Previous Cigarette Smoking Research Articles

Risk factors for small for gestational age as defined by a birthweight z-score below minus one: A prospective observational study

Objective: To determine the maternal risk factors for small-for-gestational-age newborns as defined by a birthweight z-score (BWZS) < -1.0 Design: A prospective cohort study with recruitment from August 2007 to January 2015. Setting: Recruitment at a community health centre with assessments at Tygerberg Academic Hospital, Cape Town, South Africa. Population: A largely homogeneous population in a low socioeconomic residential area in Cape Town. Methods: This study is a further analysis of the data of the Safe Passage Study which investigated whether exposure to alcohol and tobacco was associated with increased risk of stillbirth and sudden infant death syndrome (SIDS). Main outcome measures: Birthweight z-score < -1.0 Results: Individual odds ratios (ORs), in descending order, were associated with smoking, drinking, and preeclampsia (2.45), previous stillbirth (1.85), smoking (including smokers only and drinkers who also smoked) (1.55), preeclampsia (1.52), smoking and drinking (does not include smokers only or drinkers only)(1.43), hypertension (1.28), drug use (1.24), drinking during pregnancy (including drinkers only and drinkers who also smoked) (1.18), thoughts of self-harm (1.13), and crowding (1.10). After multiple logistic regression, highly significant ORs were found for previous stillbirth (1.89), cigarette smoking (1.84), hypertension (1.40), education (0.94) and body mass index (BMI) (0.95). Thoughts of self-harm then had an OR of 1.08 (95% confidence interval (CI) 1.00-1.18). Conclusion: Previous stillbirth, cigarette smoking, hypertension, lesser education, and a lower BMI were associated with the highest risks for low BWZS.

Tests for confounding with cigarette smoking in the association of E-cigarette use with respiratory disorder: 2020 National-Sample Data

Associations of e-cigarette use with respiratory disorder have been demonstrated but it has been unclear whether these are confounded by current or previous cigarette smoking. We address this question through studying different time frames for e-cigarette use and respiratory disorders in 2020 BRFSS data (N = 214,945). E-cigarette use and combustible cigarette smoking were classified into four categories: Participant never used either (Nonuse); used e-cigarettes/cigarettes but not in the past 30 days (Former Use), used in past 30 days on some days (Nondaily Use), or used past 30 days on all days (Daily Use). Contrasts for e-cigarette status and cigarette status (with nonuse as reference group) were entered with covariates in logistic regression with asthma or COPD as criterion. Stratified analyses of e-cigarette use were also performed for smokers and nonsmokers. In the total sample, results showed independent positive associations with both lifetime and current asthma for Former, Nondaily, and Daily e-cigarette use (mostly p < .0001) and the three cigarette indices. Significant positive associations with COPD were found for the three e-cigarette indices (p < .0001) and all the cigarette indices. Stratified analyses showed significant associations of e-cigarette use with respiratory disorder among nonsmokers as well as among smokers. We conclude that independent associations for former e-cigarette use (controlling for current/former smoking) and significant associations of e-cigarette use with respiratory disorder among nonsmokers indicate these associations are not confounded with cigarette smoking and suggest reverse causation is implausible. Findings for former use are discussed with reference to possible mechanisms including sensitization effects.

Quitting electronic cigarettes: Factors associated with quitting and quit attempts in long-term users

Some electronic cigarette (e-cigarette) users are interested in quitting e-cigarette use, though few studies have assessed what factors contribute to this interest. This study aimed to identify factors associated with e-cigarette quitting interest and quitting behaviors in exclusive, long-term e-cigarette users. These e-cigarette users were surveyed in January 2017 (baseline) and June 2019 (follow-up), with an average follow-up period of 2.4 years. At baseline, the sample had been e-cigarette users for an average of 5.6 years. Among the 221 participants, 205 (92.8%) did not intend to quit using e-cigarettes at baseline. At follow-up, 196 (88.7%) continued exclusive e-cigarette use, 17 (7.7%) quit e-cigarettes, 8 (3.6%) became dual users, and none became exclusive smokers. At baseline, 16 users intended to quit e-cigarettes, 2 (12.5%) of whom quit at follow-up. Predictors of quitting e-cigarettes included no previous cigarette smoking (β = -3.7, OR = 0.021, p < .01), lower Penn State Electronic Cigarette Dependence Index score (β = -0.21, OR = 0.81, p = .011), and lower number of devices used per day (β = -1.9, OR = 0.15, p = .015). Intending to quit e-cigarettes at baseline was not predictive of quitting at follow-up. At follow-up, 57 (25.8%) had tried to quit in the past. Overall predictors of trying to quit included interest in quitting at baseline (β = 1.7, OR = 5.3, p < .01) and using a drip-fed atomizer (β = 1.0, OR = 2.7, p = .022). These results suggest that long-term exclusive e-cigarette users generally have little interest in stopping e-cigarette use, and that type of device used, smoking history, e-cigarette dependence, number of devices used, and intention to quit are associated with e-cigarette quitting behaviors.

Bullying Victimization is Associated with a Significantly Greater Risk of Illicit Substance Use among US Female Adolescents: YRBS 2011 to 2017

Bullying victimization among adolescents is associated with increased illicit substance use. This research estimates whether the association between bullying victimization and substance use is significantly greater among female adolescents. Using R software and the national Youth Risk Behavior Survey (2011, 2013, 2014, and 2017), interactions were estimated to determine the association between self-reported school or electronic bullying victimization and previous 30-day alcohol use, binge drinking, marijuana use, cigarette smoking, and electronic vaping product use. Bullying victimization was significantly associated with each of the substance use variables, Effects were significantly greater in female students. Efforts should be put in place in schools and communities to reduce bullying, mitigate the harmful effects of this form of victimization, and reduce illicit substance use.

Symptom control among asthmatics with a clinically significant smoking history: a cross-sectional study in Finland

BackgroundSurprisingly little is known about asthma control among asthmatics who smoke. The aim of this cross-sectional study was to investigate asthma symptom control according to the GINA guidelines among asthmatics with a clinically significant smoking history.MethodsOne hundred ninety asthmatics from primary care in Finland were investigated. The patients were current or previous cigarette smokers with a history of 10 or more pack-years. They completed a questionnaire including questions on asthma symptoms and reliever use so that their level of asthma symptom control (well controlled, partly controlled, or uncontrolled) according to GINA could be determined.ResultsSixty-six (34.7%) patients had their asthma well controlled, 81 (42.6%) had their asthma partly controlled, and 43 (22.6%) had uncontrolled asthma. Current smokers had uncontrolled asthma more often than ex-smokers, OR 2.54 (95% CI 1.25–5.14, p = 0.01). Patients with moderate to severe asthma exacerbation during the previous year had uncontrolled asthma more often than patients without an exacerbation, OR 2.17 (95% CI 1.06–4.47, p = 0.04), and patients with FEV1 < 80% of predicted had uncontrolled asthma more often than patients with FEV1 > 80% of predicted, OR 2.04 (95% CI 1.02–4.08, p = 0.04).ConclusionsAsthmatic patients with a clinically significant smoking history often do not have well controlled asthma. Poor asthma symptom control was associated with current smoking status, history of exacerbations and impaired lung function. Therefore, every attempt should be made to help asthmatics who smoke to quit smoking.

Knowledge and attitudes toward cigarette and narghile smoking among previous smokers in Lebanon.

To evaluate the proportions of current cigarette smokers (CCS) and current narghile smokers (CNS) as well as previous cigarette smokers (PCS) and previous narghile smokers (PNS) and to assess smoking knowledge and attitudes toward supporting smoking ban or cessation among previous compared with current smokers. This cross-sectional study took place between May and December 2018, and enrolled a sample of 1598 exclusive cigarette smokers (ECS) and 2091 exclusive narghile smokers (ENS), representative of all Lebanese governorates. A questionnaire designed specifically for this study was used to collect data. Among ECS, 45.2% were CCS and 54.8% were PCS. Among ENS, 83.5% were CNS and 16.5% were PNS. Higher age (adjusted odds ratio (aOR) (95% confidence interval (CI)) = 1.02 (1.01; 1.03)), higher knowledge (1.05 (1.02; 1.08)), and attitude scores (1.11(1.09; 1.13)) were significantly associated with higher odds of being PCS. Higher age (1.02 (1.01; 1.03)), being employed (1.32 (1.004; 1.72)), higher knowledge (1.04 (1.02; 1.07)), and attitude scores (1.09 (1.07; 1.12)) were significantly associated with higher odds of being PNS. Previous smokers have higher knowledge and better attitude toward supporting smoking cessation compared with current smokers. A better knowledge along with effective interventions, might lead to a positive attitude toward supporting smoking ban or smoking cessation among the general population.

Prevalence and Incidence of Human Papillomavirus (HPV) Infection Before and After Pregnancy: Pooled Analysis of the Control Arms of Efficacy Trials of HPV-16/18 AS04-Adjuvanted Vaccine

ObjectiveData on human papillomavirus (HPV) prevalence around pregnancy were inconsistent. We assessed HPV prevalence before and after pregnancy, HPV incidence after pregnancy, and risk factors for HPV infection.MethodData from 15 754 women in control arms of 5 AS04-HPV-16/18 vaccine efficacy trials were analyzed, including 3001 women with at least 1 pregnancy. Results of HPV deoxyribonucleic acid testing on cervical samples were available. We analyzed risk factors, including age, region, pregnancy and its outcomes, duration from pregnancy resolution to collection of first postresolution cervical sample, previous HPV infection, cigarette smoking, and number of sexual partners with Cox regression.ResultsPrevalence of high-risk oncogenic (hr)-HPV types was similar before and after pregnancy (20.8% vs 19.8%). Incidence of hr-HPV was 40.1 per 1000 person-years (95% confidence interval [CI], 23.4–64.2) at 0–3 months, 266.7 (95% CI, 217.4–323.7) at 3–6 months, and 95.7 (95% CI, 83.9–108.7) at >6 months after pregnancy. Risk factors associated with HPV infection after pregnancy are previous HPV infection, elective abortion, and younger age at pregnancy resolution.ConclusionsPregnancy could not be confirmed as a risk factor for HPV infection in this population despite an increased incidence detected 3–6 months after pregnancy resolution. Most women remained HPV negative after pregnancy.Clinical Trial RegistrationNCT001226810 (HPV-008 trial), NCT00294047 (HPV-015 trial), NCT00316693 and NCT00929526 (HPV-032/063 trials), and NCT00779766 (HPV-039 trial).

Incident stroke among Ghanaians with hypertension and diabetes: A multicenter, prospective cohort study

BackgroundThe burden of stroke among hypertensive and diabetic population in sub-Saharan Africa remains high. We sought to identify the risk factors associated with stroke occurrence in these high-risk population groups. MethodsA prospective cohort study involving adults with hypertension and or type II diabetes mellitus at 5 public hospitals in Ghana who were stroke-free at enrollment. Patients were followed every 2 months at clinic for 18 months and assessed clinically for first ever stroke by physicians. We calculated crude incidence rates for stroke and assessed the factors associated with stroke occurrence using a multivariate Cox Proportional Hazards regression models. ResultsOf 3220 eligible participants with 3805 person-years of follow-up, there were 54 clinically confirmed new strokes. Incidence rate of stroke was 14.19 events per 1000 person-years [95% CI: 10.77–18.38], with rates among diabetics with hypertension being 16.64 [10.58–25.00], hypertension of 13.77 [9.33–19.64] and diabetes was 9.81 [3.59–21.74]. Two factors independently associated with stroke occurrence were previous cigarette smoking with adjusted HR (95% CI) of 2.59 (1.18–5.67) and physical inactivity, 1.81 (1.06–3.10). In secondary analysis, stage II hypertension compared with optimal BP was associated with aHR of 3.04 (1.00–9.27), p = .05 for stroke occurrence. ConclusionIncident stroke among Ghanaians with hypertension and diabetes is quite high. Stricter control of blood pressure and engaging in regular physical activities are strongly recommended to reduce the risk of strokes.

Binge drinking and associated factors among school students: a cross-sectional study in Zhejiang Province, China

ObjectiveTo investigate the prevalence and correlating factors of binge drinking among middle and high school students in Zhejiang Province, China.MethodsWe performed a cross-sectional study using data from a school-based survey....

E-cigarette use as a predictor of cigarette smoking: results from a 1-year follow-up of a national sample of 12th grade students

ObjectiveTo prospectively examine vaping as a predictor of future cigarette smoking among youth with and without previous cigarette smoking experience. A secondary aim is to investigate whether vaping may desensitise...

Smoking-Related Interstitial Lung Disease in a Non-Smoker

SESSION TITLE: Fellow Case Report Poster - Diffuse Lung Disease I SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM INTRODUCTION: Pulmonary Langerhans cell histiocytosis (PLCH) is an uncommon diffuse cystic lung disease that occurs almost exclusively in young adult smokers. We present a case of PLCH in a non-smoker. CASE PRESENTATION: A 23-year-old male presented with acute onset of sharp, left-sided chest pain and shortness of breath. His past medical history was significant for two episodes of left-sided pneumothoraces, which were managed with chest tube placement. He did not have a history of current or prior cigarette smoking. He did not have a significant second-hand cigarette smoke exposure. On presentation, his vitals were stable. Physical examination revealed decreased breath sounds on the left side of the chest. Chest X-ray showed left-sided pneumothorax and bilateral diffuse interstitial infiltrates. He was treated with chest tube placement. CT of the chest revealed bilateral, multiple thick and thin walled cysts in the upper and middle lung fields with relative sparing of the bases. Video-assisted thoracoscopic lung biopsy (VATS) was obtained and mechanical pleurodesis was performed to treat his recurrent pneumothorax. Immunohistochemical staining for S-100 protein was positive in the Langerhans cells, consistent with PLCH. DISCUSSION: PLCH is a rare interstitial lung disease characterized by infiltration and proliferation of Langerhans cells. It occurs mostly in young adults, 20-40 years of age. Cigarette smoking is considered to be the inciting factor. There are no direct experimental data that support the role of cigarette smoke in the pathogenesis of PLCH. But, there are several observational studies, suggesting that the disease may be causally related to smoking. A history of current or previous cigarette smoking is identified in up to 97 percent of patients. PLCH has also been described in association with malignancy especially bronchogenic carcinoma and Hodgkin’s lymphoma. It is extremely rare in non-smokers and the etiology remains unknown. CONCLUSIONS: The overwhelming majority of adult patients with PLCH smoke cigarettes or were exposed to substantial second-hand smoke. PLCH has been described under the spectrum of smoking-related interstitial lung diseases. PLCH in non-smokers is not well studied. Reference #1: Suri H, Yi E, Nowakowski G, et al. Pulmonary langerhans cell histiocytosis. Orphanet J Rare Dis. 2012; 7: 16. doi: 10.1186/1750-1172-7-16 PMCID: PMC3342091 Reference #2: Abbott G, et al. Pulmonary Langerhans cell Histiocytosis1. Archives of the AFIP. DOI: http://dx.doi.org/10.1148/rg.243045005 DISCLOSURE: The following authors have nothing to disclose: Sathish Kumar Krishnan, Kumar Shah, Gurminder Dhillon No Product/Research Disclosure Information

OP.5C.02] MICROALBUMINURIA PREDICTS THE RECURRENCE OF CARDIOVASCULAR EVENTS IN PATIENTS WITH ESSENTIAL HYPERTENSION

Objective: Microalbuminuria is associated with an enhanced risk for cardiovascular (CV) events. The prevalence of microalbuminuria and its prognostic impact in patients with essential hypertension followed by general practitioners (GP's) remains poorly investigated. This is an observational, prospective study performed by 13 GP's in the area of Azienda Sanitaria Locale Napoli 3 Sud aimed to assess the prevalence and prognostic relevance of microalbuminuria in essential hypertension. Design and method: Patients with essential hypertension and recent determination of microalbuminuria were invited to participate to the study and followed for 3 years. As primary end point was considered the occurrence of major CV events. Results: From 1024 patients enrolled from January 2009 to March 2010, 804 completed the 3-year follow-up period. Patients were categorized in two groups according the absence (n = 523, 65%) or presence (n = 281, 35%) of microalbuminuria. The prevalence of diabetes (42% vs 12%, p < 0.001), hypercholesterolemia (30% vs 19%, p < 0.001) and metabolic syndrome (42% vs 11%, p < 0.001) was higher in patients with microalbuminuria compared with those without microalbuminuria. At last follow-up visit, no difference of blood pressure (BP) were found between the two groups. In particular, systolic and diastolic BP were 129 ± 6 mmHg and 80 ± 7 mmHg and 131 ± 9 mmHg (p = 0.491) and 81 ± 8 mmHg, (p = 0.197) in patients without and with microalbuminuria, respectively. During the follow-up, there were recorded 41 CV events (1.69 events/100 patient-years). There were detected 26 and 15 CV events in patients without and with microalbuminuria (p = 0.316). The presence of microalbuminuria was not associated with increased risk of CV events (adjusted HR = 1.32; 95% C.I. 0.290–4.340, p = 0.097). When the analysis was restricted to the patients with previous CV event, microalbuminuria (adjusted HR = 2.18; 95% C.I. 0.42–2.43, p = 0.031), with age, metabolic syndrome, diabetes and cigarette smoking resulted to be a predictor of CV events. Conclusions: Presence of microalbuminuria in patients with uncomplicated hypertension is not associated with increased risks for CV events On the contrary, in patients with previous CV events, microalbuminuria is a predictor of recurrent events. Thus, the assessment of microalbuminuria should be considered an useful tool in secondary prevention.

Risk factors of admission for acute colonic diverticulitis in a population-based cohort study: The North Trondelag Health Study, Norway.

AIMTo assess risk factors of hospital admission for acute colonic diverticulitis.METHODSThe study was conducted as part of the second wave of the population-based North Trondelag Health Study (HUNT2), performed in North Trondelag County, Norway, 1995 to 1997. The study consisted of 42570 participants (65.1% from HUNT2) who were followed up from 1998 to 2012. Of these, 22436 (52.7%) were females. The cases were defined as those 358 participants admitted with acute colonic diverticulitis during follow-up. The remaining participants were used as controls. Univariable and multivariable Cox regression analyses was used for each sex separately after multiple imputation to calculate HR.RESULTSMultivariable Cox regression analyses showed that increasing age increased the risk of admission for acute colonic diverticulitis: Comparing with ages < 50 years, females with age 50-70 years had HR = 3.42, P < 0.001 and age > 70 years, HR = 6.19, P < 0.001. In males the corresponding values were HR = 1.85, P = 0.004 and 2.56, P < 0.001. In patients with obesity (body mass index ≥ 30) the HR = 2.06, P < 0.001 in females and HR = 2.58, P < 0.001 in males. In females, present (HR = 2.11, P < 0.001) or previous (HR = 1.65, P = 0.007) cigarette smoking increased the risk of admission. In males, breathlessness (HR = 2.57, P < 0.001) and living in rural areas (HR = 1.74, P = 0.007) increased the risk. Level of education, physical activity, constipation and type of bread eaten showed no association with admission for acute colonic diverticulitis.CONCLUSIONThe risk of hospital admission for acute colonic diverticulitis increased with increasing age, in obese individuals, in ever cigarette smoking females and in males living in rural areas.

Assessment of the Tobacco Dependence Screener Among Smokeless Tobacco Users.

Variants of the Fagerström Tolerance Questionnaire and Fagerström Test for Nicotine Dependence (FTND) are widely used to study dependence among smokeless tobacco (ST) users. However, there is a need for a dependence measure which is based on the clinical definition of dependence and is easy to administer. The Tobacco Dependence Screener (TDS), a self-administered 10-item scale, is based on the Diagnostic and Statistical Manual, fourth edition (DSM-IV) and ICD-10 definitions of dependence. It is commonly used as a tobacco dependence screening tool in cigarette smoking studies but it has not been evaluated for dependence in ST users. The purpose of this study is to evaluate the TDS as a measure of tobacco dependence among ST users. Data collected from a community-based sample of exclusive ST users living in Oklahoma (n = 95) was used for this study. TDS was adapted to be used for ST dependence as the references for smoking were changed to ST use. Concurrent validity and reliability of TDS were evaluated. Salivary cotinine concentration was used as a criterion variable. Overall accuracy of the TDS was assessed by receiver's operating characteristic (ROC) curve and optimal cutoff scores for dependence diagnosis were evaluated. There was no floor or ceiling effect in TDS score (mean = 5.42, SD = 2.61). Concurrent validity of TDS as evaluated by comparing it with FTND-ST was affirmative. Study findings showed significant association between TDS and salivary cotinine concentration. The internal consistency assessed by Cronbach's alpha indicated that TDS had acceptable reliability (α = 0.765). TDS was negatively correlated with time to first chew/dip and positively correlated with frequency (number of chews per day) and years of ST use. Results of logistic regression analysis showed that at an optimal cutoff score of TDS 5+, ST users classified as dependent had significantly higher cotinine concentration and FTND-ST scores. TDS demonstrated acceptable reliability and concurrent validity among ST users. These findings are consistent with the results of previous cigarette smoking studies evaluating TDS. A self-administered tobacco dependence measure for ST users based on a clinical definition of dependence is an effective tool in research setting. ST dependence research is still evolving. This is the first study of the TDS among ST users providing preliminary evidence about some of the psychometric properties of the scale. Similar to cigarette smokers, TDS is an effective measure of ST dependence. Study showed moderate reliability and affirmative concurrent validity of the TDS among ST users.

Systematic review of cigar smoking and all cause and smoking related mortality.

BackgroundCigars are a growing public health concern, given the changes in cigar use patterns in the US and elsewhere since the 1960s. We conducted a systematic review of published studies on current cigar smoking and all-cause and cause-specific mortality risks to inform potential regulatory approaches and future research that would strengthen the body of evidence.MethodsUsing 3 different databases and handsearching, we identified epidemiological studies published prior to June 2014 that examined the association between cigar smoking and all-cause mortality and smoking-related mortality. Detailed study characteristics as well as association-level characteristics, including effect estimates and 95% confidence intervals, were abstracted or calculated from each selected study.ResultsA total of 22 studies from 16 different prospective cohorts were identified. Primary cigar smoking (current, exclusive cigar smoking with no history of previous cigarette or pipe smoking) was associated with all cause-mortality, oral cancer, esophageal cancer, pancreatic cancer, laryngeal cancer, lung cancer, coronary heart disease (CHD), and aortic aneurysm. Strong dose trends by cigars per day and inhalation level for primary cigar smoking were observed for oral, esophageal, laryngeal, and lung cancers. Among primary cigar smokers reporting no inhalation, relative mortality risk was still highly elevated for oral, esophageal, and laryngeal cancers.ConclusionsIn summary, cigar smoking carries many of the same health risks as cigarette smoking. Mortality risks from cigar smoking vary by level of exposure as measured by cigars per day and inhalation level and can be as high as or exceed those of cigarette smoking. The body of evidence would be strengthened by future studies that focus on the health effects of primary cigar smoking and incorporate more contemporary and diverse study populations to better reflect the current patterns of cigar use in the US. Ideally, these studies would also collect detailed information on cigar type, exposure level, and biomarkers of exposure and potential harm.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1617-5) contains supplementary material, which is available to authorized users.

Previous History and Cigarette Smoking as Interfering Factors for the Effect of Vaccine on Human Papillomavirus Infection

Previous History and Cigarette Smoking as Interfering Factors for the Effect of Vaccine on Human Papillomavirus Infection

Risk Behaviors Related to Cigarette Smoking Among Persons With Spinal Cord Injury

Smoking, while detrimental to health in any population, has greater health implications for those with spinal cord injury (SCI) because of additional risks posed by SCI. The aims of this study were to document smoking status after SCI and to assess relationships between smoking status with injury severity and alcohol/pain medication use. Participants (n = 1,076) were identified from a large rehabilitation hospital in the southeastern part of the United States. Eligibility criteria included (a) traumatic SCI resulting in residual impairment, (b) adult, and (c) 1+ years postinjury. Previous and current cigarette smoking and quitting attempts were assessed. Relationships were assessed between smoking status (current, former, and never), alcohol use, and pain medication use. Of participants (72% male, M age = 49.6 years, M = 16.1 years since SCI), 49.2% had never smoked, 28.2% were former smokers, and 22.6% were current smokers. Of current smokers, 39.2% attempted quitting in the past year and 77.2% had ever tried to quit. Only 29.9% of those who ever tried to quit sought professional help. Ambulatory persons, regardless of injury level, were 2.32 times more likely to be current smokers than nonambulatory persons with a high-level cervical injury. Lower socioeconomic status, binge drinking, and misuse of pain medication all predicted current smoking. Smoking prevalence among persons with SCI is largely consistent with the general population. Additionally, we found smoking to be associated with other risk behaviors (binge drinking and prescription medication misuse) and differs by injury severity. Future studies should assess smoking interventions, which may differ by injury severity.

Waterpipe Smoking and Dependence are Associated with Chronic Obstructive Pulmonary Disease: A Case-Control Study

Introduction: Waterpipe smoking gained popularity during recent years. Although waterpipe smoking exposes people to the same noxious substances found in cigarettes, popular belief considers it harmless. Our objective was to evaluate the association between waterpipe smoking and dependence, and COPD. Methods: We conducted a case-control study in two tertiary care hospitals. Cases were included if diagnosed as COPD by a pulmonologist and confirmed by post-bronchodilator FEV1/FVC&lt;0.7; controls were included if free of any respiratory disease or symptom. After oral consent, a standardized questionnaire was administered and spirometry results were collected. Results: 211 COPD cases and 527 controls were studied. In previous smokers, any smoking type was associated with COPD. The ORs were 29.0[14.3-58.8] (p&lt;0.001) for previous cigarette smoking, 11.7[4.4-31.2] (p&lt;0.001) for previous waterpipe smoking, and 44.1[16.3-4.4] (p&lt;0.001) for previous mixed smoking. In current smokers, the ORs were 20.5[10.2-41.2] (p&lt;0.001) for cigarette smoking, 1.8[0.5-5.9] (p=0.299) for waterpipe smoking, and 9.4[3.81-23.0] (p&lt;0.001) for mixed smoking. Nevertheless, we found in waterpipe current smokers, an OR=8.9[3.9-20.7] (p&lt;0.001) for the association between dependence evaluated by LWDS-11 scale, and COPD. These results were confirmed by stratified and multivariate analysis, after adjustment for cigarette smoking and confounding variables. A cumulative smoking of one waterpipe per week for 20years (or its equivalent) was predictive of higher risk of COPD. Discussion: Whereas evidence showing harmful effects of waterpipe smoking is sparse, this study showed a high OR between the risk of developing COPD and being an ex-smoker of waterpipe, or a current waterpipe dependent individual. Additional studies are necessary to confirm our results.

Primary Hyperparathyroidism With Concurrent Primary Aldosteronism

Primary aldosteronism (PA) is a common cause of secondary hypertension, because it involves 11.2% of referred hypertensive patients.1 Primary hyperparathyroidism (PPTH) is much less common, with a prevalence that, albeit imprecisely known, is probably <0.01% in unselected hypertensives. However, arterial hypertension develops in the majority (56% to 80%) of the PPTH patients,2 which can explain why they are held to be at increased risk for cardiovascular complications and death.3 The association of PPTH with arterial hypertension and increased cardiovascular risk would appear to be paradoxical, inasmuch as the parathyroid hormone (PTH) has been described to induce vasodilation through endothelium-independent mechanisms.4 Therefore, it would be expected to lower rather than to raise blood pressure.5 The mechanisms by which excess PTH increases blood pressure remained obscure until Mazzocchi et al6 reported that PTH stimulates in vitro the secretion of aldosterone from human adrenocortical cells in a concentration-dependent manner. These findings suggested that PTH acts as an aldosterone secretagogue that might be involved in causing human PA. However, whether this mechanism, although appealing, could be involved in causing human PA and might explain the development of arterial hypertension in patients with PPTH remained unsupported by any clinical data. We herein report on a patient who presented with resistant arterial hypertension and was found to have PA. Unilateral adrenalectomy resulted in cure of the PA and control of blood pressure despite a tapering of antihypertensive treatment, but the patient developed hyperparathyroidism caused by a PTH-secreting adenoma that was surgically removed. Gene expression and immunohistochemistry studies unveiled the expression of type 1 PTH receptor in the aldosterone-producing adrenocortical nodules and of the mineralocorticoid receptor (MR) in the nuclei of parathyroid adenoma cells. This latter finding was confirmed in a series of normal human parathyroid glands. Thus, this unique case …

A modified new method for estimating smoking-attributable mortality in high-income countries

Abstract Preston, Glei, and Wilmoth (2010) recently proposed an innovative regression-based method for estimating smoking-attributable mortality in developed countries based on observed lung cancer death rates. Their estimates for females, however, differ appreciably from some published estimates. This article presents a modified version of the Preston, Glei, and Wilmoth method that includes an age-period interaction term in its model. This modified version produces improved estimates of smoking-attributable mortality that are consistent with results from a modified version of the Peto-Lopez indirect method. (ProQuest: ... denotes formulae omitted.) 1. Introduction and review of existing methods for estimating smoking-attributable mortality Attention has recently been directed to methods that estimate smoking-attributable mortality because of their usefulness in examining the role of smoking in mortality differences among developed countries. Several studies have shown a divergence in mortality trends at older ages among developed countries in recent decades, particularly for females. Mesle and Vallin (2006) observed that life expectancy at age 65 for females increased only slightly from 1984 to 2000 in the U.S. and the Netherlands, even as female e65 increased steadily in France and Japan during this period. Janssen, Kunst, and Mackenbach (2007) found similar differences in mortality declines at ages 80 and over in seven European countries, with declines steadily continuing in France, but stagnating in countries such as Denmark and the Netherlands. They concluded that these differences among countries were largely due to differences in smoking-related mortality. The effect of previous cigarette smoking on these mortality trends deserves particular attention. Decades of medical and epidemiological research have demonstrated that cigarette smoking is the leading cause of preventable mortality in the U.S. and most other developed countries (DHHS 2000; Ezzati et al. 2002). More specifically, Staetsky (2009) recently showed that smoking is a principal cause of observed mortality differences among selected developed countries. Staetsky also used the indirect Peto-Lopez method to estimate mortality in these countries in the absence of smoking-attributable deaths. Various methods have been proposed and used to measure smoking-attributable mortality in populations. Perez-Rios and Montes (2008) provided a useful systematic review of these methods. They found that two general types of methods were most commonly used in the research literature. Both types of methods generally calculate the fraction of deaths in a population that are attributable to smoking (smoking-attributable fraction or SAF). The first group of methods, which Perez-Rios and Montes called analysis, calculate SAF from data for current and former smoker prevalence, usually obtained from surveys, and relative risks for smoking, usually obtained from prospective cohort studies, such as the American Cancer Society's Cancer Prevention Study II (CPS II). Perez-Rios and Montes cited the method used by the U.S. Centers for Disease Control and Prevention (CDC) to estimate smoking-attributable mortality as an example of a prevalence-based analysis. The CDC method (2008) estimates adult smoking-attributable mortality using current and former smoker prevalence data from the National Health Interview Survey (NHIS), with relative risks for 19 causes obtained from the CPS-II. It estimates infant smoking-attributable mortality using maternal smoking prevalence from birth certificate data and relative risks for four causes for infants of mothers who smoke obtained from a meta-analysis of epidemiologic studies. Separate methods are used by the CDC to estimate smoking-attributable mortality due to secondhand smoke and burns. Perez-Rios and Montes identified the indirect method presented by Peto et al. (1992, 1994) as the other commonly used method for estimating smoking-attributable mortality. …