Smoking Practices Research Articles

Nutritional status and food security in Sub-Saharan Africa: Predictions for 2020

The subject of the future regarding nutritional status and food security, and of their ramifications in terms of nutrition-related disorders/diseases in Sub-Saharan African (SSA) populations, is a complex one. As well as social unrest, a country's socioeconomic situation may affect food availability and, crucially, influence the generally low proportions of the Gross National Product devoted to health services. Additional determinants include changes in the roles of non-dietary adverse factors (i.e. smoking practice, alcohol consumption, physical inactivity) and of infections (i.e. gastroenteritis, malaria, tuberculosis and, particularly, HIV). As to future health in 2020, major increases in socioeconomic status are very unlikely; in fact, there has been a deterioration in some countries with food shortages affecting nutrition status and food security. However, with some measures of prosperity there are likely to be decreases in family size and falls in the proportions of children born with low birthweights or with protein-energy-malnutrition (PEM), and of children lying under the 5th percentile of growth reference standards. Simultaneously, though. there will be variable rises, especially in urban dwellers, in the occurrence of hypertension, diabetes, cardiovascular disease and certain cancers. Improvements in the health status of both children and adults are likely to be strongly affected by whether HIV infection can be controlled or whether it becomes rampant.

Interacting effects of the serotonin transporter gene and neuroticism in smoking practices and nicotine dependence.

Individual differences in propensity to nicotine dependence appear to be mediated, in part, by genetic factors.1 The serotonin transporter gene has a functional polymorphism (5-HTTLPR) which modulates gene transcription and reuptake.2,3 A possible role in nicotine dependence is suggested by a link between 5-HTTLPR and neuroticism,4 a personality trait which has been related to smoking practices.5 In a cross-sectional study of 185 smokers, we utilized multiple linear regression modeling to examine the interacting effects of the 5-HTTLPR and neuroticism on smoking practices and nicotine dependence. Genotype was classified according to the presence or absence of the short (s) allele vs the long (l) allele of 5-HTTLPR (ie, s/s or s/l vs l/l). Models controlled for gender, age, race, and alcohol use. The 5-HTTLPR by neuroticism interaction effect was statistically significant in the models of nicotine intake (P = 0.05), nicotine dependence (P = 0.001), and smoking motivations (smoking to reduce negative mood (P = 0.01); smoking for stimulation (P = 0.01)). The results suggested that neuroticism was positively associated with these smoking practices among smokers with 5-HTTLPR S genotypes (s/s or s/l), but not among smokers with the L genotype (l/l). The 5-HTTLPR may modify the effects of neuroticism on smoking motivations and nicotine dependence. Assessment of 5-HTTLPR genotype and neuroticism may help to identify smokers who are more responsive to psychotropic medications, such as selective serotonin reuptake inhibitors (SSRIs), which are being used in smoking cessation treatment.

Knowledge, attitude and practice of smoking among university students of allied health sciences in Japan.

A study was conducted to determine the knowledge, attitude and practice (KAP) of cigarette smoking among freshman students of Tokyo Metropolitan University of Health Sciences. Students were categorized as 'ever-smoker' or 'nonsmoker'. 18.3% of the 356 subjects were categorized as 'ever-smoker'. The two categories were then compared to determine significant differences in health knowledge, attitudes towards health and smoking, smoking perceptions and preferences, knowledge on the economic impact of tobacco and attitudes towards tobacco control measures. In most cases, significant differences were found between the two groups. However, concerning knowledge on the economic impact of tobacco, the majority of both ever-smokers and nonsmokers had poor knowledge. Increased tobacco control education and related efforts are needed as is further research in determining the factors or influences that shape the significant differences found. Such information will be invaluable in formulating appropriate tobacco control measures for the future.

Tabagismo e etilismo em funcionários da Universidade Estadual do Ceará

O presente estudo pretendeu identificar os hábitos de tabagismo e etilismo de funcionários da Universidade Estadual do Ceará, em Fortaleza. O estudo abrangeu 317 funcionários. Aplicou-se um questionário contendo dados de identificação, socioeconômicos e referentes ao tabagismo e etilismo, que foram tabulados e analisados pelo Epi-Info 6.0. O grupo entrevistado foi constituído de 157 homens e 160 mulheres, com faixa etária predominante de 30-49 anos e alta escolaridade. A renda familiar para 146 funcionários situou-se na faixa igual ou superior a 10 salários mínimos mensais. Declararam-se fumantes 83 funcionários, observando-se maior prevalência no sexo masculino (56). Em média, o consumo de cigarros foi de 12,3/dia e tal atividade era exercida havia 23,2 anos. Quanto ao etilismo, 183 indivíduos ingeriam bebida alcóolica, também encontrando-se maior prevalência nos homens. A freqüência do consumo foi principalmente em fins de semana ou raramente. A bebida mais citada foi a cerveja - 96, seguida pela aguardente de cana - 20 pessoas. O consumo médio diário de etanol foi de 29,9g. Os consumidores simultâneos de tabaco e álcool foram eminentemente do sexo masculino. A escolaridade e a renda foram maiores nas mulheres exclusivamente fumantes e a renda foi maior entre as exclusivamente etilistas. Apesar de as prevalências de tabagismo e etilismo encontradas não terem sido elevadas, ainda configuram um risco para doenças crônico-degenerativas, principalmente quanto à quantidade de etanol ingerida pelos homens, devendo haver aprofundamento do estudo em relação à associação com outras diferentes variáveis ambientais.

Relationship of blood lead levels to personal hygiene habits in lead battery workers: Taiwan, 1991-1997.

The blood lead concentrations of workers in lead battery factories are more than 4 times higher than those of the general population in Taiwan. Therefore, efforts are needed to reduce lead exposure in this high-risk population. A health promotion program on personal habits that reduce lead exposure has been carried out in a lead battery factory since 1991. This study investigated the longitudinal relationship of workers' blood lead concentrations and personal hygiene habits from 1991 through 1997. In each of the 7 years of the study, occupational physicians questioned workers regarding nine personal hygiene items, personal information, and medical history before their annual health examination. The relationship between blood lead concentrations and personal hygiene habits was analyzed by longitudinal multiple regression in a mixed effect model with adjustment for potential confounders. In addition, the risk ratio of a blood lead concentration exceeding 40 micrograms/dL in men and 30 micrograms/dL in women (the action levels set by the Department of Health, Taiwan) was estimated by generalized estimating equations. Blood lead levels decreased significantly in the first 5 years of the study. The personal habits most closely related to blood lead concentrations were smoking at work sites (estimated coefficient = 3.13, P < 0.001), and eating at work sites (estimated coefficient = 1.38, P = 0.069). The risk ratio for workers with both these habits exceeding the action level of blood lead was 2.93 (95% CI 1.27-6.77). Difference in job titles, however, accounted for a major portion of the variance in blood lead. For example, working in "pasting" and "plate-cutting" was associated with blood lead elevations > 20 micrograms/dL in comparison to the "low- or no-exposure jobs." Health promotion programs can decrease exposure of lead workers; reducing the practices of smoking and eating at work sites should be the core of such programs. However, a major reduction in lead exposure for some jobs (e.g., "pasting" and "plate cutting") in lead battery factories in Taiwan is unlikely to occur without major engineering changes.

Doing a shotgun: a drug use practice and its relationship to sexual behaviors and infection risk

There has been a rise in the frequency with which inhalational routes such as smoking are used for illicit drug use. A growing population of new inhalational drug users augments the pool of individuals at risk for transition to injection drug use. Further, illicit drug smoking has been implicated in the transmission of a variety of pathogens by the respiratory route, and crack smoking has been associated with an increased risk of HIV infection, particularly through the exchange of high-risk sex for drugs. Shotguns are an illicit drug smoking practice in which smoked drugs are exhaled or blown by one user into the mouth of another user. We conducted a series of ethnographic observations to attempt to characterize more fully the practice of shotgunning, the range of associated behaviors, and the settings and contexts in which this practice occurs. Shotguns may be seen as a form of drug use which has close ties to sexual behaviors, and which has both pragmatic and interpersonal motivations, combining in a single phenomenon the potential direct and indirect risk of disease transmission by sexual, blood borne and respiratory routes. These data support the need to develop and evaluate comprehensive risk reduction interventions, which take into consideration the relationships between interpersonal and sexual behaviors and specific forms of drug use.

Knowledge, Attitudes and Practice of Smoking among Students at Tokyo Metropolitan University of Health Sciences

Knowledge, Attitudes and Practice of Smoking among Students at Tokyo Metropolitan University of Health Sciences

Providers' Smoking Cessation Attitudes and Practices for Older Patients

A mail survey of 136 providers in a health maintenance organization in the Chicago metropolitan area examined smoking cessation attitudes and performance of the 4As protocol (asking, advising, assisting, arranging) for patients aged 50 years or older. Asking about smoking was most frequent, followed by arranging, advising, and assisting. Physicians and nurse practitioners performed each of the 4As more often than did registered and licensed practical nurses. In multiple logistic regression analyses, provider type was the only significant predictor of asking about smoking. Advising, assisting, and arranging follow-ups were more likely to be performed by providers who perceived a sense of professional responsibility about older patients' smoking; advising was more likely for providers who perceived that they had enough time to advise older patients about smoking; and assisting and arranging were more likely for providers with a stronger sense of self-efficacy for helping older patients stop smoking.

French general practitioners' attitudes and reported practices in relation to their participation and effectiveness in a minimal smoking cessation programme for patients.

To examine the participation and effectiveness of GPs in offering a minimal smoking cessation intervention according to attitudinal and reported behaviour variables. General practitioners were surveyed about their practices and attitudes and then matched pairs of smoking and non-smoking doctors were invited to participate in a regional smoking cessation intervention. The relationship of survey responses and the degree of participation and effectiveness in a smoking cessation trial was examined. Primary care doctors in a large region of southern France, Provence-Alpes-Côte d'Azur (PACA). Two thousand, eight hundred and sixty GPs from the PACA region in France were interviewed about their attitudes and behaviours. From among 371 smoking GPs and 375 non-smoking GPs invited to take part in a smoking cessation trial with patients, 170 smokers and 202 non-smokers participated. The GPs' attitudes and reported professional and personal practices were assessed in a telephone interview. These responses were compared with the GPs' participation in the cessation trial, and with GP "success" (1 or more patients stopping smoking at 1 month, 12 months or both) or "non-success" (no patient cessation at 1 month or at 12 months). A significantly lower proportion of smokers than non-smokers among the GPs who initially accepted did not participate in the study (45% vs. 54.1%, chi 2 = 5.147 df = 1, p < 0.05, difference: 8.3% 95% CI: 1.2%; 15.5%), but thereafter, there were no significant associations between GPs' reported smoking practices and attitudes and the extent of their participation or effectiveness. The study results indicate that, when minimal advice has an effect, it is due more to the systematic nature of the provision of the intervention than to the attitudes or reported practices of the practitioner providing the advice.

The Health and Physical Readiness of Army Reservists: A Current Review of the Literature and Significant Research Questions

Individual soldier combat readiness through enhanced physical fitness is a major emphasis in the United States military today. Unfortunately, the prevalence of cigarette smoking, alcohol abuse, and other poor health practices continues to be reported at higher rates for active duty military personnel than for civilian populations. There is a dearth of research about health and fitness in the Army Reserve. Changing trends point toward more rapid mobilization of reservists for peacekeeping and combat missions throughout the world; however, it is important to remember that the Army Reserve is unique in its blending of both military and civilian occupational environments. The purpose of this paper is to review the current literature regarding Army Reserve health behaviors and physical readiness. Examples of significant future research questions are provided. More studies are needed to assess both individual motivational activities and organizational values that enhance health-promoting efforts. Interventions can then be designed to eliminate impediments to health and endorse specific organizational values and interpersonal skills that increase healthy behaviors.

Prevalence of Chronic Disease Risk and Protective Behaviors among American Indian Women Living on the Hopi Reservation

PURPOSE: There is a growing need for disease risk factor data for various chronic diseases among American Indian (AI) populations. The purpose of this study was to determine the prevalence of disease risk and protective behaviors among AI women living on the Hopi reservation.METHODS: 559 randomly selected AI women 18–89 years of age completed an interviewer-administered questionnaire which included questions on smoking, alcohol consumption, weight, height, and self-identified practices to keep healthy.RESULTS: The proportions of smoking and alcohol consumption were low with only 5.4% women reported currently smoking and 23.1% reported consuming any alcohol. Both these risk factors significantly decreased with age and significantly increased with higher education. The proportions who were overweight (body mass index (BMI) 27.3–32.2) and obese (BMI ≥ 32.3) were 36.2% and 27.0%, respectively, and were highest in the ages 25–64 years. Over 80% of women reported practicing behaviors to keep healthy. Significantly higher proportions of older women reported practicing behaviors to keep healthy compared with younger women.CONCLUSIONS: To develop and evaluate programs aimed at decreasing rates of chronic diseases among AI populations a disease risk factor surveillance system needs to be implemented by region and tribe.

Variations in cotinine levels in smokers during and after pregnancy

Objective: To compare the antenatal and postnatal cotinine levels in smoking women after controlling for the differences in smoking practices. Study Design: A paired comparison of two measurements of cotinine concentration was conducted in 40 smoking women voluntarily recruited in a prenatal education program held in La Fe Hospital, Valencia, Spain, during 1990 and 1991. Cotinine concentration was assayed by gas chromatography in samples of saliva obtained during and after pregnancy. The Wilcoxon matched-pairs test and multiple linear regression analysis were used. Results: The cotinine per cigarette ratio during pregnancy (median 3.53 ng/ml per cigarette) was significantly lower than the ratio in the postnatal testing (median 9.87 ng/ml per cigarette). This difference persisted after allowing for differences in reported cigarette consumption. Conclusion: These findings suggest that the available equivalencies between cotinine level and nicotine intake obtained from adult nonpregnant populations cannot be directly applied during pregnancy. (Am J Obstet Gynecol 1998;178:568-71.)

Depression and self-medication with nicotine: the modifying influence of the dopamine D4 receptor gene.

This study evaluated whether there are genetic subgroups of depressed individuals who are more or less predisposed to engage in self-medication smoking practices. Smokers (N = 231) completed self-report questionnaires of depression and smoking practices and were genotyped for the dopamine D4 receptor (DRD4) gene. A significant interaction (DRD4 Genotype x Depression) was found for stimulation smoking and negative-affect reduction smoking. Specifically, these smoking practices were significantly heightened in depressed smokers homozygous for the short alleles of DRD4 but not in those heterozygous or homozygous for the long alleles of DRD4. These preliminary results suggest that the rewarding effects of smoking and the beneficial effects of nicotine replacement therapy for depressed smokers may depend, in part, on genetic factors involved in dopamine transmission.

Cigarette smoking and changes in the histopathology of lung cancer.

Adenocarcinoma of the lung, once considered minimally related to cigarette smoking, has become the most common type of lung cancer in the United States. The increased incidence of this cancer might be explained by advances in diagnostic technology (i.e., increased ability to perform biopsies on tumors in smaller, more distal airways), changes in cigarette design (e.g., the adoption of filtertips), or changes in smoking practices. We examined data from the Connecticut Tumor Registry and two American Cancer Society studies to explore these possibilities. Connecticut Tumor Registry data from 1959 through 1991 were analyzed to determine whether the increase in lung adenocarcinoma observed during that period could be best described by birth cohort effects (i.e., generational changes in cigarette smoking) or calendar period effects (i.e., diagnostic advances). Associations between cigarette smoking and death from specific types of lung cancer during the first 2 years of follow-up in Cancer Prevention Study I (CPS-I), initiated in 1959) and Cancer Prevention Study II (CPS-II, initiated in 1982) were also examined. Adenocarcinoma incidence in Connecticut increased nearly 17-fold in women and nearly 10-fold in men from 1959 through 1991. The increases followed a clear birth cohort pattern, paralleling gender and generational changes in smoking more than diagnostic advances. Cigarette smoking became more strongly associated with death from lung adenocarcinoma in CPS-II compared with CPS-I, with relative risks of 19.0 (95% confidence interval [CI] = 8.3-47.7) for men and 8.1 (95% CI = 4.5-14.6) for women in CPS-II and 4.6 (95% CI = 1.7-12.6) for men and 1.5 (0.3-7.7) for women in CPS-I. The increase in lung adenocarcinoma since the 1950s is more consistent with changes in smoking behavior and cigarette design than with diagnostic advances.

Variations in Smoking Policies on Psychiatric Units

BACKGROUND: The high prevalence of smoking among clients with psychiatric disorders and the effect of smoking on metabolism of psychiatric medications has been documented. Implementation of inpatient smoking policies that alter smoking patterns may affect symptom presentation and medication metabolism. OBJECTIVE: Variations in how smoking policies are implemented on psychiatric units are described. DESIGN: A telephone survey of nurses working on 32 psychiatric units was used to collect information about how smoking policies were implemented. RESULTS: Most (n = 23) units allowed smoking only in designated areas outside the facility. Smoking frequency varied widely, ranging from twice a day to anytime, and some units placed restrictions on the number of cigarettes that could be smoked at each opportunity. CONCLUSION: The large variation in how smoking policies are implemented warrants further research. Smoking policies may alter smoking practices that affect psychotropic medication blood levels, side effects, and symptom presentation.

Variations in smoking policies on psychiatric units

Abstract Background : The high prevalence of smoking among clients with psychiatric disorders and the effect of smoking on metabolism of psychiatric medications has been documented. Implementation of inpatient smoking policies that alter smoking patterns may affect symptom presentation and medication metabolism. Objective : Variations in how smoking policies are implemented on psychiatric units are described. Design : A telephone survey of nurses working on 32 psychiatric units was used to collect information about how smoking policies were implemented. Results : Most (n = 23) units allowed smoking only in designated areas outside the facility. Smoking frequency varied widely, ranging from twice a day to anytime, and some units placed restrictions on the number of cigarettes that could be smoked at each opportunity. Conclusion : The large variation in how smoking policies are implemented warrants further research. Smoking policies may alter smoking practices that affect psychotropic medication blood levels, side effects, and symptom presentation.

Tobacco control activities of primary-care physicians in the Community Intervention Trial for Smoking Cessation. COMMIT Research Group.

OBJECTIVE: To compare tobacco control practices of physicians and their staff in Intervention communities with those in Comparison communities of the Community Intervention Trial for Smoking Cessation (COMMIT). DESIGN: COMMIT...

Coronary heart disease: outlook for Africa.

In Africa, coronary heart disease (CHD) is near absent in rural areas, and very uncommon in urban centres, where many Africans are in an advanced stage of transition. Among town dwellers intakes of food, especially fat, have risen and intakes of fibre-containing foods have fallen. Mean serum cholesterol level is almost double that of rural populations living traditionally. Obesity in females has risen enormously. Prevalence of hypertension exceeds that in the white population. The same applies to the practice of smoking in males, but not in females. The level of physical activity has fallen generally. With these increases in risk factors we can expect urban Africans to attain the high mortality rate for CHD now experienced by Afro-Americans. Prevention by urging reversion to previous life-style behaviour is a non-starter. However, as long as Africa remains impoverished, a major rise in CHD is unlikely.

"Shotgunning" as an illicit drug smoking practice.

There has been a rise in illicit drug smoking in the United States. "Shotgunning" drugs (or "doing a shotgun") refers to the practice of inhaling smoke and then exhaling it into another individual's mouth, a practice with the potential for the efficient transmission of respiratory pathogens. Three hundred fifty-four drug users (239 from a syringe exchange and 115 from a drug detoxification program) were interviewed about shotgunning and screened for tuberculosis (TB). Fifty-nine (17%; 95% CI 12.9%-20.9%) reported shotgunning while smoking crack cocaine (68%), marijuana (41%), or heroin (2%). In multivariate analysis, age < or = 35 years (OR 2.0, 95% CI 1.05-3.9), white race (OR 1.2, 95% CI 1.2-4.8), drinking alcohol to intoxication (OR 2.2, 95% CI 1.1-4.3), having engaged in high-risk sex (OR 2.6, 95% CI 1.04-6.7), and crack use (OR 6.0, 95% CI 3.0-12) were independently associated with shotgunning. Shotgunning is a frequent drug smoking practice with the potential to transmit respiratory pathogens, underscoring the need for education of drug users about the risks of specific drug use practices, and the ongoing need for TB control among active drug users.

Clinical epidemiology of acute myocardial infarction in Sharjah, United Arab Emirates

Little published information about the clinical epidemiology of acute myocardial infarction (AMI) in the United Arab Emirates (UAE) is available. To fill this knowledge gap, all patients with confirmed AMI who were treated at the intensive care unit of the Kuwait Hospital, Sharjah, during 1991 were prospectively studied. This hospital, primarily for expatriate patients, provides outpatient and hospital care to expatriates for a nominal fee and to UAE citizens free of charge. It is estimated that about 80% of all expatriate AMI patients in Sharjah receive initial treatment at this hospital. Of all 153 patients studied, 95.4% were men and 4.6% were women. Preexisting ischaemic heart disease, hypertension and diabetes were recorded in 30.2 (39/129), 17.8 (27/152) and 14.6% (22/151) of the patients, respectively. Overall, 73.7% (112/152) of the patients were current cigarette smokers. Of all 153 patients, 48.4, 35.9, 7.2 and 8.5% had anterior, inferior, lateral and `other' types of AMI, respectively. Of 152 patients with available data, 15 (9.9%) died in the hospital. In a multivariate logistic regression model including all significant univariate correlates of in-hospital death (age, nationality, history of hypertension and current smoking practice) as independent variables, only being a current cigarette smoker was significantly related to a lower risk of in-hospital death in the study patients (O.R.=0.27; 95% C.I.: 0.08–0.96). Also, UAE Arab nationality and preexisting hypertension were notable, though nonsignificant, positive correlates of in-hospital death in this model. These finding should guide future in-depth studies of the clinical epidemiology of AMI in Sharjah and elsewhere in the UAE.