study their relationship with clinical variables and disability. One hundred and twenty two patients who met DSM-IV criteria for schizophrenia, and were on clozapine treatment were included in the study. Clinical status was evaluated through a clinical interview and review of the medical records, and physical measures and laboratory tests were recorded. Patients were assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders, UKU (Udvalg for Kliniske Undersogelser) Side Effect Rating Scale, World Health Organization (WHO)-Disability Assessment Schedule II, Positive and Negative Syndrome Scale, Global Assessment Scale, Clinical Global Impression Scale. Common side effects of clozapine were hypersalivation, fatigue, sedation and constipation. The relationship between constipation and clozapine dose, and dizziness and norclozapine plasma levels were significant. The prevalence of metabolic syndrome was 50%, and patients with metabolic syndrome had higher means of age and lifetime cigarette consumption. Disability was positively correlated with the severity of psychopathology and the number of side effects, and negatively correlated with the age at onset of illness. Severity of the psychopathology and the number of side effects predicted the severity of the disability. Clozapine was associated with various side effects and half of the patients had metabolic syndrome. Assessment of common side effects due to clozapine is important for reducing disability.

A haplotype-specific linkage disequilibrium pattern of monoamine oxidase A gene associated with regular smoking in women.

Cigarette smoking in women is raising a public health problem. The X-linked monoamine oxidase A (MAOA) was considered as a susceptibility gene to substance abuse of tobacco, but the evolutionary effect of MAOA may lead to a positive or negative association between genetic variations and smoking development among study regions. Based on linkage disequilibrium (LD), we performed a haplotype-based association to explore the effect of MAOA gene on women's smoking risk in a case-control study. Genotyped single nucleotide polymorphisms (SNPs) of MAOA gene, rs5953210G>A, rs2283725A>G and rs1137070T>C, were significantly associated with current smoking risk in women, and the increased level of plasma MAO-A activity was raised with per copy increment of risk allele in current smokers (P < .01). The haplotype patterns with minor haplotype frequency >.05 were constructed using the Expectation-Maximization algorithm, and the haplotype-specific A-G-C pattern raised the 2-fold risk to develop regular smoking (P = .0005). In the diplotype analysis based on X-inactivation mechanism relative to no and full dosage compensation, we showed that A-G-C haplotype not only increased regular smoking risk in a dose-dependent manner (Ptrend = .0011) but also contributed to smoking risk in the dosage compensation mechanism. Compared to non-smokers, the effect of A-G-C haplotype on random X-activation was associated with the raised MAO-A activity in women smokers (P < .05) although the lifetime cigarette consumption showed a difference that was not statistically significant. This study provides information on MAOA LD-based haplotype and diplotype patterns in women smoking.

Levels of physical dependence on tobacco among adolescent smokers in Cyprus

PurposeThe purpose of this study is to assess tobacco dependence among Cypriot adolescents and examine its association to cigarette consumption and attitudes towards smoking. MethodsThe current study used cross-sectional data from the 2011 Cyprus Global Youth Tobacco Survey which adopted multistage cluster sampling methods to select adolescents registered in middle and high schools in Cyprus. Tobacco use, physical dependence on tobacco, and attitudes towards tobacco use were measured in 187 adolescents aged 13–18years old who reported that they had smoked at least once in the preceding 30days. Physical dependence was assessed using the Levels of Physical Dependence scale. ResultsPhysical dependence was present in 86% of the adolescent smokers. The mean latency to needing among smokers in the highest dependence group was 101h. Significant associations were observed between physical dependence and the perceived difficulty in quitting (OR=13.1, 95% CI: 4.0, 43.0) as well as the expectation to continue smoking for the next five years (OR=3.3, 95% CI: 1.3, 8.4). Significant associations were also observed between physical dependence and the number of smoking days per month, daily smoking, daily cigarette consumption, lifetime cigarette consumption, and perceived difficulty in abstaining from smoking for one week. ConclusionsPhysical dependence provides a symptom-based approach to assess dependence and it is a strong predictor of adolescents' perceptions of their ability to quit or to refrain from smoking for a week. Physical dependence on tobacco was highly prevalent among adolescent smokers in Cyprus and it was associated with greater perceived difficulty in quitting. Interventions targeting adolescent smoking must account for the high prevalence of physical dependence.

MP27-02 THE ASSOCIATION BETWEEN VASCULAR RISK FACTORS AND OVER ACTIVE BLADDER

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality of Life1 Apr 2015MP27-02 THE ASSOCIATION BETWEEN VASCULAR RISK FACTORS AND OVER ACTIVE BLADDER Teruhiko Tsuru, Isao Araki, Sayaka Kadowaki, Takashi Hisamatsu, Akira Fujiyoshi, Akihiro Kawauchi, Katsuyuki Miura, and Hirotsugu Ueshima Teruhiko TsuruTeruhiko Tsuru More articles by this author , Isao ArakiIsao Araki More articles by this author , Sayaka KadowakiSayaka Kadowaki More articles by this author , Takashi HisamatsuTakashi Hisamatsu More articles by this author , Akira FujiyoshiAkira Fujiyoshi More articles by this author , Akihiro KawauchiAkihiro Kawauchi More articles by this author , Katsuyuki MiuraKatsuyuki Miura More articles by this author , and Hirotsugu UeshimaHirotsugu Ueshima More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1164AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Bladder wall ischemia caused by the arteriosclerosis with age is paid attention to the factor of over active bladder (OAB). To investigate the association between vascular risk factors and OAB, we performed a random cross-sectional epidemiological study. METHODS This study was conducted using a population-based sample of 518 male, aged 61-83 years, who participated in the Shiga Epidemiological Study of Subclinical Atherosclerosis (SESSA) between 2010 and 2013. We investigate the association between Over Active Bladder Symptom Score (OABSS) and Vascular Risk Factors: age, body mass index (BMI), percent body fat, waist circumference, lifetime cigarette consumption, drinking history, sleep time, systolic blood pressure, diastolic blood pressure, hypertension, diabetes mellitus (DM), hyperlipidemia, ankle/brachial pressure index (ABI), pulse wave velocity (PWV), abdominal aortic calcification score, total cholesterol (TC), high-density lipoprotein (HDL), triglycerides (TG). RESULTS The mean age was 71.8+/-6.0 years old and the mean OABSS was 2.9+/-2.2. The proportions of OAB were 19.9% and OAB wet were 9.1%. OAB patient, compared with non OAB patient, was significantly higher in lifetime cigarette consumption (p=0.0006), abdominal aortic calcification score (p=0.007), age (p=0.01), percent body fat (p=0.01), BMI (p=0.02). In univariate regression Aanalysis, age (p<0.0001), triglycerides (p=0.012), abdominal aortic calcification score (p=0.023), diastolic blood pressure (p=0.028),and hyperlipidemia (p=0.036) were significantly correlated with OABSS. In multivariate logistic regression analysis, age (p<0.0001), HL (p=0.03), lifetime cigarette consumption (p=0.03), TG (p=0.03) were significantly correlated with OABSS. CONCLUSIONS According to our data, age and classical vascular risk factors: hyperlipidemia, lifetime cigarette consumption, and triglycerides, are independent predictors of OABSS, but abdominal aortic calcification score, considered to be directly correlated with Bladder wall ischemia, is not proved because of collinearity with age. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e302-e303 Peer Review Report Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Teruhiko Tsuru More articles by this author Isao Araki More articles by this author Sayaka Kadowaki More articles by this author Takashi Hisamatsu More articles by this author Akira Fujiyoshi More articles by this author Akihiro Kawauchi More articles by this author Katsuyuki Miura More articles by this author Hirotsugu Ueshima More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Smoking and long-term labour market outcomes

ObjectiveTo examine the long-term effects of smoking on labour market outcomes using twin data matched to register-based individual information on earnings.MethodTwin data for Finnish men born 1945–1957 was used to...

Association between plasma adiponectin levels and decline in forced expiratory volume in 1 s in a general Japanese population: the Takahata study.

Background:Adiponectin is an anti-inflammatory and cardio-protective cytokine. However, several studies have demonstrated that plasma adiponectin levels were inversely associated with pulmonary function in patients with chronic obstructive pulmonary disease, suggesting a proinflammatory or pulmonary-destructive role. It is still unclear whether adiponectin is a potent biomarker predicting declines in pulmonary function. The aim of this study was to investigate the association between adiponectin and pulmonary function among Japanese individuals who participated in an annual health check-up.Methods:Spirometry and blood sampling, including measurements of plasma adiponectin, were performed for 3,253 subjects aged 40 years or older who participated in a community-based annual health check-up in Takahata, Japan from 2004 to 2006. In 2011, spirometry was re-performed, and the data from 872 subjects (405 men and 467 women) were available for a longitudinal analysis.Results:Plasma adiponectin levels were found to be significantly associated with age, body mass index (BMI), and alanine aminotransferase (ALT), triglycerides (TG), and high-density lipoprotein-cholesterol (HDL-c) levels among both men and women in the study population. Plasma adiponectin levels were found to be associated with lifetime cigarette consumption (Brinkman index, BI) in men only. Plasma adiponectin levels were inversely correlated with forced expiratory volume in 1 s (FEV1) per forced vital capacity in both men and women. In addition, the annual change in FEV1 was inversely associated with plasma adiponectin levels in both genders. A multiple linear regression analysis revealed that this association was independent of other confounding factors such as age, BMI, BI, ALT, TG, and HDL-c.Conclusions:The results of the present study suggest that adiponectin levels are predictive of declines in FEV1 in the general population.

Reversible Increase in Smoking After Withdrawal of Ventral Capsule/Ventral Striatum Deep Brain Stimulation in a Depressed Smoker

How smoking affects reward systems in mood disorders remains unclear. Functional neuroimaging suggests more dysfunction among depressed than nondepressed smokers (Brody, 2009). Abnormal reward mechanisms could increase smoking’s hedonic value, thus sustaining dependence (Koob & LaMoal, 1997). Deep brain stimulation (DBS) of the ventral striatum and adjacent ventral capsule (VC/VS) enhances positive affect in OCD or major depression (Greenberg et al., 2008; Malone et al, 2009). DBS might compensate for reward deficits and reduce smoking. Conversely, smoking might increase if DBS stops. Case Report A 43-year-old woman enrolled in an FDA- and IRB-approved trial of DBS for otherwise intractable depression (Malone et al, 2009). Before surgery, lifetime cigarette consumption (average <10/day) and tobacco dependence was low (Fagerstrom Test for Nicotine Dependence=3). Bilateral DBS leads (Model 3391, Medtronic Inc.) were implanted following the trajectory of the anterior limb of the internal capsule at the level of the anterior commissure, extending into VS (on right: 0.2mm anterior to the anterior commissure, 7.5mm lateral, and -1.8mm below the AC-PC plane; on left: 0.1, 8.9, and -1.9mm, respectively). Before DBS, depression remained severe despite aggressive conventional treatments (Montgomery-Asberg Depression Rating Scale (MADRS=33). After left unilateral VC/VS DBS she sustained remission (MADRS≤7) for four years, except when stimulator batteries were depleted. Stimulation parameters: contacts 0+1-2-3+, 130Hz, pw 120 µSec, 6.0V. Concomitant medications including Valproate 1500 mg; Clonezapam 3 mg; Eszopiclone 3 mg; Oxcarbazepine 600 mg.

Occupational Gradients in Smoking Behavior and Exposure to Workplace Environmental Tobacco Smoke

This study examines associations of occupation with smoking status, amount smoked among current and former smokers (number of cigarettes per day and lifetime cigarette consumption (pack-years)), and workplace exposure to environmental tobacco smoke (ETS) independent from income and education. This is a cross-sectional analysis of data from a community sample (n = 6355, age range: 45-84) using logistic and multinomial regression. All analyses were stratified by sex and adjusted for socio-demographic variables. Male blue-collar and sales/office workers had higher odds of having consumed more than 20 pack-years of cigarettes than managers/professionals. For both male and female current or former smokers, exposure to workplace ETS was consistently and strongly associated with heavy smoking and greater pack-years. Blue-collar workplaces are associated with intense smoking and ETS exposure. Smoking must be addressed at both the individual and workplace levels especially in blue-collar workplaces.

Psychometric Properties of the Autonomy over Tobacco Scale in German

Background/Aims: We investigated the psychometric properties of a German translation of the 12-item Autonomy over Tobacco Scale (AUTOS) among 1,195 eighth-grade students. Methods: Data for this study were collected as part of the fourth wave of data collection of the Smokefree Class Competition intervention in the Saxony-Anhalt region of Germany. Students from the control arm of the Smokefree Class Competition study who indicated that they had ever smoked ‘at least a few puffs’ on a cigarette were classified as ever-smokers. They self-completed questionnaires distributed by teachers. Results: AUTOS scores ranged from 0 to 36 with a distribution highly skewed toward lower-response categories. Inter-item correlations ranged from 0.65 to 0.89 (mean = 0.79, SD = 0.06). Composite reliability for the AUTOS was high (Ω = 0.96) and 3 lower-order factors were also reliable (withdrawal: 0.89, psychological dependence: 0.91, cue-induced cravings: 0.87). Concurrent validity was supported by strong relationships between the AUTOS and both lifetime cigarette consumption and current smoking frequency. Youths were 18 times more likely to be current smokers (95% CI = 11.9–27.2, p < 0.001) if they endorsed any AUTOS item. Conclusion: The German AUTOS is reliable and valid, and the results are consistent with the English AUTOS for use with adolescents.

Temporal sequence of incident cigarette, coffee, and alcohol use among AA participants

Background: Cigarettes and coffee are widely used psychoactive substances among alcoholics. Due to the devastating public health impact of alcohol use disorders, it is important to determine if using cigarettes or coffee may influence alcoholism. Previous studies indicate that cigarette smoking is associated with progression of alcohol dependence, but the effects of coffee drinking have yet to be investigated. Objectives: To retrospectively determine the temporal sequence of incident cigarette, coffee, and alcohol use and attributed subjective effects in AA participants. Methods: Volunteers at all Nashville open-AA meetings (n = 289 [126 women], completion rate = 94.1%) were administered a Lifetime Drinking History modified to also include lifetime cigarette and coffee consumption, as well as coffee consumption and effects questions, the Fagerstrom Test for Nicotine Dependence, and the Smoking Effects Questionnaire. Results: Average ages (years) at first regular use of alcohol, cigarettes, and coffee were 15.4 (IQR: 13.0–18.0), 16.7 (IQR: 13.0–18.5), and 18.5 (IQR: 14.0–23.5), respectively. In a subset who used all three substances (n = 236;102 women) alcohol consumption preceded cigarette smoking (p < .001) and coffee drinking (p < .001), and cigarette smoking preceded coffee drinking (p < .001); these relationships did not differ by gender. Conclusions: Recovering alcoholics started regular alcohol consumption prior to cigarette smoking and coffee drinking. Scientific Significance: In AA participants, coffee does not precede initiation of regular smoking or alcohol drinking as might be anticipated for a gateway drug.

Smoking behaviours and contextual influences on adolescent nicotine dependence

The objectives of the study were to analyse nicotine-dependence patterns among secondary school students in New Zealand (NZ), and identify factors associated with levels of nicotine dependence. This study uses data from the 2004 Youth Lifestyle Study, a survey of Year 10 and 12 students from randomly selected schools in NZ. The analysis included 625 current adolescent smokers. Nicotine dependence was measured with the Hooked on Nicotine Checklist (HONC). Potential dependence-associated factors studied include: socio-demographic factors; smoking behaviours; and smoking contexts. A large percentage (87.9%) of the current adolescent smokers reported at least one HONC symptom, with a mean HONC score of 4.9 out of a possible 10. Multivariate analyses identified: school decile; age at which started smoking monthly; lifetime cigarette consumption; and peers smoking as statistically significant predictors of nicotine dependence. Adolescent smokers are very likely to become dependent on nicotine. Students from the highest school decile had markedly lower HONC scores. Earlier onset of monthly smoking, heavier overall consumption and peers smoking were associated with higher HONC scores. These findings provide important insights into factors that may need to be modified to help reduce nicotine dependence among adolescents.

Nicotine increases neural response to unpleasant stimuli and anxiety in non‐smokers

Studies in smokers suggest that nicotine might exert anxiolytic, stress-dampening and mood-enhancing effects and beneficially influences neural processing of affective information. Regarding non-smokers, results are inconsistent, and no data exist on the effect of nicotine on neural emotion processing. We applied functional magnetic resonance imaging (fMRI) to assess the influence of nicotine on brain activation during processing of emotional stimuli in 31 non-smokers with a maximum lifetime cigarette consumption of 20 cigarettes. Participants were subjected to two fMRI scans with event-related presentations of images taken from the International Affective Picture System, receiving nicotine (2 mg) and placebo gums in a double-blinded, randomized cross-over design. Furthermore, subjective affect was assessed. Nicotine increased brain activity in response to unpleasant stimuli in the amygdala, anterior cingulate cortex (ACC) and basal ganglia, whereas processing of pleasant stimuli was not altered. Psychophysiological interaction (PPI) analyses revealed that nicotine increased connectivity between the amygdala and the perigenual ACC (pACC) during processing of unpleasant stimuli and decreased connectivity between those structures during processing of pleasant stimuli. Participants reported higher state anxiety under nicotine than placebo. A single dose of nicotine acted as a stressor in non-smokers, leading to increased anxiety and neural activation elicited by unpleasant stimuli as well as altered connectivity within the amygdala-pACC circuit. Besides the possibility that reactions to nicotine may differ between non-smokers and smokers due to tolerance and neuroadaptive processes that occur during prolonged nicotine use, a priori differences in smokers and non-smokers might potentially explain diverse effects of nicotine on affect and emotional reactivity.

Nicotine Addiction in Light Smoking African American Mothers

Although African Americans (AA) smoke fewer average cigarettes per day (CPD) than European Americans (EA), they carry a disproportionate tobacco related morbidity and mortality burden. To evaluate ethnic differences in markers of nicotine addiction, including rates of lifetime nicotine dependence (ND) symptoms, current smoking and smoking during pregnancy across different levels of peak lifetime cigarette consumption. Data from 237 EA (N=118) and AA (N=119) mothers participating in the Missouri Family Study (2003-2005), an ethnically diverse family study of offspring outcomes in high and low risk families, were used to contrast prevalence of ND symptoms and other smoking behaviors between EA and AA women at low (1-10 CPD), moderate (11-19 CPD), and high (≥ 20 CPD) levels of lifetime peak daily cigarette consumption. Compared with EA smokers, AAs had lower lifetime prevalence of DSM-IV ND (68% v. 54%, p<.05), consumed fewer CPD during their heaviest lifetime consumption (18% EA v. 58% AA smoked ≤ 10 CPD, p<.0001), but did not differ in overall rates of smoking during pregnancy or current smoking. However, stratifying by categories of peak lifetime daily cigarette use, AA mothers who smoked ≤ 10 CPD reported greater lifetime ND symptoms and current smoking than their EA counterparts. In addition, nearly two-thirds of AA mothers in this smoking category smoked during pregnancy and 30% smoked throughout an entire pregnancy. The respective prevalence estimates in EA mothers were 38% and 0%. Stratifying the sample into categories of lifetime peak daily cigarette use revealed significant ethnic/racial differences in smoking prevalence during pregnancy that were obscured in overall analysis. Substantial public health risks warranting clinical attention exist among light smokers, particularly AA women.

The association between smoking and hypertension in a population-based sample of Vietnamese men

The association between tobacco smoking and blood pressure in epidemiological studies remains unclear despite experimental evidence that smoking elevates blood pressure. This study examined the association between smoking and hypertension in a population-based sample of Vietnamese men. The study utilized a population-based sample of men (n = 910) from a survey of risk factors of noncommunicable diseases in Vietnam. Measurements including behavioural risk factors, body composition, and blood pressure were performed according to internationally standardized protocols. Poisson regression was used to obtain prevalence ratios and 95% confidence intervals (CIs). All analyses were performed using complex survey methods. There were significant trends of increasing prevalence of hypertension with increasing years (P = 0.05) and pack-years (P = 0.03) of smoking after adjusting for age, BMI, and alcohol intake. Relative to never-smokers, the risk of hypertension for those who had smoked for 30 years or more and those who had smoked 20 pack-years or more were 1.52 (95% CI 0.95-2.44) and 1.34 (95% CI 0.94-1.91), respectively. Overall, however, current smokers were not at higher risk of hypertension than never-smokers (prevalence ratio = 1.08, 95% CI 0.70-1.68), and ex-smokers were more likely to be hypertensive than either never-smokers (prevalence ratio = 1.81, 95% CI 1.07-3.06) or current smokers (prevalence ratio = 1.67, 95% CI 1.25-2.23), similarly adjusted. In this population-based sample, hypertension was associated with smoking in a dose-response manner when characterized as number of years of smoking and lifetime cigarette consumption, but was not associated with current smoking status.

The loss of autonomy over smoking in relation to lifetime cigarette consumption

New Zealand youth who had smoked only one cigarette had diminished autonomy over smoking. We sought to examine this issue in a US sample and examine the early onset of DSM-IV nicotine dependence. A self-administered survey was completed by 367 adolescent smokers in Massachusetts. Diminished autonomy was measured with the Hooked on Nicotine Checklist. Diminished autonomy was present in 5.7% of youth after one cigarette, in 9% after 2, in 26% after 3–4, in 44% after 5–9, in 43% after 10–19, in 67% after 20–99, and in 96% after 100 or more. DSM-IV nicotine dependence was absent in youth who had not smoked 10 cigarettes but was present in 9% after 10–19 cigarettes, in 17% after 20–99, and in 58% after 100 or more. Our data confirm the New Zealand study by showing diminished autonomy among subjects who had smoked only 1 or 2 cigarettes. Diminished autonomy after one or two cigarettes, and DSM-IV nicotine dependence after 10–19, support the sensitization-homeostasis theory of nicotine addiction that the addiction process is initiated by the first few cigarettes.

Retrospective cohort study of smoking and lung cancer incidence in rural prefecture, Japan

We conducted an epidemiological study of the relationship between lung cancer incidence and smoking, with special reference to the benefits of smoking cessation for reducing lung cancer incidence, to promote a local smoking control program. The study was a retrospective cohort study. The population studied was 16,383 male examinees of lung cancer health examinations in 1995 in Tottori Prefecture, Japan. Smoking status from the questionnaire during the health examination was used as the exposure variable. Endpoint (lung cancer incidence) was obtained from the Tottori population-based cancer registry. A multivariable analysis using the Cox proportional hazard model was adapted for statistical analysis. The average follow-up period was 4.3 years. The hazard ratio of current smokers for the incidence of lung cancer was 4.9, whereas that of ex-smokers was 2.2. The dose-response relationship between lung cancer incidence and lifetime cigarette consumption (pack year) was determined. The ratio increased among younger subjects (under 65 years old). The hazard ratio of ex-smokers decreased with years just after quitting smoking, and reached the level of never smokers after 10-19 years from smoking cessation. We reconfirmed that the magnitude of risk estimates of smoking for lung cancer incidence was similar to those of previous studies, and smoking cessation was effective for reducing lung cancer risk.

Measuring adults' loss of autonomy over nicotine use: The Hooked on Nicotine Checklist

The Hooked on Nicotine Checklist (HONC) is a 10-item screening tool originally developed to assess loss of autonomy over tobacco in adolescent smokers. A smoker's endorsement of any item indicates some loss of autonomy, and the sum of endorsed items indicates the degree to which autonomy has been lost. This study extends the HONC to adult smokers. Self-administered questionnaires were completed by a convenience sample of 1,102 adults who were recruited in their natural environments while observed smoking. Subjects were mostly experienced smokers who consumed a mean of 17.5 cigarettes per day and had smoked an average of 20.9 years. HONC scores ranged from 0 to 10, with a mean of 7.1. The HONC appears to measure a single dimension. Internal HONC consistency was high (alpha = .83), and interitem correlations were low to moderate. HONC scores correlated positively with levels of current and peak lifetime cigarette consumption. The HONC scores of heavy, moderate, and light smokers differed significantly in the expected direction. Subjects with higher HONC scores were more likely to report a shorter duration of abstinence and greater use of pharmacological aids when quitting. The HONC appears to be psychometrically sound in both adolescents and adults. It is a reliable and valid measure of lost autonomy for both novice and experienced smokers, and it allows for comparisons between these populations.

Predictors of Survival in Severe, Early Onset COPD

Multiple risk factors for mortality in patients with COPD have been described, but most studies have involved older, primarily male subjects. The purpose of this study was to determine the mortality rate and predictors of survival in subjects with severe, early onset COPD. The cohort of 139 probands in the Boston Early-Onset COPD Study was recruited from lung transplant and general pulmonary clinics between September 1994 and July 2002. Subjects were < 53 years old, had an FEV(1) of < 40% of predicted, did not have severe alpha(1)-antitrypsin deficiency, and had not undergone lung transplantation. The initial evaluation included a standardized respiratory questionnaire, spirometry, and a blood sample. A follow-up telephone interview was conducted between May and December 2002. Subjects were young (mean age at enrollment, 47.9 years) and had severe airflow obstruction (mean baseline FEV(1), 19.4% predicted). A total of 72.7% of the subjects were women (p < 0.0001 [comparison to equal gender distribution]). The median estimated survival time was 7.0 years from the time of study enrollment, determined by the Kaplan-Meier method. The majority of deaths were due to cardiorespiratory illness. In a multivariable Cox proportional hazards model, adjusting for age, gender, and baseline FEV(1), lifetime cigarette consumption (hazard ratio [HR], 1.20 [per 10 pack-years]; 95% confidence interval [CI], 1.02 to 1.40) and recent smoking status (HR, 2.50; 95% CI, 1.03 to 6.05) were both significant predictors of mortality. In this cohort, recent smoking status predicted increased mortality independent of the effects of lifetime smoking intensity. Smoking cessation may confer a survival benefit even among patients with very severe COPD.