Reduce Tobacco Smoking Research Articles

Supporting smoking cessation in healthcare: obstacles in scientific understanding and tobacco addiction management

Despite ongoing efforts to reduce tobacco smoking, the smoking prevalence in many countries has remained stable for years. This may be a consequence of either lack of knowledge about effective ways to reduce smoking, or failing treatment of tobacco addiction in healthcare. This study explored gaps in the current understanding of smoking cessation and the challenges facing tobacco addiction management in order to formulate recommendations for future research and healthcare practice. A narrative review was written to determine areas in which more research is needed as well as areas in which sufficient knowledge is already available. Recommendations for future research were prioritised using a Delphi-procedure. Recommendations for healthcare practice were confirmed by expert’s assessment. Smoking is not widely acknowledged as an addiction and a relatively small number of smokers ask help from a healthcare professional when trying to stop smoking. Most healthcare professionals recognise the importance of advising patients to stop smoking, but experience certain barriers to actually do this. Overall, healthcare professionals need to be convinced that tobacco smoking is an addiction and should be treated likewise. If all healthcare professionals systematically advise their patients to give up smoking, eventually more smokers will successfully stop smoking.

La consultation d’aide au sevrage tabagique de l’institut de cancérologie Salah-Azeiz de Tunis : résultats à un an

Background To reduce tobacco smoking is, in Tunisia, a public health priority. The tobacco cessation consultation is one of the interventions to fight against the tobacco epidemic; it is a new activity developed in the Salah-Azeiz Tunis cancer centre. The objective of this work is to evaluate the impact of the consultation on the smokers after one year of activities and to analyse the prognostic factors of tobacco cessation in order to improve the efficacy of such an activity in the future, in Tunisia. Methods The cessation methods were based on cognitive and behavioral therapies associated with nicotine patch, delivered free of charge. During one year (July 2003 to June 2004), 340 smokers were attended. Data on their smoking status and psychological characteristics were collected using a standardized questionnaire. Results The patients were mostly men (79%), these smokers did not present important anxiodepressive troubles, 68% thought that they were able to quit easily. The majority (57%) smoked more than 20 cigarettes a day and was nicotinodependant (Fagenström > 7). Half of this population had already intended to stop, they declared to smoke mostly because of stress. The global cessation rate after a median follow-up of 32 weeks is 27%. The cessation rate lasting six months for 83 patients followed regularly was 23%. The good prognostic factors of cessation, after multivariate analysis, were (when taking out from the model the regular follow-up), to be confidant on the possibility to stop (OR = 0.87 [0.78–0.97]). On the contrary, a high score (>7) for Fagerström test (OR = 1.9 [1.1–3.4), the use of smoking to fight against stress (OR = 1.08 [1.0–1.2) and a smoking environment at home (OR = 4.5 [1.1–18.9]) were prognostic of a failure in quitting smoking. Conclusion These results show that the cessation rate, which is still too low as compared with the literature, could be increased by a better follow-up of smokers associated with an information campaign on the existing possibilities to quit smoking in Tunisia.

The changing pattern of kidney cancer incidence and mortality in Europe

To update trends in kidney cancer mortality in 32 European countries and the European Union (EU) as a whole, as mortality from kidney cancer has increased throughout Europe until the late 1980s or early 1990s, and has tended to stabilise or decline thereafter. Data from the World Health Organization mortality database over the period 1980-2004 were used to compute age-specific and age-standardized (world standard) rates per 100,000 persons at all ages, and truncated to 35-64 years. In men in the EU, mortality rates from kidney cancer peaked at 4.8 per 100,000 in 1990-1994, and declined to 4.1 (-13%) in 2000-2004. In women in the EU, the corresponding values were 2.1 in 1990-1994 and 1.8 (-17%) in 2000-2004. The main decreases were in Scandinavian countries, and other western European countries. In most eastern European countries kidney mortality rates tended to stabilise, even if values remained high, especially in the Czech Republic and Baltic countries. For kidney cancer incidence, there were decreases in rates for both sexes in Sweden throughout the 25-year calendar period considered. In the last 10 years considered, incidence rates decreased or tended to stabilise also in other northern European countries in both sexes, except in the UK. The present work confirms and further quantifies the recent favourable trends in kidney cancer mortality and (to a lesser degree) in incidence across most European countries. Thus, improvements in diagnosis and treatments cannot largely explain the declines in mortality. Apart from a favourable role of reduced tobacco smoking in men, the interpretation of these trends remains undefined.

Effects of comprehensive smoke-free legislation in Europe

This paper reviews data regarding the effects of the legislation banning smoking in enclosed public places, including workplaces, restaurants and bars which entered into force in several countries of Europe starting with the year 2004. The source of data is represented by articles and short information published in peer reviewed journals or in electronic format between the years 2005 and 2008. Highlights include a consideration of the effects of these laws on the attitudes of the population regarding their implementation, exposure to passive smoking in public places as well as the scientific evidence on the public health and economic impact of these laws. The results of smoking ban in public places observed in several parts of Europe support initiatives in many countries toward implementing smoke-free legislation, particularly those who have ratified the Framework Convention on Tobacco Control, which calls for legislation to reduce tobacco smoke pollution.

Tobacco Smoking within Psychiatric Inpatient Settings: Biopsychosocial Perspective

Tobacco smoking remains a neglected issue within general psychiatry despite high rates of associated morbidity and mortality. While there has been a coordinated community campaign to reduce tobacco smoking within the general population, mental health facilities have been reluctant to adopt such regulatory controls, and rarely target smoking prevention or treatment. This paper summarizes and discusses evidence relating to the clinical impact of tobacco smoking within inpatient psychiatric settings. A selective review of psychiatric and psychological research on smoking within inpatient settings was conducted, with a particular focus on the influence of smoking on the physical and mental health, pharmacotherapy, and social interactions of patients during their inpatient stay. Patients frequently alter their smoking habits during inpatient treatment, which can affect both their presentation and pharmacotherapeutic management. Smoking also appears to play a central role in social interactions on the ward, with staff frequently using cigarettes to reinforce certain behaviours. Despite current guidelines, mental health professionals rarely address nicotine use among their patients. Nevertheless, programmes that assist patients to quit during an inpatient stay have been shown to be both efficacious and cost-effective. Strategies that address staff concerns and assist in the implementation of effective smoking bans on psychiatric units are also available. Cessation should be a key component of inpatient treatment planning because this setting provides a safe and timely opportunity to help patients quit. A flowchart of interventions that could be incorporated within standard inpatient settings is proposed.

Parental smoking behaviour and effects of tobacco smoke on children's health in Finland and Russia

There is little information on potential differences in smoking behaviour of parents between Finland and Russia and on the effects of environmental tobacco smoke (ETS) exposure on allergic and respiratory diseases among Finnish and Russian children. The aim of the study was to compare the smoking behaviour of parents and school children and to assess the relations of tobacco smoke exposure during pregnancy and childhood with occurrence of allergic diseases and respiratory infections among school children. We conducted a population-based cross-sectional study in the neighbour towns across the border of Imatra in Finland and Svetogorsk in Russia. The study population consisted of 512 Finnish and 581 Russian school children aged 7-16 years (response rate 79%). Children's tobacco smoke exposure differed markedly between Finland and Russia. The risk of asthma was particularly related to high maternal smoking exposure during pregnancy (adjusted OR 3.51, 95% CI 1.00-12.3), infancy (3.34, 1.23-9.07) and currently (3.27, 1.26-8.48), and the risk of common cold was related to high combined parental smoking during infancy (1.83, 1.06-3.17) in Finnish children. Among Russian children allergic conjunctivitis was related to maternal smoking during infancy (4.53, 1.49-13.8) and currently (2.82, 1.07-7.44). Smoking behaviour of parents and ETS exposure during childhood differed markedly between Finland and Russia. Asthma was particularly increased in relation to high exposure to maternal smoking in Finland. The results suggest that more efforts should be directed to reducing tobacco smoke exposure of children in both Finland and Russia. (250 words).

An international review of tobacco smoking among medical students

We conducted a systematic international review of tobacco smoking habits among medical students. Particular attention was paid to countries where smoking rates have been historically well-documented in local journals, but were less often included in larger international review articles. The methodology involved a search of relevant medical subject headings, after which the reference lists of journal papers were also examined to find additional publications. A total of 66 manuscripts met the inclusion criteria. The most common countries previously studied included India, the United States, Australia, Japan, Pakistan, Turkey and the United Kingdom. Overall, our review suggests that the prevalence of smoking among medical students varies widely amongst different countries and also between male and female students within the same areas. Consistently low smoking rates were found in Australia and the United States, while generally high rates were reported in Spain and Turkey. Given their important future role as exemplars, more effective measures to help reduce tobacco smoking among medical students are clearly needed worldwide.

Plant extract reduces tobacco smoke harmful effects on alveolar macrophage immune responses

Tobacco smoke is a major factor responsible for lung cancer and chronic obstructive pulmonary disease. Although the best solution to reduce the incidence of these diseases is to quit smoking, there are still a large number of smokers. Thus, given the immunoregulatory properties of plant extracts, their capacity to reduce tobacco smoke harmful effects on alveolar macrophage (AM) functions was investigated. AM were treated with tobacco smoke extract and parenchymata tissue extract (PTE), or mesophyll cell extract (MCE) of Spinacia oleacea. The effects of tobacco smoke extract from PTE and MCE-treated cigarette filters were also investigated. AM production of tumor necrosis factor (TNF), interleukin-10 (IL-10) and macrophage chemoattractant protein-1 (MCP-1), and AM cytotoxicity were measured. Tobacco smoke extract significantly inhibited TNF, IL-10, and MCP-1 release, and AM cytotoxicity. The addition of PTE and MCE to tobacco smoke extract abrogated the inhibition of AM mediator release. However, only MCE restored AM cytotoxicity. Interestingly, tobacco smoke extract of PTE and MCE-treated cigarette filters showed reduced effects on AM functions. Tobacco smoke extract from MCE-treated (0.25%) cigarette filters did not inhibit TNF, IL-10, and MCP-1 release in contrast to tobacco smoke extract from buffer-treated cigarette filters. AM cytotoxic activity was not inhibited by the treatment with tobacco smoke extract from MCE-treated cigarette filters. Our data suggest that the presence of plant extract in cigarette filters reduces the inhibitory effects of cigarette smoke on AM functions. Thus, MCE-treated cigarette filters may help reducing lung diseases associated with smoking.

Reductions in tobacco smoke pollution and increases in support for smoke-free public places following the implementation of comprehensive smoke-free workplace legislation in the Republic of Ireland: findings from the ITC Ireland/UK Survey

Objective: To evaluate the psychosocial and behavioural impact of the first ever national level comprehensive workplace smoke-free law, implemented in Ireland in March 2004. Design: Quasi-experimental prospective cohort survey: parallel...

Predictors of Increased Body Mass Index Following Cessation of Smoking

The objective of this study was to explore nicotine withdrawal symptoms as predictors of increased body mass index (BMI) after an attempt to quit or reduce tobacco smoking. The authors used a survey study, with a probability sample of 4,075 18-64-year-old residents. The participation rate was 70.2%, which included 1,545 current daily smokers. Follow-ups were carried out for current smokers after thirty and 36 months. The authors found that smokers who experienced increased appetite or weight gain (IAW) as a nicotine withdrawal symptom had a higher BMI than smokers without IAW. They concluded that IAW after quitting might be a specific determinant of the BMI increase following smoking cessation in a subgroup of smokers.

Cancer Prevention: A Global Perspective

This review will be restricted to measures aimed at primary prevention of cancer; reduction of the death rate through screening will not be covered. In many instances, cancer prevention is just one outcome of the benefits of good health practices, which may also benefit cardiovascular, lung, infectious, and metabolic diseases. Thus, reducing tobacco smoking will bring benefits in heart disease, neonatal and maternal health, stroke, and peripheral vascular disease as well as a variety of cancers, while dietary advice appropriate to cancer risk reduction will bring benefits in diabetes, stroke, kidney, and heart disease.

Pharmacotherapy for schizophrenia and co-occurring substance use disorders.

Research on the optimal pharmacotherapy for people with schizophrenia and co-occurring substance use disorders remains in its infancy. This report reviews existing data and provides an update on recent research. The confluence of findings is consistent with a model of a reward dysfunction inherent in the neuropathology of schizophrenia, leading to a heightened vulnerability of people with schizophrenia to substance use disorders. Studies indicate that patients with dual disorders have difficulty tolerating conventional antipsychotics, have higher rates of medication nonadherence, and have greater impulsivity and sensation seeking. Limited evidence suggests that clozapine treatment may be associated with reduced substance abuse, with weaker evidence suggesting that other novel antipsychotics may have similar, but potentially less potent, effects. Controlled trials to test the effects of these medications are underway. A number of recent studies indicate that bupropion can facilitate reduced tobacco smoking among patients with schizophrenia. The preferential use of novel antipsychotics, a lower threshold for prescription of clozapine, the use of bupropion for smoking cessation, careful monitoring of compliance, and possible use of other medications for substance use disorders when indicated are recommended in pharmacologic management for people with co-occurring substance use disorders and schizophrenia.

Enquête sociale et de santé de 1998 au Québec: divers déterminants des maladies chroniques respiratoires

In the course of the "1998 Health and Social Survey", questions were included to verify the prevalence of chronic respiratory diseases and also of wheezing. The objectives of this study were 1) to verify the prevalence of wheezing and its validity as an indicator of chronic respiratory diseases in Québec; and 2) to examine the relationship between chronic respiratory diseases and some of their potential determinants. A total of 30,386 individuals participated in the study. For all ages, the prevalence of wheezing was 5.4%. It was associated with asthma, allergies, chronic bronchitis and emphysema. A low familial income and tobacco smoking were associated with wheezing, asthma, chronic bronchitis and emphysema. Passive smoking was associated with wheezing whereas the presence of carpets was associated with wheezing and asthma. Between 32 and 48% of families with an asthmatic or an allergic member modified their dwelling to alleviate respiratory problems. The prevalence of wheezing documented here was lower than in anglosaxon countries. This result could be explained by a cultural factor (the French translation or the perception of wheezing). This study emphasizes the role of reducing tobacco smoking in the prevention of chronic respiratory diseases.

Modification of a 747 Aircraft Ventilation System to Reduce Tobacco Smoke Transport

Modification of a 747 Aircraft Ventilation System to Reduce Tobacco Smoke Transport

Tabaquismo escolar en el medio rural de Castilla-León. Actitudes de la población escolar

Tobacco smoking is the most important health problem among school-age children and educational programs aiming at prevention must be taken up by all members of the school community (parents, teachers and students) as well as by health providers. We designed an anti-smoking campaign lasting three years directed towards sixth, seventh and eight-grade elementary school students and secondary school pupils attending classes in the area of Vitigudino (Salamanca). We report the results of student attitude surveys done at the beginning of the program. Sixty-eight percent of boys and 50.7% of girls have smoked at some time. The average age of first contact with tobacco was 12.1 +/- 2.4 years, with boys starting to smoke at a significantly younger age (p < 0.001) than girls. At present, 13.7% of school children smoke. The main reasons given for starting to smoke were that friends smoked (56.9%) and curiosity (55.4%). Tobacco smoking in the family was mentioned by only 29.5% of the students surveyed. Knowledge of medical problems related to smoking was limited. Intention to smoke upon leaving school was reported by 9%, while 46.7% did not know if they would smoke. The fact that only 44.1% of school children believe they will not smoke upon leaving school highlights the need to provide support information that will help students abstain. Programs aimed at school children have been shown to help reduce tobacco smoking in this population. An adolescent who learns to avoid tobacco is unlikely to be a smoker in adulthood.(ABSTRACT TRUNCATED AT 250 WORDS)

The Role of Public Health in Improving the Health of America

5r ~ AM honored to be with you today and want to thank all of you in APHA-those of you at the state, g local, and national levels-for your commitment and dedication, for all of the help and support that APHA has given me as your Surgeon General. But I ,zo d want to tell you one thing. I didn't just want to get this job. I wanted to do the job. That is why I have been out there trying to make sure we address the health care needs of those who need it most and support those who are involved in protecting and improving the health of all Americans. I want to thank you for protecting us against many of the epidemic diseases in our society. Thank you for protecting the environment, the workplace, our housing, our food and water. Thank you for promoting healthy behaviors. Thank you for monitoring the health of our population and telling us where we need to be concerned. I want to thank you for mobilizing community action and getting your communities involved in prevention. Whether it is reducing tobacco smoking, preventing the spread of HIV disease, or preventing unintentional injuries, it is these things that help make a community whole, productive, and healthy. Thank you for responding to the many natural disasters this country has faced in recent years. I went down to Georgia this year, and I've never really seen the aftermath of a flood before. You know, we sit in our living rooms, and they show us the water up to the top of the buildings. What they don't show us is the disaster that is left behind-the rubble, what is left of a family's belongings piled up on

Risk Factors for Acute Wheezing in Infants and Children: Viruses, Passive Smoke, and IgE Antibodies to Inhalant Allergens

To examine the prevalence of viral infection, passive smoke exposure, and IgE antibody to inhaled allergens in infants and children treated for acute wheezing. Case-control study of actively wheezing children who were compared with children without respiratory tract symptoms. University of Virginia Pediatric Emergency Room. Convenience sample of 99 wheezing patients (2 months to 16 years of age) and 57 control patients (6 months to 16 years of age). Serum IgE antibody to inhalant allergens, measured by radioallergosorbent test (RAST), was uncommon in wheezing and control patients under age 2. After 2 years of age, the percentage of RAST-positive patients increased markedly and was significantly higher in wheezing patients than controls after age 4 (72%, n = 54, and 30%, n = 40, respectively, P < .001). Total IgE levels and nasal eosinophilia were strongly correlated with a positive RAST after age 2. Viral pathogens, predominantly respiratory syncytial virus, were identified in nasal washes from 70% (n = 20) of wheezing patients younger than 2 years of age compared with 20% of controls (n = 10), P < .05. After age 2, viruses, particularly rhinovirus, were isolated in washes from 31% (n = 70) of wheezing patients, 64% of whom were also RAST-positive. Levels of cotinine, a nicotine metabolite, were elevated (> or = 10 ng/mL) in saliva from a large percentage of smoke-exposed, wheezing patients under 2 (74%, n = 19) compared with those over 2 (14%, n = 51), P < .001. Odds ratios for wheezing were significant for virus (8.2, confidence interval [CI] = 1.3 to 5.0), and cotinine (4.7, CI = 1.0 to 21.3) in children under 2, and IgE antibody by RAST (4.5, CI = 2.0 to 10.2), virus (3.7, CI = 1.3 to 10.6), and the combination of IgE antibody and virus (10.8, CI = 1.9 to 59.0) were significant risk factors after age 2. Wheezing children younger than 2 years of age had a high rate of viral infection and a low rate of IgE antibody to inhalant allergens. When these children were exposed to passive smoke, salivary cotinine levels were elevated suggesting heavy exposure. After 2 years of age, sensitization to inhaled allergens became increasingly important and viruses remained a significant risk factor for wheezing. These data support recommendations to reduce tobacco smoke exposure at home, especially for young patients, and to consider sensitization to inhaled allergens and allergen avoidance in wheezing children at an early age, particularly after age 2 years.

Prevention in developing countries

Developing countries have implemented primary health care programs directed primarily at prevention and management of important infectious and nutritional problems of children. Successful programs have emphasized the need for individual and community involvement and have been characterized by responsible government policies for equitable implementation of efficacious and cost-effective health interventions. Unfortunately, developing countries must also face increases in the chronic disease and social problems commonly associated with industrialized countries. Prevention efforts, for example, to reduce tobacco smoking, to modify the diet, to reduce injuries, or to avert environmental contamination, are needed to contain future morbidity and rapidly increasing medical care costs. Developing countries can build on their successful approaches to program implementation and add other measures directed at preservation of health and prevention of disease in adult as well as child populations.

Does switching from cigarettes to pipes or cigars reduce tobacco smoke exposure?

Cigarette smoking histories, reported depth of inhalation, number of pipe and cigars (PC) smoked, serum thiocyanate (SCN) and expired air carbon monoxide (CO) levels were examined in PC male smokers enrolled in the Multiple Risk Factor Intervention Trial (MRFIT). Serum SCN levels for all PC smokers were higher than for non-smokers and lower than for current cigarette smokers. Levels were related to the amount of product smoke. Prior cigarette smokers had higher SCN levels when compared to PC users who had never smoked cigarettes, smoked a larger number of tobacco products per day, and reported inhaling into the chest more often. Prospective data on baseline cigarette smokers demonstrated that smokers who stopped all tobacco products had a greater drop in SCN and CO than those who switched to PC. The findings strongly suggest that cessation of all tobacco products is the best strategy for decreasing exposure to tobacco smoke.

The action exerted by certain pneumoconiotic factors upon the acid mucopolysaccharide contents of pulmonary macrophages.

<b>Objective:</b> To evaluate the psychosocial and behavioural impact of the first ever national level comprehensive workplace smoke-free law, implemented in Ireland in March 2004. <b>Design:</b> Quasi-experimental prospective cohort survey: parallel cohort telephone surveys of national representative samples of adult smokers in Ireland (n = 769) and the UK (n = 416), surveyed before the law (December 2003 to January 2004) and 8–9 months after the law (December 2004 to January 2005). <b>Main outcome measures:</b> Respondents’ reports of smoking in key public venues, support for total bans in those key venues, and behavioural changes due to the law. <b>Results:</b> The Irish law led to dramatic declines in reported smoking in all venues, including workplaces (62% to 14%), restaurants (85% to 3%), and bars/pubs (98% to 5%). Support for total bans among Irish smokers increased in all venues, including workplaces (43% to 67%), restaurants (45% to 77%), and bars/pubs (13% to 46%). Overall, 83% of Irish smokers reported that the smoke-free law was a “good” or “very good” thing. The proportion of Irish homes with smoking bans also increased. Approximately 46% of Irish smokers reported that the law had made them more likely to quit. Among Irish smokers who had quit at post-legislation, 80% reported that the law had helped them quit and 88% reported that the law helped them stay quit. <b>Conclusion:</b> The Ireland smoke-free law stands as a positive example of how a population-level policy intervention can achieve its public health goals while achieving a high level of acceptance among smokers. These findings support initiatives in many countries toward implementing smoke-free legislation, particularly those who have ratified the Framework Convention on Tobacco Control, which calls for legislation to reduce tobacco smoke pollution.