Low Tobacco Consumption Research Articles

Analysis of mortality trends due to cardiovascular diseases in Panama, 2001–2014

ObjectiveCardiovascular diseases (CVDs) are still the leading cause of death worldwide despite the recent decline in mortality rates attributable to CVD in Western Europe and the Americas. The aim of...

PRS5 - Tax Losses and Gains Attributed to Smoking Cessation in Korea

Conventional economic analyses of smoking cessation may exclude important economic gains. From the governments’ perspective, smoking represents a source of tax revenue and a public health cost. Apart from smoking-attributable mortality and morbidity, there is an established relationship between smoking and reduced productivity. In this research we assess how public investments in smoking cessation that changes productive output can influence future government tax revenue and social transfer costs. The analysis described here follows the generational accounting framework developed to assess intergenerational relationships between morbidity and mortality and lifetime tax revenue and social transfers for government. Based on the current prevalence of smoking in Korea, a cohort model was developed for smoker, former-smokers and non-smokers. The model simulated the lifetime discounted fiscal transfers for each of the aforementioned segments in Korean Won (KRW) based on 2012 costs. In addition to the health costs, smoking results in foregone earnings and tax due to premature mortality and decreased productive output of smokers. The average per person health cost savings from smoking cessation were estimated at KRW974,000. Smoking cessation resulted in average lifetime tax revenue gain of KRW 4,214,120 and KRW 1,442,050 per person for the age groups of 24-45 and 45-65, respectively. The corresponding average tax revenue loss due to lower tobacco consumption were KRW2,085,023 and KRW 883,014. The average fiscal return on investment from smoking cessation for all age groups was estimated at 1.27. Investing in smoking cessation was estimated to have positive fiscal returns for the government due to reduced mortality, morbidity, increased productivity and wages. Although ROI declined by age, reduced smoking prevalence generated significant per person tax revenue gains for government across all ages. After factoring in expected tobacco tax revenue loss from quitting smoking, the net tax revenue for the Korean government was positive.

Incidence of Lung Adenocarcinoma Biomarker in a Caribbean and African Caribbean Population

IntroductionLung cancer is the leading cause of cancer deaths in the United States and worldwide. Biomarker testing is critical to personalized therapy in lung adenocarcinoma and has been extensively investigated in whites and Asians. However, little information addresses the underlying genetic changes among Caribbean and African Caribbean patients. In this study, we identified targetable biomarkers in Caribbean patients with lung adenocarcinoma. MethodsDNA extracted from lung adenocarcinoma specimens collected from 157 patients in whom primary lung adenocarcinoma was diagnosed from 2013 to 2015 in the University Hospital of Martinique was tested for mutation of the epidermal growth factor receptor gene (EGFR), Kirsten rat sarcoma viral oncogene homolog gene (KRAS), B-Raf proto-oncogene, serine/threonine kinase gene (BRAF), phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha gene (PIK3CA), ROS proto-oncogene 1, receptor tyrosine kinase gene (ROS), and MMNG HOS Transforming gene (MET). Clinical characteristics of our patients have been retrospectively gathered and correlated with mutational status. ResultsMutations in EGFR were identified in 57 cases (36%). Women accounted for 68% of patients with mutations versus 38% of those without mutations (p < 0.001). Eighteen percent of patients with mutations were smokers versus 62% of patients without mutations (p < 0.001). Sex, smoking habit, and age were significantly associated with differences in mutational status in univariate analysis, and the difference remained statistically significant in multivariate analysis (p = 0.0411, p = 0.001, and p = 0.0483, respectively). After the analysis was restricted to patients born in the French West Indies, the mutation rates reached 41%. ConclusionPatients in Martinique, and specifically those of African descent, show very high levels of EGFR mutation as opposed to what can be found in mainland France or in African Americans. These findings may be ascribed to low tobacco consumption as well as to genetic factors. Systematic screening in patients of African Caribbean origin should be prescribed.

Exposición a tabaco, alcohol y drogas de abuso en gestantes. Estudio de prevalencia en gestantes de Málaga (España)

The prevalence of substance abuse in women who become pregnant is similar to that of the general population, resulting in a high fetal exposure rate during the most vulnerable period regarding neurodevelopment and organogenesis. The present study was intended to assess the level of prenatal exposure to tobacco, alcohol or illicit drugs in the city of Málaga (Spain). It was designed as a cross-sectional study, and based on the anonymous self-reports of participants. A total of 451 pregnant women were recruited in the first, second or third trimester. The prevalence in each of the quarters respectively was 21.2%, 18.5% and 13.3% for smoking, 40.7%, 23.1% and 17.1% for alcohol and 4.8%, 1.9% and 1.2% for cannabis. We also found that a higher educational level was associated with a lower consumption of tobacco (RR 0.659 [0.537-0.810] p&lt;0.0001) and greater exposure to alcohol (RR 1.87 [1.30-2.69] p&lt;0.0007). These results, particularly in regard to alcohol intake, are sufficiently alarming to alert obstetric care providers about the need to implement preventive measures.

Prognostic value of p16 expression irrespective of human papillomavirus status in patients with oropharyngeal carcinoma.

In a previous study, we reported the value of p16 expression and alcohol consumption in oropharyngeal carcinoma in Japan. We now report the clinical significance of human papillomavirus status and p16 expression in oropharyngeal carcinoma in Japan. Over a 9-year period, a retrospective case comparison study of the pathology database was conducted at the University of Tokyo to identify tumor samples of oropharyngeal carcinoma. We performed immunohistochemistry for the p16 protein, in situ hybridization for human papillomavirus-deoxyribonucleic acid and polymerase chain reaction for the human papillomavirus-deoxyribonucleic acid oncogene E6 in oropharyngeal carcinoma in Japanese patients. We evaluated the human papillomavirus status in patients with oropharyngeal carcinoma to determine its prevalence and association with prognosis. We defined human papillomavirus(+) and human papillomavirus(-) oropharyngeal carcinoma cohorts as those with and without polymerase chain reaction for the human papillomavirus-deoxyribonucleic acid oncogene E6 or in situ hybridization-human papillomavirus. In oropharyngeal carcinoma, the prevalences of p16(+)human papillomavirus(+), p16(+)human papillomavirus(-), p16(-)human papillomavirus(+) and p16(-)human papillomavirus(-) were 32% (48/150), 7% (10/150), 2% (3/150) and 59% (89/150), respectively. Low tobacco and alcohol consumption, tonsil or base of tongue localization, but not age, were associated with p16(+)human papillomavirus(+). Low alcohol consumption was associated with p16(+)human papillomavirus(-). There was a significant difference in overall survival between p16(+)human papillomavirus(-) and p16(-)human papillomavirus(-) (P = 0.03). In multivariate Cox regression models, p16 was the independent prognostic factor, regardless of human papillomavirus status. p16 expression was a reliable prognostic biomarker regardless of human papillomavirus status.

Carotenoid intake and head and neck cancer: a pooled analysis in the International Head and Neck Cancer Epidemiology Consortium.

Food and nutrition play an important role in head and neck cancer (HNC) etiology; however, the role of carotenoids remains largely undefined. We explored the relation of HNC risk with the intake of carotenoids within the International Head and Neck Cancer Epidemiology Consortium. We pooled individual-level data from 10 case-control studies conducted in Europe, North America, and Japan. The analysis included 18,207 subjects (4414 with oral and pharyngeal cancer, 1545 with laryngeal cancer, and 12,248 controls), categorized by quintiles of carotenoid intake from natural sources. Comparing the highest with the lowest quintile, the risk reduction associated with total carotenoid intake was 39% (95% CI 29-47%) for oral/pharyngeal cancer and 39% (95% CI 24-50%) for laryngeal cancer. Intakes of β-carotene equivalents, β-cryptoxanthin, lycopene, and lutein plus zeaxanthin were associated with at least 18% reduction in the rate of oral and pharyngeal cancer (95% CI 6-29%) and 17% reduction in the rate of laryngeal cancer (95% CI 0-32%). The overall protective effect of carotenoids on HNC was stronger for subjects reporting greater alcohol consumption (p<0.05). The odds ratio for the combined effect of low carotenoid intake and high alcohol or tobacco consumption versus high carotenoid intake and low alcohol or tobacco consumption ranged from 7 (95% CI 5-9) to 33 (95% CI 23-49). A diet rich in carotenoids may protect against HNC. Persons with both low carotenoid intake and high tobacco or alcohol are at substantially higher risk of HNC.

Information and communication technologies for approaching smokers: a descriptive study in primary healthcare.

BackgroundCommon interventions for smoking cessation are based on medical advice and pharmacological aid. Information and communication technologies may be helpful as interventions by themselves or as complementary tools to quit smoking. The objective of the study was to determine the use of information and communication technologies (ICTs) in the smoking population attended in primary care, and describe the major factors associated with its use.MethodsDescriptive observational study in 84 health centres in Cataluña, Aragon and Salamanca. We included by simple random sampling 1725 primary healthcare smokers (any amount of tobacco) aged 18–85. Through personal interview professionals collected Socio-demographic data and variables related with tobacco consumption and ICTs use were collected through face to face interviews Factors associated with the use of ICTs were analyzed by logistic regression.ResultsUsers of at least one ICT were predominantly male, young (18–45 years), from most favoured social classes and of higher education. Compared with non-ICTs users, users declared lower consumption of tobacco, younger onset age, and lower nicotine dependence. The percentages of use of email, text messages and web pages were 65.3%, 74.0% and 71.5%, respectively. Factors associated with the use of ICTs were age, social class, educational level and nicotine dependence level. The factor most closely associated with the use of all three ICTs was age; mainly individuals aged 18–24.ConclusionsThe use of ICTs to quit smoking is promising, with the technology of mobile phones having a broader potential. Younger and more educated subjects are good targets for ICTs interventions on smoking cessation.

Association of Fitness With Life Satisfaction, Health Risk Behaviors, and Adherence to the Mediterranean Diet in Spanish Adolescents

The aim of this study was to examine the association between aerobic, musculoskeletal, and motor capacity and life satisfaction, risk behavior, and adherence to the Mediterranean diet in adolescents. A total of 1,988 Spanish adolescents (12-16 years old) participated in this cross-sectional study. Life satisfaction, risk behavior, and adherence to the Mediterranean diet were measured by validated questionnaires for these ages. Aerobic, musculoskeletal muscle, and motor capacity were evaluated objectively with the ALPHA battery tests. Adolescents with low aerobic capacity had a higher risk of showing less (vs. very happy) life satisfaction (odds ratio [OR] = 1.303, 95% confidence interval [CI] = 1,054-1,611). These adolescents were also more likely to report risk behaviors such as sometimes (vs. never) of smoking tobacco (OR = 1.752, 95% CI = 1,218-2,520), besides having a low adherence to the Mediterranean diet (vs. high) (OR = 1.410, 95% CI = 1,113-1,786). Adolescents with low upper-body musculoskeletal capacity showed a lower risk of reporting risk behaviors such as alcohol consumption or getting drunk occasionally (vs. never) (OR = 0.662, 95% CI = 520-843; OR = 0.561, 95% CI = 419-753, respectively). The results suggest that the aerobic capacity contributes significantly to greater adherence to the Mediterranean diet, greater life satisfaction, and lower tobacco consumption, whereas musculoskeletal capacity seems to be related to alcohol consumption.

An improved method of early diagnosis of smoking-induced respiratory changes using machine learning algorithms

The purpose of this study was to develop an automatic classifier to increase the accuracy of the forced oscillation technique (FOT) for diagnosing early respiratory abnormalities in smoking patients. The data consisted of FOT parameters obtained from 56 volunteers, 28 healthy and 28 smokers with low tobacco consumption. Many supervised learning techniques were investigated, including logistic linear classifiers, k nearest neighbor (KNN), neural networks and support vector machines (SVM). To evaluate performance, the ROC curve of the most accurate parameter was established as baseline. To determine the best input features and classifier parameters, we used genetic algorithms and a 10-fold cross-validation using the average area under the ROC curve (AUC). In the first experiment, the original FOT parameters were used as input. We observed a significant improvement in accuracy (KNN=0.89 and SVM=0.87) compared with the baseline (0.77). The second experiment performed a feature selection on the original FOT parameters. This selection did not cause any significant improvement in accuracy, but it was useful in identifying more adequate FOT parameters. In the third experiment, we performed a feature selection on the cross products of the FOT parameters. This selection resulted in a further increase in AUC (KNN=SVM=0.91), which allows for high diagnostic accuracy. In conclusion, machine learning classifiers can help identify early smoking-induced respiratory alterations. The use of FOT cross products and the search for the best features and classifier parameters can markedly improve the performance of machine learning classifiers.

Clinical phenotypes of Italian and Spanish patients with α1-antitrypsin deficiency

With the aim of providing better clinical characterisation of patients with α1-antitrypsin deficiency (AATD), we analysed the data of adult patients with severe AATD enrolled in the Spanish and Italian national registries. We assessed 745 subjects, 416 of whom were enrolled in the Spanish registry and 329 in the Italian registry. 57.2% were male and 64.9% were smokers or former smokers with a mean±sd age of 49.9±13.8 years. Most (81.2%) were index cases, mainly having the PI*ZZ genotype (73.4%), and the mean±sd diagnostic delay was 9.0±12.1 years. Patients with chronic bronchitis were younger, had better preserved lung function and lower tobacco consumption. Overlap patients (chronic obstructive pulmonary disease with asthma) were mainly females, more frequently never-smokers and received respiratory medications more often. 48% of emphysema, 27.5% of chronic bronchitis and 44.8% of overlap subjects were receiving augmentation therapy. Compared with PI*ZZ patients (n=547), the PI*SZ (n=124) subjects were older at diagnosis and had more preserved lung function, despite a higher mean smoking consumption. Early diagnosis of AATD is still an unmet need. Augmentation therapy is administered to similar proportions of patients with different clinical phenotypes. PI*ZZ patients in both registries had more severe respiratory disease than those with PI*SZ, despite lower smoking levels.

Alaska Native smokers and smokeless tobacco users with slower CYP2A6 activity have lower tobacco consumption, lower tobacco-specific nitrosamine exposure and lower tobacco-specific nitrosamine bioactivation

Nicotine, the psychoactive ingredient in tobacco, is metabolically inactivated by CYP2A6 to cotinine. CYP2A6 also activates procarcinogenic tobacco-specific nitrosamines (TSNA). Genetic variation in CYP2A6 is known to alter smoking quantity and lung cancer risk in heavy smokers. Our objective was to investigate how CYP2A6 activity influences tobacco consumption and procarcinogen levels in light smokers and smokeless tobacco users. Cigarette smokers (n = 141), commercial smokeless tobacco users (n = 73) and iqmik users (n = 20) were recruited in a cross-sectional study of Alaska Native people. The participants' CYP2A6 activity was measured by both endophenotype and genotype, and their tobacco and procarcinogen exposure biomarker levels were also measured. Smokers, smokeless tobacco users and iqmik users with lower CYP2A6 activity had lower urinary total nicotine equivalents (TNE) and (methylnitrosamino)-1-(3)pyridyl-1-butanol (NNAL) levels (a biomarker of TSNA exposure). Levels of N-nitrosonornicotine (NNN), a TSNA metabolically bioactivated by CYP2A6, were higher in smokers with lower CYP2A6 activities. Light smokers and smokeless tobacco users with lower CYP2A6 activity reduce their tobacco consumption in ways (e.g. inhaling less deeply) that are not reflected by self-report indicators. Tobacco users with lower CYP2A6 activity are exposed to lower procarcinogen levels (lower NNAL levels) and have lower procarcinogen bioactivation (as indicated by the higher urinary NNN levels suggesting reduced clearance), which is consistent with a lower risk of developing smoking-related cancers. This study demonstrates the importance of CYP2A6 in the regulation of tobacco consumption behaviors, procarcinogen exposure and metabolism in both light smokers and smokeless tobacco users.

Perfil del anciano institucionalizado en residencias privadas de la ciudad de Soria

IntroductionWe have aimed to describe the profile of the institutionalized elderly population in private residential homes in the city of Soria (Spain), assessing the factors that promote healthy aging and help to maintain an optimal health status. Material and methodsA total of 156 institutionalized elderly subjects were studied. Sociodemographic variables and healthy lifestyle habits were determined by using an ad-hoc questionnaire prepared by our research group. Their degree of dependence was assessed by the Barthel Index. ResultsThe population studied was predominantly female (64.7%) and with a high average age (85.3±5.3). The predominant civil status of the population studied was “widowe” (53.2%). Most of them had a low educational level and good perception of their health status (50.6%). Of the total population, 78.8 had been institutionalized for more than a year. Females reported lower tobacco consumption, while men showed a greater capacity for social interaction, went out of the institution more frequently (P=.024) and performed more exercise (P=.020). ConclusionsThe predominant profile obtained is that of a widowed woman over 80 years, without any toxic habits and with more functional disability the men, despite having been institutionalized for a shorter time. Women are less active and stay longer in the institution. Promoting physical activity and social relations favors the maintenance of functional performance in the institutionalized elderly. The physical therapist is the healthcare professional responsible for conducting specific exercise programs based on the psycho-physical characteristics of these elderly people.

Abstract P142: Smokers Can Lose Weight When They Quit Smoking

Background: Smoking is one of the major risk factors of CVD. It is well-known that smokers increase weight when they quit smoking, and concomitant weight increase after smoking cessation may blunt beneficial effects of smoking cessation on e.g. glucose metabolism. However, not all smokers gain weight. To our knowledge, predictors of weight-loss after smoking cessation have not previously been investigated. Methods: in a large population-based study, the Inter99 study, 2,408 daily smokers were included at baseline. Out of these, 262 attended the five year follow-up and reported that they had not smoked for at least 12 months. Participants completed self-report questionnaires at baseline and follow-up. In multivariable logistic regression analyses we investigated predictors of weight-loss. Results: A total of 17.6% of the quitters had lost weight from baseline to 5 years follow-up. Neither sex, age, number of daily meals, energy intake, dietary quality, physical activity, alcohol consumption, nor change in physical activity or alcohol consumption from baseline to five year follow-up was associated with weight-loss at five year follow-up. Quitters with high education had significantly higher probability of weight-loss compared to quitters with low education (OR=3.88(1.04–14.50), p=0.044). Increasing BMI at baseline increased (OR=1.20(1.06–1.36), p=0.004) and increasing tobacco consumption decreased (OR=0.93(0.87–0.99), p=0.038) the probability of weight-loss. Furthermore, quitters who reported a healthier diet at five-year follow-up than at baseline had increased probability of weight-loss (OR=3.23(1.07–9.82), p=0.038). The mean weight-gain in quitters with normal baseline BMI was 5.66kg (±4.8), quitters who were overweight at baseline gained 5.32kg (±7.0) and quitters who were obese gained 1.98kg (±8.3), p=0.038. Conclusion: Weight-loss after quitting smoking is feasible and was achieved by about two out of ten quitters. High BMI, high education and low tobacco consumption at baseline and change to a healthier diet predicted weight loss in daily smokers who had quit for at least 12 months. Discussion: Obese smokers who had quit had the lowest weight-gain. A reason could be that normal-weight smokers are used to eat whatever they want, whereas obese smokers are used to focus on what and how much they eat. Obese smokers should definitely not be advised against quitting smoking in fear of further weight-gain. The large positive cardiovascular health effects of quitting overshadow the negative health effects of a small weight gain, and this study shows that weight-loss after smoking cessation is feasible, especially in obese smokers.

Misperceptions of "light" cigarettes abound: National survey data

BackgroundMany smokers believe that "light" cigarettes are less harmful than regular cigarettes, which is at variance with the scientific evidence. The Framework Convention on Tobacco Control (FCTC) aims to address this problem in Article 11 which deals with misleading labelling of tobacco products. In this study we aimed to determine smokers' use and beliefs concerning "light" and "mild" cigarettes ("lights"), including in relation to ethnicity, deprivation and other socio-demographic characteristics.MethodsThe New Zealand (NZ) arm of the International Tobacco Control Policy Evaluation Survey (ITC Project) uses as its sampling frame the NZ Health Survey. This is a national sample with boosted sampling of Maori, Pacific peoples and Asians. From this sample we surveyed adult smokers (n = 1376) about use and beliefs relating to "light" cigarettes. We assessed the associations with smoking "lights" after adjusting for socio-demographic variables, and smoking-related behaviours and beliefs.ResultsMany smokers of "lights" believed that smoking "lights" made it easier to quit smoking (25%), that "lights" are less harmful (42%), and that smokers of "lights" take in less tar (43%). Overall most "lights" smokers (60%) had at least one of these three beliefs, a proportion significantly higher than for smokers of "regular" cigarettes at 45% (adjusted odds ratio (aOR) = 1.96, 95% CI = 1.29 – 2.96). While "lights" smokers had significantly lower tobacco consumption and were more aware of smoking harms, they were no more likely to be intending to quit or have made a previous quit attempt.By ethnicity, both Maori and Pacific people were less likely to smoke "lights" than Europeans (aOR = 0.53, 95% CI = 0.35 – 0.80 and aOR = 0.14, 95% CI = 0.05 – 0.40 respectively). In contrast there was no significant difference by level of deprivation. Roll-your-own (RYO) tobacco smokers were less likely to smoke "light" forms of RYO tobacco while both older and women smokers were more likely to smoke "lights".ConclusionMost "lights" smokers have one or more misperceptions about the product they use, and were no more likely to intend to quit or to have made a quit attempt. In response to such misperceptions, governments could act further to eliminate all misleading tobacco marketing. Ideally, they could not only adopt FCTC requirements, but go further by requiring plain packaging for all tobacco products.

Dietary and Lifestyle Practices of Hmong in California

As Hmong adapt to life in Fresno, California, their dietary and lifestyle patterns are examined. Data on tobacco and alcohol use, dietary practices, and socio-demographic variables were collected from a convenience sample, stratified by age and sex. The 248 participants were interviewed. Descriptive analyses reveal that more than 63% of Hmong adults were either overweight or obese. Only 57% could speak English fluently, and 71% were economically impoverished. Hmong do not consume tobacco and alcoholic products excessively. Rice, chicken, beef, and eggs were the most frequently identified food items. Fruits and vegetables were also identified. Low alcohol and tobacco consumption may offer Hmong some protection against certain diseases. However, low socioeconomic status and rapid urbanization may have resulted in a shift from a high-energy expenditure lifestyle and high fiber diets to a sedentary lifestyle with high saturated fat food diets, which may be detrimental to the health of many Hmong.

High risk strategy in smoking cessation is feasible on a population-based level. The Inter99 study

Introduction A high risk strategy is one of more strategies in public health. Smoking remains the most important contributor to the burden of disease in developed countries. Methods A population-based multi-factorial intervention study, Inter99 (1999–2006), Copenhagen, Denmark, using a high risk strategy. All 2408 daily smokers were repeatedly offered individual face-to-face lifestyle counselling. Smokers in the high-intensity group were offered participation in smoking cessation groups. We measured point abstinence at 1, 3 and 5-year follow-up and compared with a control group, using adjusted intention-to treat analyses. Results Compared with the control group it was twice as likely to be self-reported abstinent at 5-year follow-up in the high-intensity intervention group (OR: 2.19; 95%CI: 1.7–2.8; p < 0.001). The effect of the intervention was significant, even when comparing validated abstinence in the intervention groups with self-reported abstinence in the control group (OR: 1.38; 95%CI: 1.1–1.8; p = 0.014). Male gender, vocational training, higher age at onset of smoking, high knowledge of harm of smoking and lower tobacco consumption predicted abstinence. Conclusion A high risk strategy showed a significant effect on smoking in the long term. Proactive recruitment, face-to-face setting, repeated offer of assistance to quit and a multi-factorial approach may explain the success of the intervention.

Cigarette Smoking and Alveolar Bone in Young Adults: A Study Using Digitized Radiographs

Evidence indicates that cigarette smoking is one of the most significant risk factors for periodontal diseases; however, there have been few radiographic prospective studies of alveolar bone in young populations. The purpose of this study was to evaluate the effect of smoking on alveolar bone in young adults. Eighty-one dental students (mean age: 20.5 years), considered not to have periodontitis according to clinical criteria, participated in this study. Forty-two subjects were smokers (mean consumption was 14.1 cigarettes/day for > or =2 years), and 39 subjects had never smoked. A parallel-arm prospective design was used. All subjects took part in a dental hygiene program (DHP) that included oral hygiene instructions, mechanical debridement, and polishing. The following clinical variables were measured before and after the DHP: plaque index (PI), gingival crevicular fluid (GCF) flow rate, gingival index (GI), probing depth, and clinical attachment level (CAL). Standardized posterior vertical bitewing radiographs were taken and digitized preexperimentally and on days 180, 365, and 545. The following analyses were performed: bone height measurement (BHM), computer-assisted densitometric image analysis (CADIA), and qualitative analysis of digital subtraction radiography (DSR). Repeated-measures multiple-way analysis of variance (ANOVA) was performed between the groups, and one-way ANOVA was performed within the groups. The mean PI and GI were significantly greater in the smokers (P <0.01). The mean GCF flow rate was significantly lower in the smokers (P <0.01). CAL and the number of sites with recession were significantly greater in the smokers (P <0.001). The BHM indicated a significantly lower mean alveolar bone height in the smokers (P <0.01). The smokers showed significantly lower CADIA values, which indicated a lower bone density on days 0 (P <0.05), 180, 365, and 545 (P <0.01). CADIA values decreased during the study in the smokers, with significant differences on day 545 (P <0.05). The smokers had a significantly higher mean percentage of sites that had decreased density, as assessed by DSR (P <0.001). In the smokers, the mean percentage of sites with decreased density, as assessed by DSR, had increased significantly by days 365 (P <0.05) and 545 (P <0.01). Smoking produces an adverse effect on clinical periodontal variables and alveolar bone height and density, acting as a potential risk factor for alveolar bone loss, even at an early age with low tobacco consumption. It is very important to inform young smokers about the risk of this habit in relation to periodontal health.

Tobacco smoking and the risk of upper aero‐digestive tract cancers: A reanalysis of case–control studies using spline models

Although tobacco smoking has long been recognized as a major risk factor for cancer of the upper aero-digestive tract (UADT, i.e., oral cavity, pharynx, larynx, and oesophagus), very few studies have provided estimates of the effect of very low tobacco consumption. Step-functions have been the common statistical methods for risk estimates, but the choice of reference category and of interval cutpoints influence the results, especially when data are sparse. In the present analysis, the dose-response relationship between UADT cancers and tobacco smoking was evaluated through logistic regression spline models. We included 1,241 UADT male cases and 2,835 male controls pooled from a large series of case-control studies conducted in northern Italy and in the Swiss Canton of Vaud during the last 2 decades. For cancers of the pharynx, larynx and oesophagus, the risk steadily increased with number of cigarettes/day. The risk of oral, pharyngeal and oesophageal cancers was significantly higher in smokers than in nonsmokers beginning with as low as 2 cigarettes/day. The effect of tobacco smoking at low levels seemed less evident for laryngeal cancer since the raise in risk begun with 6 cigarettes/day. In conclusion, for all the examined UADT sites, a monotonic dose-response relationship between cancer risk and cigarette smoking emerged. The excess of risk among people smoking 2 cigarettes/day highlights the absence of any harmless level for cigarette smoking, and it further supports the need of public health programs against tobacco smoking.

Do Tobacco-Control Programs Lower Tobacco Consumption?

California is often considered the model for tobacco-control programs due to its early adoption of comprehensive programs aimed at lowering tobacco consumption. Tobacco control began when voters approved the California Tobacco Tax and Health Promotion Act of 1988. More than $2 billion has been spent on tobacco-control in California since 1988. The findings of this article indicate that tobacco-control spending is a significant factor for the widening gap between consumption in the United States and in California only in equations that exclude cigarette prices and smoking bans as control variables. When significant, however, estimates suggest that, for every $1 increase in tobacco-control spending per capita, the sales gap widens by only 0.11 to 0.18 cigarette packs per capita, or roughly 2 to 4 cigarettes per capita. This study suggests that future research should address the complexity of interactions among tobacco-control programs, cigarette prices, and smoking bans.

The Influence of Parity and Smoking in the Social Environment on Tobacco Consumption among Daily Smoking Women in Denmark

The aim of this paper isto determine factors associated with higher tobacco consumption in a large cohort of daily smoking Danish women 27–39 years of age with a main focus on the smoking habits of people in the women’s social environment and parity. A cohort of 12,023 Danish women was examined in a cross-sectional study design with a mailed questionnaire. Among the 3,672 daily smokers, 2,365 (64.4%) smoked more than 15 cigarettes per day. Smokers in the childhood home, living alone or cohabiting with a smoking partner, friends smoking, and colleagues smoking were associated with higher tobacco consumption, while short duration of smoking was associated with lower tobacco consumption. Anti-smoking programs should focus on the social network of the women. Furthermore, there is a need to target mothers who smoke, especially less educated mothers.