Negative Health Effects Of Smoking Research Articles

306 Effects of Resident Education on Smoking Cessation Counseling in the Emergency Department

Tobacco use disorder is a common concomitant condition among emergency department (ED) patients (between 21-41%). The negative health effects of smoking are well known. Patients who visit EDs can be influenced by emergency physicians who take several minutes to inform them of the risks. The objective of this study was to evaluate the effects of educating emergency medicine residents on the public health impact, counseling techniques, and proper documentation of tobacco use disorder and smoking cessation counseling (SCC).

Health Effects of Smoking and the Benefits of Quitting

An overview of the negative health effects of smoking and the benefits to be gained from quitting. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

Immediate consequences of cigarette smoking: rapid formation of polycyclic aromatic hydrocarbon diol epoxides.

Polycyclic aromatic hydrocarbons (PAH) are among the likely major causative agents for lung cancer in smokers. PAH require metabolic activation to exert their carcinogenic effects, and one important pathway proceeds through a three-step sequence resulting in the formation of diol epoxides, which react with DNA to produce adducts that can cause mutations and initiate the carcinogenic process. However, no previous published studies have examined this critical pathway in humans specifically exposed to PAH by inhalation of cigarette smoke. This study used a unique approach employing a stable isotope derivative of phenanthrene, the simplest PAH with a bay region, a feature closely associated with PAH carcinogenicity. Twelve subjects each smoked a cigarette to which [D(10)]phenanthrene had been added. Plasma was analyzed for [D(10)]r-1,t-2,3,c-4-tetrahydroxy-1,2,3,4-tetrahydrophenanthrene ([D(10)]PheT), the major end product of the diol epoxide metabolism pathway of phenanthrene. The analysis was performed by gas chromatography--negative ion chemical ionization--tandem mass spectrometry, using [(13)C(6)]PheT as internal standard. The results demonstrated that the three-step pathway resulting in the formation of diol epoxides, as monitored by [D(10)]PheT, occurred with remarkable rapidity. Levels of [D(10)]PheT in plasma of all subjects were maximal at the earliest time points examined, 15-30 min after smoking the cigarette containing [D(10)]phenanthrene, and decreased thereafter. These results demonstrate that the formation of a PAH diol epoxide occurs rapidly in smokers. Because PAH diol epoxides are mutagenic and carcinogenic, the results clearly demonstrate immediate negative health consequences of smoking, which should serve as a major warning to anyone contemplating initiating tobacco use.

Abstract CN07-02: Polycyclic aromatic hydrocarbon tetraols: Potential phenotypic indicators of lung cancer susceptibility in smokers

Abstract Polycyclic aromatic hydrocarbons (PAH) are believed to be among the major causative agents for lung cancer in smokers. PAH require metabolic activation to exert their carcinogenic effects, and one important pathway proceeds through a three-step metabolic sequence resulting in the formation of diol epoxides which react with DNA producing adducts that can cause mutations and initiate the carcinogenic process. Many studies demonstrate wide interindividual differences in PAH metabolism. Our working hypothesis is that individuals who metabolically activate PAH by the diol epoxide pathway more extensively will be at higher risk for lung cancer than those who are less proficient. We have used a phenotyping approach to investigate this hypothesis. In this approach, we use gas chromatographytandem mass spectrometry to quantify PAH tetraols, the major end products of the diol epoxide metabolic activation pathway, in plasma or urine. In one recent nested case-control study of 475 lung cancer cases and 475 controls, all smokers, in the Shanghai Cohort Study of over 18,000 men, we demonstrated a significant relationship to lung cancer of urinary levels of r,1-t-2,3,c-4-tetrahydroxy-1,2,3,4-tetrahydrophenanthrene (PheT), the major end product of the diol epoxide pathway of phenanthrene, the simplest PAH with a bay region, a feature closely associated with carcinogenicity. With advances in mass spectrometry, we are now able to directly assess levels of tetraols resulting from diol epoxide formation from the prototypic carcinogenic PAH, benzo[a]pyrene. These studies demonstrated higher levels of this tetraol in the urine of smokers than non-smokers. Our approach to individual phenotyping of smokers uses a stable isotope labeled PAH, [D10]phenanthrene. Smokers either use cigarettes to which [D10]phenanthrene has been added, or take the substance orally. Plasma and urine are analyzed for the tetraol, [D10]PheT, the major end product of the diol epoxide metabolism pathway of phenanthrene. The results of these ongoing studies show a large interindividual variation in [D10]PheT production and demonstrate that this approach is feasible for identifying those individuals who extensively metabolize phenanthrene. These studies also showed for the first time that the three-step pathway resulting in formation of diol epoxides, as monitored by [D10]PheT, occurred with remarkable rapidity in all subjects. Levels of [D10]PheT in plasma of all subjects were maximal 15-30 min after smoking a cigarette containing [D10]phenanthrene, and decreased thereafter. These results demonstrate that the formation of a PAH diol epoxide occurs rapidly in smokers. Since PAH diol epoxides are mutagenic and carcinogenic, the results clearly demonstrate immediate negative health consequences of smoking which should serve as a major warning to anyone contemplating initiating tobacco use. Citation Information: Cancer Prev Res 2010;3(12 Suppl):CN07-02.

Understanding how Graphic Pictorial Warnings Work on Cigarette Packaging

The 2009 Family Smoking Prevention and Tobacco Control Act requires cigarette packages to contain stronger warnings in the form of color, graphic pictures depicting the negative health consequences of smoking. The authors present results from a between-subjects experiment with more than 500 smokers that test (1) the effectiveness of pictorial warnings that vary in their graphic depiction of the warning and (2) an underlying mechanism proposed to drive potential effects of the manipulation of the graphic depiction. The findings indicate that more graphic pictorial warning depictions strengthen smokers’ intentions to quit smoking. Recall of warning message statements is reduced by moderately or highly graphic pictures compared with a no-picture control or less graphic pictures. The results also show that the graphic warnings affect evoked fear, and in turn, fear mediates the effects of the graphic warning depiction on intentions to quit for the sample of smokers. This pattern of results indicates that though highly graphic pictures may reduce specific message recall and limit the direct effect of recall on intentions to quit, highly graphic pictures increase intentions to quit smoking through evoked fear (i.e., fear fully mediates the effect of the graphic depiction level). The authors discuss implications for consumer health and policy decisions.

The Contribution of Antismoking Advertising to Quitting: Intra- and Interpersonal Processes

This study explored the roles of transportability—the tendency to become absorbed in a narrative—and interpersonal discussion in the use of televised antismoking advertising in attempts to quit smoking. We used data from a representative population survey of adults (n = 2,999), examining responses from current smokers (n = 594) and former smokers who had quit in the last 5 years (n = 167). Logistic regression analysis revealed that current and former smokers higher in transportability were more likely to recall an antismoking ad (OR = 1.08, p < .001), and to perceive they had been helped by antismoking advertising in their attempts to quit smoking (OR = 1.05, p < .01). Transportability also was related to the recall of narrative antismoking advertisements (OR = 1.06, p < .05). Among current smokers, those who engaged in interpersonal discussion about any antismoking advertising were more likely to have made a quit attempt (OR = 2.76, p < .001). Finally, individuals were most likely to discuss advertising containing information about the negative health consequences of smoking using graphic images or simulations of bodily processes. These results suggest that the effectiveness of antismoking advertising is dependent upon both intra- and interpersonal processes that are triggered by the advertisements.

The barriers to smoking cessation in Swiss methadone and buprenorphine-maintained patients

BackgroundSmoking rates in methadone-maintained patients are almost three times higher than in the general population and remain elevated and stable. Due to the various negative health effects of smoking, nicotine dependence contributes to the high mortality in this patient group. The purpose of the current study was to investigate Swiss methadone and buprenorphine-maintained patients' willingness to stop smoking and to clarify further smoking cessation procedures.MethodsSubstance abuse history, nicotine dependence, and readiness to stop smoking were assessed in a sample of 103 opiate-dependent patients in the metropolitan area of Zurich, Switzerland. Patients were asked to document their smoking patterns and readiness to quit.ResultsOnly a small number of patients were willing to quit smoking cigarettes (10.7%) and, even though bupropione or nicotine replacement therapy was included in the fixed daily treatment care, only one patient received nicotine replacement therapy for smoking cessation. A diagnosis of depression in patients' clinical records was associated with readiness to stop smoking. No significant associations were found between readiness to quit smoking and age, methadone treatment characteristics, and presence of co-dependencies.ConclusionThe current prescription level of best medicine for nicotine dependence in Swiss methadone and buprenorphine-maintained patients is far from adequate. Possible explanations and treatment-relevant implications are discussed.

Dire warnings redux

Health Canada is considering new, even more graphic images on tobacco products to reinforce the negative health effects of smoking — a move that is being both lauded and criticized. ![Figure][1]</img> Figure. These new images are designed to shock smokers. Photo by: Health Canada Cynthia

Prevention of coronary heart disease: smoking

Smoking is the leading preventable cause of illness and premature death in Germany, claiming over 110,000 lives a year because it directly increases the risk of dying from heart disease, stroke, emphysema and a variety of cancers. The overwhelming majority of smokers begin tobacco use before they reach adulthood. Among those young people who smoke, the average age is now 13-14. In Germany, about 39% of male and 31% of female adults (age 18-60 years) continue to smoke, despite information about the unequivocally negative health consequences of smoking. The exact mechanisms of smoking-related vascular disease are not yet known. Smoking causes acute hemodynamic alterations such as increase in heart rate, systematic and coronary vascular resistance, myocardial contractility, and myocardial oxygen demand. These short-term effects could lower the ischemic threshold in smokers with coronary artery disease and contribute to the increased risk for acute cardiovascular events. Endothelial damage is thought to be an initiating event in atherosclerosis and early studies have demonstrated that long-term smoking has direct toxic effects with structural changes of human endothelial cells. Recent research has shown the importance of the functional role of the endothelium in regulating vascular tone, platelet-endothelial interactions, leukocyte adhesion and smooth muscle cell proliferation via synthesis and release of a variety of substances such as nitric oxide. There is strong evidence that smoking leads to endothelial dysfunction mainly by increased inactivation of nitric oxide by oxygen-derived free radicals. Smoking also increases oxidative modification of LDL and is associated with lower HDL plasma levels. Smoking induces a systemic inflammatory response with increased leukocyte count and elevation of the C-reactive protein level. Importantly, the prothrombotic effects of smoking have been repeatedly demonstrated to cause alterations in platelet function, imbalance of antithrombotic vs prothrombotic factors, and decrease of fibrinolytic activity. Given the enormous health hazard of tobacco use, complete abstinence from smoking should be achieved. Smoking cessation counselling should be given to healthy subjects and even more vigorously to patients with manifested disease. Every effort should be undertaken to prevent children and adolescents from starting to smoke. Brief tobacco dependence treatment is effective, and every smoker should be offered at least brief treatment at every office visit. More intensive treatment is more effective in producing long-term abstinence from tobacco. Nicotine replacement therapy (nicotine patches or gum), clinician-delivered social support, and skills training are the three most effective components of smoking cessation treatment. A framework for tobacco control measures is necessary to reduce tobacco consumption and exposure to tobacco smoke. Recommendations on specific tobacco control interventions are: 1. increase in tobacco taxes; 2. comprehensive tobacco advertising bans; 3. legislation prohibiting smoking in work and public places; 4. prohibiting the sales of tobacco products to persons under 18; 5. comprehensive disclosure of the physical, chemical and design characteristics of all tobacco products; 6. training of health professionals to promote smoking prevention and cessation interventions; and 7. development of a national network of smoking cessation treatment services.

Effects of Smoking on Productivity: Estimating Aggregate Production Technology Using Cross-Sectional Time Series Data

The negative health effects of smoking are substantial and well documented. There are, however, few studies that focus on another aspect of the costs of smoking, namely its impact on productive activities, specifically in terms of productivity loss as a result of smoking. Previous economic studies of smoking tend to focus on the effectiveness of various smoking control measures, and the externalities of smoking in the form of higher health care costs that smokers impose on the wider community. The present study make use of aggregate time-series and cross-sectional data to carefully examine the relationship between smoking and productivity as measured by a properly specified and estimated aggregate production function. The questions we examine are whether smoking affects productivity, and if so, by how much. The empirical analysis makes use of data of 14 OECD countries over a period of 23 years, from 1970 to 1992. The results indicate that smoking appears to be a statistically significant factor in explaining productivity, in both level and growth. There is, however, no firm evidence that smoking has an adverse effect on productivity, although results from the output growth model appear to indicate that the effects are mostly negative, especially for countries with high per capita tobacco use.

Pharmacotherapy and Pharmacogenetics of Nicotine Dependence

The authors review recent advances in the pharmacotherapy and pharmacogenetics of nicotine dependence. Despite the negative health consequences of smoking, approximately 23% of adults in the United States are daily tobacco smokers and approximately 13% are nicotine dependent. Data for development of new medications for nicotine dependence are likely to come from animal models of the reinforcing value of nicotine, studies to identify proteins in transgenic rodents, and pharmacological studies of nicotine withdrawal. The initial pharmacogenetic studies of pharmacotherapies approved by the United States Food and Drug Administration for treatment of nicotine dependence-nicotine replacement (nicotine gum, nicotine nasal spray, and transdermal nicotine) and bupropion-have identified candidate alleles at the dopamine D2 receptor gene and mu opioid receptor gene that may predict therapeutic response. Because no one medication is likely to be safe and efficacious for a majority of persons with nicotine dependence, it will be useful to develop genetics-based methods and other tools to predict therapeutic response in subgroups of nicotine-dependent persons.

Motivation to quit using cigarettes: A review

This review asks why persons decide to quit using cigarettes. We summarize three literatures from five decades, including over 30 data sets grouped by different methodologies: (a) retrospective reports of ex-smokers ( n = 15), (b) cross-sectional surveys of current smokers ( n = 14), and (c) prospective studies of smokers in cessation studies ( n = 6). Taken together, the data strongly suggest that health concern is the primary motive for quit attempts. These data fit with theoretical reasoning that persons wish to control danger and negative affect. The data also suggest that health professionals should continue emphasizing the negative health consequences of smoking to motivate cessation attempts.

Tobacco Cessation in Primary Care: Beyond Just Quitting

The article, “Tobacco Cessation in Primary Care: Maximizing Intervention Strategies”1 does a fine job of summarizing the recommended, yet often not implemented, practices for provider-based smoking cessation. There is no doubt that smoking cessation will begin to improve the health of the individual smoker by decreasing the risk of tobacco-related disease within a short period of time.2,3 The importance of reduced exposure to secondhand smoke and the benefits of reduced tobacco consumption should also be discussed with the patient. One way for healthcare providers to reduce tobacco-related disease is to educate patients about the dangers of secondhand smoke. By providing the smoker with information on secondhand smoke, there is a heightened awareness that his/her decision to smoke also have a negative effect on those in the surrounding area. Secondhand smoke results in increased morbidity and mortality among nonsmokers. The California Environmental Protection Agency and the Surgeon General, among others, concluded that secondhand smoke causes eye and nasal irritation, lung cancer, nasal sinus cancer, heart disease mortality and acute chronic coronary heart disease morbidity; children, in particular, may experience low birth weight, sudden infant death syndrome, acute lower respiratory tract infections, asthma induction and exacerbation, chronic respiratory symptoms and middle ear infections.4,5 In addition to adhering to the cessation recommendations set forth by the Public Health Service6 and asking about the individual patient's smoking status, providers should also ask about the environment in which the patient resides. In conducting the “Five A's,” providers should inquire about the patient's smoking status and exposure to tobacco smoke on a regular basis. If the patient is a nonsmoker living with regular tobacco smoke exposure, the provider should advise the patient to ask the smoker to smoke outdoors. Pediatricians should also be asking parents if they smoke and if so, advise them to quit or smoke away from the children. This offers a positive model for children and increases the likelihood that the children will refrain from smoking in the future.7 One effective step toward cessation is for smokers to move outside to smoke.7 In addition to being a burden to step outside, it changes the act of smoking from a reflex to a conscious decision and reinforces the notion that smoking is not socially acceptable. All of these factors can help a smoker decide to stop smoking and reduce consumption as the smoker may forego smoking some cigarettes. A second way for providers to help smoking patients is to encourage them to reduce their cigarette consumption. Reduced tobacco consumption is a predictor of a successful quit attempt7 and decreases the risk of tobacco-related disease because tobacco-related disease is dose dependent.4,5 A decline in cigarette consumption in California alone between 1989 and 1997 was associated with 59,000 fewer coronary heart deaths.8 This finding is based on a decline in tobacco consumption among smokers and not merely a reduction in the total number of smokers in California. If a patient is a smoker but is not prepared to quit, the provider should advise him/her to reduce the number of cigarettes smoked and explain that this will aid in future quit attempts,7 as the transition from light smoker to nonsmoker is easier than from smoker to nonsmoker. Healthcare providers should keep in mind that complete cessation is not the only way in which to improve the health of smokers. A reduction in tobacco consumption can also provide benefits to the new light smoker and to those around him/her. Effective smoking cessation treatment by a provider should address the negative health effects of smoking and of secondhand smoke and offer ways in which to decrease or eliminate those effects. At a minimum, educating patients on the dangers of secondhand smoke will get them thinking about the need to quit, how their smoking affects the health of the people around them, and may help to reduce tobacco consumption, if not make a quit attempt.

Smoking cessation strategies for the 21st century.

Cigarette smoking is the leading preventable cause of illness and premature death in the United States, claiming over 400 000 lives a year because it directly increases the risk of dying from heart disease, stroke, emphysema, and a variety of cancers.1 Approximately 25% of adults in the United States continue to smoke, despite information about the unequivocally negative health consequences of smoking.2 Part of the reason for continued cigarette smoking is the addictive nature of nicotine, a substance found in all types of tobacco products. In the 1988 Surgeon General’s Report on the Health Consequences of Smoking ,3 nicotine was declared an addictive drug similar to heroin or cocaine. It is important to emphasize that nicotine itself is probably not responsible for most of the negative health consequences of smoking. Instead, persons who stop using nicotine-containing tobacco products experience an unpleasant withdrawal syndrome that may include such …

School policy in COMMIT: a promising strategy to reduce smoking by youth.

Organizational smoking policy has been identified as a potentially effective way to influence health behavior, particularly in worksites. Examining the elements of existing school smoking policies for both students and employees can provide insight into the potential effectiveness of these policies in changing young people's smoking behavior. This paper examines selected components of existing school smoking policies in a national sample of schools at all levels of education as part of the Community Intervention Trial for Smoking Cessation. Schools were questioned about their school smoking policies, related resources, and compliance. The data show much variation in the elements of school tobacco use policy to change smoking behavior. Existing policies in schools differ among grade levels, thus providing different messages about the appropriateness of smoking. Policies differ for students and adults, providing another opportunity for confusion about the messages that policy can deliver. In general, resources available to support existing policies are lacking. Many schools offer classes on knowledge of negative health effects of smoking but do not teach the psychosocial skills necessary to resist tobacco use. In its present forms, school policy has great potential for an effective tool for health promotion, but considerable reform is needed to overcome current barriers.

Four pathways to young-adult smoking status: Adolescent social-psychological antecedents in a midwestern community sample.

Evaluated the ability of social-psychological factors, measured in adolescence, to predict young-adult smoking outcomes. Results showed substantial continuity in the antecedents of adolescent and young-adult smoking but important discontinuities as well. Beliefs in the negative social consequences of smoking and beliefs about academic success and independence were important to adolescent but not to adult smoking. Conversely, beliefs in the negative health consequences of smoking were more important to adult smoking than to adolescent smoking. Results also showed an appreciable amount of smoking onset after the high school years, as well as an appreciable amount of adolescent smoking that did not persist into young adulthood. Antecedents of late-onset smoking and of nonpersistent smoking are described.

Smoking Prevention: Behavioral Prescriptions for the Pediatrician

Pediatricians are important instigators of behavior change for the promotion of nonsmoking. Smoking is harmful to infants, children, and adolescents, and evidence is reviewed that passive smoking can have potent deleterious effects. Interventions with young adolescents based on social-psychologic theory have shown promise in changing smoking behavior and reducing smoking onset rates. Interventions are described, based on epidemiologic and etiologic data, that are appropriate for infants, children, adolescents, and parents. Interventions for parents should encourage cessation and the creation of a smoke-free environment for children. Interventions for children should emphasize the negative health effects of smoking and help them build an armamentarium against factors that promote experimentation with smoking. Interventions for adolescents should encourage them to remain nonsmokers in an environment of social pressure to smoke. The rationale for these strategies and methods of implementation in the pediatrician's office are described.

Should dentists advise smokers to stop?

This study surveyed 391 dentists to determine their current practices with patients who smoke. About two-thirds of respondents (71%) said they advise smokers to stop. Although most respondents advised patients of negative health effects of smoking, few provided suggestions to patients, referred them to smoking cessation programs, provided self-help materials, or scheduled follow-up sessions. Recent evidence suggests that even brief counseling interventions can help some patients stop smoking.