Lower Prevalence Of Current Smoking Research Articles

Association between tobacco control policies and smoking behaviour in Europe

Abstract Background Smoking is an important public health problem. The European Health Interview Survey (EHIS) provides regular data on prevalence and determinants of smoking for the populations of European countries, while the Tobacco Control Scale (TCS) quantifies the implementation of tobacco control measures. The aim is to examine the associations between tobacco control policies at country level and individual-level smoking prevalence. Methods Using multi-level regression modelling, individual data from EHIS 2019/2020 and country-level data from TCS 2019 were analysed. The outcome measure was self-reported current smoking (daily or occasional) at the individual level. Predictor variables were at the individual level: gender, age and education attainment level, and at country level: scores of TCS policy components ‘Price', ‘Public place bans', ‘Advertising bans', ‘Health warnings', ‘Treatment’ and ‘Illicit trade'. Microdata from the 3rd wave of EHIS for 28 European countries were used with a total of n = 66.934 individuals aged >15 years. A weighting factor was applied to consider each country proportionally according to its sample size in EHIS. Results There are large cross-national differences in current smoking prevalence ranged from 12.6% (95% confidence interval (CI) 11.9-13.3) in Sweden to 36.2% (95% CI 35.0-37.4) in Bulgaria. In the final multi-level model besides individual variables (female gender, age 60 years and over, medium or high education level), following variables at country level were significantly associated with lower prevalence of current smoking: ‘Price’ (Odds Ratio (OR)=0.96 (p < 0.05) and ‘Treatment’ OR = 0.88; (p < 0.01). For ‘Public place bans', ‘Advertising bans', ‘Health warnings’ and and ‘Illicit trade’ association were in same direction but without significance. Conclusions Tobacco control policies help to reduce the prevalence of smoking in population, although the different measures have differing impact. Key messages • Our study confirms the link between the implementation of tobacco control policies and smoking prevalence using recent data. • Policy components have different effects on smoking prevalence at population level.

Exploring the Potential for Smoke-Free Laws to Reduce Smoking Disparities by Sexual Orientation in the USA.

We examined associations between smoke-free laws and smoking outcomes in a nationally representative sample of US adults, including exploring whether these associations differed for heterosexual and sexual minority (SM) adults. We constructed county-level variables representing the percent of the population covered by state-, county-, or city-level smoke-free laws in workplaces and hospitality venues. We combined this information with restricted individual-level adult data with masked county identifiers from the National Health Interview Survey (NHIS), 2013-2018. We used modified Poisson regression to explore associations between each type of smoke-free law and the prevalence ratio (PR) of current smoking, and we used linear regression to explore associations with smoking intensity (mean cigarettes per day). We assessed interactions between smoke-free laws and SM status on the additive scale to determine whether associations were different for SM and heterosexual adults. In adjusted models without interaction terms, smoke-free laws in hospitality venues were associated with lower prevalence of current smoking (PR = 0.93, 95% confidence interval (CI) = 0.89, 0.98). Both types of smoke-free laws were associated with lower mean cigarettes per day (workplace law change in mean = - 0.50, 95% CI = - 0.89, - 0.12; hospitality law change in mean = - 0.72, 95% CI = - 1.14,-0.30). We did not observe any statistically significant interactions by SM status, though statistical power was limited. We did not find evidence that smoke-free laws were differentially associated with smoking outcomes for heterosexual and SM adults. Additional studies are needed to further explore the potential for tobacco control policies to address the elevated risk of smoking in SM communities.

Changes in EPA and DHA during supplementation with omega-3 fatty acids and incident cardiovascular events: secondary analysis from the OMEMI trial

Abstract Background In the OMEMI trial, elderly post-MI patients did not achieve reduction in cardiovascular events from supplementation of 1.8g n-3 polyunsaturated fatty acids (PUFA). In two recent trials of hypertriglyceridaemic patients the REDUCE-IT trial demonstrated an association between high levels of serum eicosapentaenoic acid (EPA) and reduced risk of CV events with 4 g/day icosapent ethyl supplements while in the STRENGTH trial no such association was present in patients treated with 4 g/day of EPA+ docosahexaenoic acid (DHA). Purpose To assess associations between changes in concentrations of EPA and DHA during two years supplementation with n-3 PUFA and incident cardiovascular events in the OMEMI trial. Methods In the randomized controlled OMEMI trial, 1014 elderly patients with a recent acute myocardial infarction (AMI) were treated with 1.8g/day of EPA and docosahexaenoic acid (DHA) or placebo for two years, and followed for the primary outcome of MACE (AMI, coronary revascularization, stroke or heart failure hospitalization) and secondary outcome of new-onset atrial fibrillation (AF). Serum concentrations of EPA and DHA were measured at inclusion and at study completion by gas chromatography, and reported as % weight of total FA (%wt) in serum phospholipids. Results Serial EPA and DHA measurements at study inclusion and completion were available in 881 patients (92% of survivors). At baseline EPA and DHA concentrations were (mean±SD) 2.84±1.41 and 5.71±1.35%wt, respectively. Higher baseline EPA and DHA concentrations were associated with previous n-3 PUFA supplementation, lower prevalence of current smoking and diabetes, lower levels of triglycerides and higher levels of HDL-cholesterol (all p<0.05). In patients randomized to n-3 PUFA, EPA and DHA increased with 2.32±1.92 and 0.91±1.19%wt, respectively, whereas in the placebo group EPA and DHA decreased with −0.39±1.37 and −0.43±1.13%wt, respectively. Greater increases in EPA and DHA during follow-up were associated with a lowering of triglyceride concentrations, increasing HDL concentrations, and lower baseline concentrations of EPA and DHA (all p<0.001). Among patients treated with n-3 PUFA (n=438), a greater increase in EPA was associated with a lower risk of incident MACE (HR 0.89 [95% CI 0.78–1.00] per %wt, p=0.059) and higher risk of new-onset AF in patients free of AF at inclusion (n=339): HR 1.31 [1.06–1.62] per %wt, p=0.012 (Figure). There were no such associations for changes in DHA: HR 0.86 (95% CI 0.70–1.05), p=0.13 for MACE and HR 1.29 (0.91–1.83), p=0.16 for new-onset AF. Conclusion Patients treated with 1.8 g/day n-3 PUFA for two years experienced a doubling of serum EPA concentrations. Greater increases in EPA were associated with a lower risk of MACE, but also a higher risk of new-onset AF. Changes in DHA concentrations were not associated with outcomes, suggesting that EPA may be the more important n-3 PUFA with respect to risk of cardiovascular events. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Oslo University Hospital, Ullevål Figure 1

Myocardial Infarction Is Associated With Increased Stroke Severity, In-Hospital Mortality, and Complications: Insights From China Stroke Center Alliance Registries.

BackgroundPrior studies have shown an increased risk of ischemic stroke (IS) after myocardial infarction (MI); however, there are limited studies concerning the characteristics, in‐hospital mortality, and complications of patients with IS with a medical history of MI. We hypothesized that patients with IS with a medical history of MI may experience more severe strokes and have a higher risk of in‐hospital mortality and complications than patients with IS without a medical history of MI.Methods and ResultsConsecutive in‐hospital data were extracted from the China Stroke Center Alliance database from August 2015 to July 2019. Patient characteristics, hospital tests, in‐hospital mortality, and complications were analyzed and compared in patients with IS with or without a history of MI. Of 893 429 patients with IS, we identified 81 646 (9.1%) patients with a history of MI (MI group). Compared with patients with IS without MI, MI group patients were older, had a lower prevalence of current smoking, had a higher prevalence of a relative medical history, and took more medications before admission. Compared with the group with IS without MI, the MI group had a higher National Institute of Health Stroke Scale score after onset (4.0 versus 3.0; Hodges‐Lehmann estimator, 22.5) and a higher proportion of severe strokes (National Institute of Health Stroke Scale score ≥15) (7.1% versus 4.4%; absolute standardized difference=11.6%). In the fully adjusted models, the risk of in‐hospital mortality was higher in the MI group (odds ratio [OR], 1.74; 95% CI, 1.57–1.92; P<0.0001). MI group patients also had a higher risk of complications, including urinary tract infection (OR, 1.28; 95% CI, 1.2–1.36; P<0.0001), gastrointestinal bleeding (OR, 1.29; 95% CI, 1.19–1.39; P<0.0001), pneumonia (OR, 1.24; 95% CI, 1.21–1.28; P<0.0001), depression (OR, 1.33; 95% CI, 1.24–1.42; P<0.0001), seizure (OR, 1.35; 95% CI, 1.22–1.49; P<0.0001), atrial fibrillation (OR, 1.78; 95% CI, 1.71–1.86; P<0.0001), and cardiac or respiratory arrest (OR, 1.98; 95% CI, 1.78–2.2; P<0.0001).ConclusionsPatients with IS with a medical history of MI have an increased risk of severe stroke, in‐hospital mortality, and complications. Studies exploring the underlying mechanisms are needed to improve and tailor stroke treatment strategies.

Association Between Smoking and SARS-CoV-2 Infection: Cross-sectional Study of the EPICOVID19 Internet-Based Survey.

BackgroundSeveral studies have reported a low prevalence of current smoking among hospitalized COVID-19 cases; however, no definitive conclusions can be drawn.ObjectiveWe investigated the association of tobacco smoke exposure with nasopharyngeal swab (NPS) test results for SARS-CoV-2 infection and disease severity accounting for possible confounders.MethodsThe nationwide, self-administered, cross-sectional web-based Italian National Epidemiological Survey on COVID-19 (EPICOVID19) was administered to an Italian population of 198,822 adult volunteers who filled in an online questionnaire between April 13 and June 2, 2020. For this study, we analyzed 6857 individuals with known NPS test results. The associations of smoking status and the dose-response relationship with a positive NPS test result and infection severity were calculated as odds ratios (ORs) with 95% CIs by means of logistic and multinomial regression models adjusting for sociodemographic, clinical, and behavioral characteristics.ResultsOut of the 6857 individuals (mean age 47.9 years, SD 14.1; 4516/6857, 65.9% female), 63.2% (4334/6857) had never smoked, 21.3% (1463/6857) were former smokers, and 15.5% (1060/6857) were current smokers. Compared to nonsmokers, current smokers were younger, were more educated, were less affected by chronic diseases, reported COVID-19–like symptoms less frequently, were less frequently hospitalized, and less frequently tested positive for COVID-19. In multivariate analysis, current smokers had almost half the odds of a positive NPS test result (OR 0.54, 95% CI 0.45-0.65) compared to nonsmokers. We also found a dose-dependent relationship with tobacco smoke: mild smokers (adjusted OR [aOR] 0.76, 95% CI 0.55-1.05), moderate smokers (aOR 0.56, 95% CI 0.42-0.73), and heavy smokers (aOR 0.38, 95% CI 0.27-0.53). This inverse association also persisted when considering the severity of the infection. Current smokers had a statistically significantly lower probability of having asymptomatic (aOR 0.50, 95% CI 0.27-0.92), mild (aOR 0.65, 95% CI 0.53-0.81), and severe infections (aOR 0.27, 95% CI 0.17-0.42) compared to those who never smoked.ConclusionsCurrent smoking was negatively associated with SARS-CoV-2 infection with a dose-dependent relationship. Ad hoc experimental studies are needed to elucidate the mechanisms underlying this association.Trial RegistrationClinicalTrials.gov NCT04471701; https://clinicaltrials.gov/ct2/show/NCT04471701

Neighbourhood greenspace and smoking prevalence: Results from a nationally representative survey in England.

The current study investigated whether people are less likely to be smokers when they live in greener neighbourhoods, and whether such an association is attributable to lower rates of ever-smoking and/or higher rates of smoking cessation. Using a representative sample of the adult population of England (N = 8,059), we investigated the relationships between neighbourhood greenspace and three inter-related smoking outcomes (current smoking, ever-smoking and smoking cessation). After controlling for a range of individual and area-level covariates, including socioeconomic status, income and education, living in the highest greenspace quartile was associated with a 20% lower prevalence of current smoking, compared to living in the lowest greenspace quartile (PR = 0.80, CI = 0.67, 0.96, p < .017). Neighbourhood greenspace was not significantly associated with ever-smoking. However, amongst ever-smokers, residing in the two highest quartiles of neighbourhood greenspace quartiles (vs. 1st quartile) was associated with a 10% and 12% higher prevalence of smoking cessation (PR = 1.10, CI = 1.02, 1.18, p = .012; PR = 1.12, CI = 1.02, 1.22, p = .016, respectively). This suggests that the association between greenspace and current smoking is due to a higher likelihood of smoking cessation, rather than lower rates of ever- smoking. The associations between greenspace, current smoking and smoking cessation were similar in magnitude to those of having high (vs. low) household income and were largely unmoderated by socioeconomic measures. Our findings advocate the need to protect and invest in local greenspaces, to maximise the public health benefits they may afford. Improving access to greenspace may constitute an overlooked public health strategy for reducing smoking prevalence.

Prevalence and factors associated with smoking among Tunisian secondary school-adolescents.

This study aimed to estimate the extent of smoking experience among high and middle school adolescents in Southern Tunisia and to delineate its potential associated factors. We conducted a cross-sectional study among middle and high school-adolescents in the governorate of Sfax, South of Tunisia in the 2017-2018 school-years. A questionnaire was anonymously administered to a representative sample of 1,210 school-adolescents randomly drawn. The mean age of the school-adolescents was 15.6±4.2 years. The prevalence of lifetime smoking was 16.7% (95% CI=[14.7-18.8%]) (boys 32.6%; girls 5.9%;p<0.001). Among the respondents, 13.9% (95% CI=[11.9-15.8%]) were current smokers. In multivariate logistic regression analysis, independent associated factors of current smoking were male gender (Adjusted (AOR)=10.2; p<0.001), 16-17 and 18-19-year age-groups (AOR=2; p=0.005 and AOR=2.6; p=0.001, respectively), below average academic performance (AOR=5.2; p=0.012), divorced parents (AOR=3.9; p=0.007), family monthly income≥800 dollars (AOR=2.1; p=0.001), having a part time job (AOR=3.9; p<0.001) and a perceived high stress level (AOR=1.98; p=0.008). Secondhand smoke (AOR=1.8; p=0.011) and concomitant alcohol drink (AOR=14.56; p<0.001) were independent predictors of current smoking, while high education level of the father was independently associated with lower prevalence of current smoking (AOR=0.17; p<0.001). The prevalence of lifetime and current smoking were relatively high in Southern Tunisian middle and high schools. Multilevel influences on youth smoking behavior had been identified, which reflected the need to conceive appropriate school interventions and effective antismoking education program.

Systematic review of the prevalence of current smoking among hospitalized COVID-19 patients in China: could nicotine be a therapeutic option?

The effects of smoking on Corona Virus Disease 2019 (COVID-19) are currently unknown. The purpose of this study was to systematically examine the prevalence of current smoking among hospitalized patients with COVID-19 in China, considering the high-population smoking prevalence in China (26.6%). A systematic review of the literature (PubMed) was performed on April 1. Thirteen studies examining the clinical characteristics of hospitalized COVID-19 patients in China and presenting data on the smoking status were found. The pooled prevalence of current smoking from all studies was calculated by random-effect meta-analysis. To address the possibility that some smokers had quit shortly before hospitalization and were classified as former smokers on admission to the hospital, we performed a secondary analysis in which all former smokers were classified as current smokers. A total of 5960 patients were included in the studies identified. The current smoking prevalence ranged from 1.4% (95% CI 0.0–3.4%) to 12.6% (95% CI 10.6–14.6%). An unusually low prevalence of current smoking was observed from the pooled analysis (6.5%, 95% CI 4.9–8.2%) as compared to population smoking prevalence in China. The secondary analysis, classifying former smokers as current smokers, found a pooled estimate of 7.3% (95% CI 5.7–8.9%). In conclusion, an unexpectedly low prevalence of current smoking was observed among patients with COVID-19 in China, which was approximately 1/4th the population smoking prevalence. Although the generalized advice to quit smoking as a measure to reduce health risk remains valid, the findings, together with the well-established immunomodulatory effects of nicotine, suggest that pharmaceutical nicotine should be considered as a potential treatment option in COVID-19.

Current smoking, former smoking, and adverse outcome among hospitalized COVID-19 patients: a systematic review and meta-analysis.

Background:The purpose of this study was to examine the prevalence and effects of current smoking on adverse outcomes among hospitalized COVID-19 patients.Methods:A systematic review of the literature (PubMed) identified 18 (from a total of 1398) relevant studies. Pooled current smoking prevalence was compared with the gender-adjusted and gender and age-adjusted, population-based expected prevalence by calculating prevalence odds ratio (POR). The association between current, compared with non-current and former, smoking and adverse outcome was examined. A secondary analysis was performed by including 12 pre-publications (30 studies in total). All analyses were performed using random-effects meta-analysis.Results:Among 6515 patients, the pooled prevalence of current smoking was 6.8% [95% confidence interval (CI): 4.8–9.1%]. The gender-adjusted POR was 0.20 (95% CI: 0.16–0.25, p < 0.001), and the gender and age-adjusted POR was 0.24 (95% CI: 0.19–0.30, p < 0.001). Current smokers were more likely to have an adverse outcome compared with non-current smokers [odds ratio (OR): 1.53, 95%CI: 1.06–2.20, p = 0.022] but less likely compared with former smokers (OR: 0.42, 95% CI: 0.27–0.74, p = 0.003). When pre-publications were added (n = 10,631), the gender-adjusted POR was 0.27 (95% CI: 0.19–0.38, p < 0.001) and the gender and age-adjusted POR was 0.34 (95% CI: 0.24–0.48, p < 0.001).Conclusion:This meta-analysis of retrospective observational case series found an unexpectedly low prevalence of current smoking among hospitalized patients with COVID-19. Hospitalized current smokers had higher odds compared with non-current smokers but lower odds compared with former smokers for an adverse outcome. Smoking cannot be considered a protective measure for COVID-19. However, the hypothesis that nicotine may have a protective effect in COVID-19 that is partially masked by smoking-related toxicity and by the abrupt cessation of nicotine intake when smokers are hospitalized should be explored in laboratory studies and clinical trials using pharmaceutical nicotine products.

Association of Coronary Artery Calcium With Long-term, Cause-Specific Mortality Among Young Adults

The level of coronary artery calcium (CAC) can effectively stratify cardiovascular risk in middle-aged and older adults, but its utility for young adults is unclear. To determine the prevalence of CAC in adults aged 30 to 49 years and the subsequent association of CAC with coronary heart disease (CHD), cardiovascular disease (CVD), and all-cause mortality. A multicenter retrospective cohort study was conducted among 22 346 individuals from the CAC Consortium who underwent CAC testing (baseline examination, 1991-2010, with follow-up through June 30, 2014; CAC quantified using nonconrast, cardiac-gated computed tomography scans) for clinical indications and were followed up for cause-specific mortality. Participants were free of clinical CVD at baseline. Statistical analysis was performed from June 1, 2017, to May 31, 2018. The prevalence of CAC and the subsequent rates of CHD, CVD, and all-cause mortality. Competing risks regression modeling was used to calculate multivariable-adjusted subdistribution hazard ratios for CHD and CVD mortality. The sample of 22 346 participants (25.0% women and 75.0% men; mean [SD] age, 43.5 [4.5] years) had a high prevalence of hyperlipidemia (49.6%) and family history of CHD (49.3%) but a low prevalence of current smoking (11.0%) and diabetes (3.9%). The prevalence of any CAC was 34.4%, with 7.2% having a CAC score of more than 100. During follow-up (mean [SD], 12.7 [4.0] years), there were 40 deaths related to CHD, 84 deaths related to CVD, and 298 total deaths. A total of 27 deaths related to CHD (67.5%) occurred among individuals with CAC at baseline. The CHD mortality rate per 1000 person-years was 10-fold higher among those with a CAC score of more than 100 (0.69; 95% CI, 0.41-1.16) compared with those with a CAC score of 0 (0.07; 95% CI, 0.04-0.12). After multivariable adjustment, those with a CAC score of more than 100 had a significantly increased risk of CHD (subdistribution hazard ratio, 5.6; 95% CI, 2.5-12.7), CVD (subdistribution hazard ratio, 3.3; 95% CI, 1.8-6.2), and all-cause mortality (hazard ratio, 2.6; 95% CI, 1.9-3.6) compared with those with a CAC score of 0. In a large sample of young adults undergoing CAC testing for clinical indications, 34.4% had CAC, and those with elevated CAC scores had significantly higher rates of CHD and CVD mortality. Coronary artery calcium may have potential utility for clinical decision-making among select young adults at elevated risk of cardiovascular disease.

Smoking Trends among U.S. Latinos, 1998-2013: The Impact of Immigrant Arrival Cohort.

Few studies examine nativity disparities in smoking in the U.S., thus a major gap remains in understanding whether immigrant Latinos’ smoking prevalence is stable, converging, or diverging, compared with U.S.-born Latinos. This study aimed to disentangle the roles of period changes, duration of U.S. residence, and immigrant arrival cohort in explaining the gap in smoking prevalence between foreign-born and U.S.-born Latinos. Using repeated cross-sectional data spanning 1998–2013 (U.S. National Health Interview Survey), regressions predicted current smoking among foreign-born and U.S.-born Latino men and women (n = 12,492). We contrasted findings from conventional regression analyses that simply include period and duration of residence effects, to two methods of assessing arrival cohort effects: the first accounted for baseline differences in smoking among arrival cohorts, while the second examined smoking probabilities by tracking foreign-born arrival cohorts as they increase their duration of U.S. residence. Findings showed that Latino immigrants maintained lower prevalence of current smoking compared with U.S.-born Latinos over the period 1998–2013, and that longer duration of U.S. residence is associated with lower odds of smoking among men. Two findings are particularly novel: (1) accounting for immigrant arrival cohort dampens the overall protective effect of duration of residence among men; and (2) the earliest arrival cohort of Latino immigrant men experienced the steepest decline in smoking over duration of U.S. residence. Results have methodological and theoretical implications for smoking studies and the Latino mortality paradox.

Multilevel analysis of school anti-smoking education and current cigarette use among South African students.

IntroductionSouth Africa (SA) implemented the Global Youth Tobacco Survey (GYTS) four times between 1999 and 2011. Data from the four surveys indicated that downward trends in cigarette use among students may have stalled. Understanding the effect of school anti-smoking education on current smoking among students within schools and variability across schools may provide important insights into policies aimed at preventing or reducing tobacco use among students. The objective was to assess the student- and school-level effects of students' exposure to school anti-smoking education on current cigarette use among the study population using the most recent wave of GYTS data in SA (2011).MethodsAn analytic sample of students 13-15 years of age was selected (n=3,068) from the SA GYTS 2011. A taxonomy of two-level logistic regression models was fit to assess the relationship of various tobacco use, control, and exposure predictor variables on current cigarette smoking among the study population.ResultsAt the student-level in the full model, secondhand smoke (SHS) exposure, peer smoking, and ownership of a promotional item were significantly associated with higher risk of current smoking. At the school-level in the full model, average exposure to peer smoking was associated with significant increases in the prevalence of current cigarette use, while average family anti-smoking education was significantly associated with decreases in the outcome variable. School anti-smoking education was not a statistically significant predictor at the student- or school-levels.Conclusionin this study, exposure to school anti-smoking education had no association with current cigarette smoking among the study population. Consistent with previous studies, having peers that smoked was highly associated with a student being a current smoker. Interestingly, at the school-level in the multilevel analysis, schools with higher rates of average family anti-smoking education had lower prevalence of current smoking. This finding has potential implications for tobacco control in SA, particularly if the school-level, family-centered protective effect can be operationalized as a prevention tool in the country's tobacco control program.

Smoking in male patients with schizophrenia in China: A meta-analysis

BackgroundThe aim of this study was to examine the prevalence of current smoking in male patients with schizophrenia in China. MethodA systematic literature search was conducted from database inception until June 20, 2015 without language restrictions in PubMed, EMBASE, China National Knowledge Infrastructure (CNKI) and WanFang Database. Studies fulfilling the following criteria were included: (a) data available in male schizophrenia patients and (b) data available on current smoking status. Statistical analyses were performed with the Comprehensive Meta-Analysis program. ResultsA total of 23 studies met eligibility criteria for the meta-analysis. The pooled prevalence of current smoking was 59.1% (95% Confidence interval [CI]: 53.3–64.7%). Current smoking was significantly more frequent in inpatients than in outpatients (61.3% vs. 48.2%, Q=7.5, P=0.006), and higher in chronic compared to first-episode patients (74.5% vs. 45.1%, Q=32.3, P=0.0001). Furthermore, using a median split, patients aged 38.2 years or older smoked more often than those aged below 38.2 years (65.8% vs. 52.3%, Q=6.4, P=0.01). There were no significant associations between prevalence of current smoking and definitions of smoking, study publication year, sample size and illness duration. ConclusionsThe pooled prevalence of current smoking of male patients with schizophrenia in China is lower compared to Western and other Asian countries. Possible relationships between lower prevalence of current smoking and psychopathology in patients with schizophrenia require further investigation.

Are Partial Workplace Smoking Bans as Effective as Complete Smoking Bans? A National Population-Based Study of Smoke-Free Policy Among Japanese Employees.

Although complete workplace smoking bans are generally recommended rather than partial bans, the latter are widespread in many countries, especially Japan. Our objective was to compare complete workplace smoking bans and partial bans for associations with employee smoking and secondhand smoke (SHS)-related discomfort/ill-health. We also evaluated complete bans versus no ban and partial bans versus no ban. Eleven thousand ninety eligible employees (weighted number: 34 353 241) aged 20-64 years in 2011 (response rate: 62.5%) were analyzed using a nationally-representative, population-based cross-sectional study. Adjusted prevalence ratios for self-reported current smoking and SHS-related discomfort/ill-health according to workplace smoke-free policies were calculated, using conventional regression and propensity score (PS) weighting (targeting population of average treatment effect among both treated [TET] and untreated [TEU]). Both conventional regressions and PS weighting analyses showed complete bans were significantly associated with lower prevalence of current smoking and perceived SHS-related discomfort/ill-health among nonsmokers than partial or no ban. In contrast, partial bans were not significantly associated with either outcome compared with no ban. Using several PS trimming levels, we found interesting differences between TET and TEU in a comparison between partial and no ban: that is, significant associations in TET estimations, but none in TEU estimations. Although complete smoking bans were associated with lower levels of employee smoking and SHS-related discomfort/ill-health compared with no smoking ban, partial bans were not. Findings from PS weighting of TEU suggest that partial workplace bans may not be any more effective for Japanese employees than no ban. Therefore, complete bans may be strongly recommended for future implementation, but careful interpretation of the data is necessary because of the cross-sectional study design.

급성 심근경색증 환자에서 일차적 관상동맥 중재술 후 장기적 임상 경과-65세를 기준으로

본 연구는 일차적인 경피적 관상동맥 중재술(percutaneous coronary intervention, PCI)를 시술 받은 65세 이상의 고령 환자들에서 임상적 특성, 관상동맥 병변 및 중재술의 특성, 병원 내 및 1년 사망률과 주요심장사건(major adverse cardiac events, MACE)의 발생에 대해 알아보고자 하였다. 2006년 1월 1일부터 2010년 12월 30일까지 모 대학병원 심혈관센터에서 급성 심근경색증으로 진단받고 흉통 발생 12시간 이내 관상동맥 조영술 및 일차적 PCI를 시행 받은 환자 1,974예를 대상으로 하였고, 65세 이상의 I군(1,018예, 연령 <TEX>$73.8{\pm}5.99$</TEX>세, 남자 : 여자 = 574 : 821)과 65세 이하의 II군(956예, 연령 <TEX>$52.8{\pm}7.96$</TEX>세, 남자 : 여자 = 444 : 135)으로 나누어 분석하였다. 심혈관질환의 위험인자는 I군에서 더 높았고, 흡연력, 고지혈증, 가족력은 II군에서 높았다. PCI 표적 병변은 I군에서 좌주관지(2.7 vs. 1.6%, p=0.007)가 유의하게 많았으며, 다혈관병변(54.5 vs. 41.0%, p<0.001)도 I군에서 많았다. 병원 내 사망(8.4 vs. 1.9%)과 MACE(20.1 vs. 14.0%)는 I군에서 많이 관찰되었다(p<0.001). 로지스틱 다중회귀분석 결과 65세 이상 고령 환자에서 1년 사망률에 영향을 미치는 독립적인 인자는 내원 시 혈중 creatinine 1.3 mg/dL 이상, 뇌혈관 질환, 수축기 혈압<100 mmHg, Killip class II 이상, 다혈관 질환, 그리고 좌심실 구혈률 <40%로 나타났다. Primary percutaneous coronary intervention (PCI) has been found to be superior, in terms of hospital mortality and long-term outcome, compared with thrombolytic therapy in patients with acute myocardial infarction (AMI). However, the clinical benefits of primary PCI have not been precisely evaluated in elderly patients.1,974 patients (Group I: n=1,018, <TEX>$age{\geq}65years$</TEX>, <TEX>$73.8{\</TEX><TEX>pm}5.99years$</TEX>; Group II: n=956, age<65years, <TEX>$52.8{\pm}7.96years$</TEX>) who underwent primary PCI for AMI at Chonnam National University Hospital between 2006 and 2010 were analyzed according to their clinical, angiographic characteristics for hospital and one-year survival. Group I had a higher percentage of women, diabetes mellitus, hypertension, multi-vessel disease and lower prevalence of current smoking, hyperlipidemia, familial history than Group II. Culprit lesions were at the left anterior descending artery, left circumflex artery, right coronary artery and left main artery in 42.8% vs. 45.0%, 34.1% vs. 29.6%, 14.6% vs 14.6, 2.7% vs. 1.6%, respectively (p=0.007). Stent diameter was smaller in group I (<TEX>$3.17{\pm}0.39$</TEX> vs. <TEX>$3.29{\pm}0.42mm$</TEX>, p=0.001). In-hospital mortality was higher in group I (8.4 vs. 1.9%, p<0.001). There were significant differences in the rates of major adverse cardiac events between the two groups during one-year clinical follow-up (20.1 vs.14.0%, p<0.001). On multiple logistic regression analysis, systolic blood pressure<100mmHg, serum <TEX>$creatinine{\geq}1.3mg/dL$</TEX>, Killip class> I, multivessel disease, left ventricular ejection fraction <40% and cerebro vascular disease were independent predictors of one-year motality in patients over 65 years after PCI.

Australians at Risk: Management of Cardiovascular Risk Factors in the REACH Registry

Atherothrombosis is the leading cause of cardiovascular morbidity and mortality in Australia and around the world. The evidence base for appropriate management of these subjects has increased over the past decade through the conduct of randomised controlled trials. However little is known of the translation of evidence into clinical practice in terms of current management practice and risk factor control in high-risk patients in Australia. As part of the international REACH (Reduction of Atherothrombosis for Continued Health, protocol number C 8903) Registry, subjects at high risk of atherothrombosis based on the presence of multiple risk factors or overt coronary artery (CAD), cerebrovascular (CVD) or peripheral arterial disease (PAD) underwent a cardiovascular risk factor review. Demographic data and current medication management was also assessed. The subjects were recruited entirely through Australian general practice. Globally 67,888 patients were involved in the REACH registry of whom 2783 were recruited from 273 general practitioners around Australia. In comparison to the global population sample the Australian cohort was older (72 years versus 68 years) and had a lower prevalence of current smoking (7% versus 14%). Seventy-three percent of the Australian cohort had CAD and 15% had vascular disease in more than one location. Seventy-four percent of the cohort was either overweight or obese. Despite the widespread use of antihypertensive and lipid lowering therapy, half of the total group had a blood pressure recorded as >or=140/90 mmHg and 24% of the cohort had a total cholesterol level >5.2 mmol/L. The REACH registry offers the opportunity to provide a better understanding of the management of cardiovascular risk factors in patients at high-risk of atherothrombosis in Australia. Reducing the high rates of overweight and obesity and increasing the proportion of patients achieving therapeutic targets should remain priority areas in the management of this group of high-risk patients.

Alcoholic beverage preference and characteristics of drinkers and nondrinkers in western New York (United States)

Background and Aim: Dietary and lifestyle characteristics may differ for drinkers of specific alcoholic beverages and nondrinkers which would have important implications for studies of alcohol and disease. Our aim in this study was to describe differences in dietary and lifestyle characteristics associated with alcoholic beverage preference in a population-based sample of healthy study participants. Methods and Results: Data were collected as part of a series of case-control studies of alcohol use, myocardial infarction, and lung, breast and prostate cancer in western New York from 1846 men and 1910 women aged 35 to 79, randomly selected from the general population of Erie and Niagara Counties. Beverage preference was defined for noncurrent vs current drinkers, and drinkers of beer, wine, liquor, and mixed beverages. Generalized linear models for continuous variables and Cochran-Mantel-Haenszel statistics for categorical variables were computed for the entire sample and stratified by gender. Participant characteristics differed by alcoholic beverage preference and drinking status. In general, wine drinkers had higher education and household incomes, lower prevalence of current smoking, higher intakes of dietary fiber, potassium, vitamin E, and total carotenoids, lower total fat intakes and higher amounts of fruits, vegetables, and grain products than consumers of other beverages. Conversely, beer and liquor drinkers had somewhat lower education and household incomes, higher rates of current smoking, higher energy and total fat intakes and consumed lower amounts of fruits, vegetables, and grain products. Finally, current nondrinkers were more likely to be older, less educated, have lower household incomes, and consume diets less consistent with dietary guidelines than current drinkers. Conclusions: These results suggest that usual beverage preference may encompass other health-related behaviors and underline the importance of accurate exposure measurement and use of statistical methods to accommodate these interrelationships.