Selected annotated bibliography. (Featured CME Topic: Smoking Cessation).EDITOR'S NOTE: Smoking and tobacco use is a major health problem not only for those actively using these products, but also for innocent bystanders exposed to passive smoke. The issue is so important and has such an impact that we felt it was appropriate to have two separate issues: one concentrating on the detrimental effects of tobacco consumption (last month's issue) and one concentrating on the benefits associated with smoking cessation--this month's issue. We observed the same format we did last month: rather than having another series of review articles reiterating the benefits of smoking cessation smoking cessation Public health Temporary or permanent halting of habitual cigarette smoking; withdrawal therapies–eg, hypnosis, psychotherapy, group counseling, exposing smokers to Pts with terminal lung CA and nicotine chewing gum are often ineffective. , we decided to have an annotated bibliography on this topic. We hope that this bibliography will provide clinicians with enough ammunition to convince their patients to stop using tobacco products. CANCER Cervical Cancer Cervical Cancer Definition Cervical cancer is a disease in which the cells of the cervix become abnormal and start to grow uncontrollably, forming tumors. * Barton SE, Maddox PH, Jenkins D, et al: Effect of cigarette smoking on cervical epithelial immunity: a mechanism for neoplastic neoplastic /neo·plas·tic/ (ne?o-plas´tik) 1. pertaining to a neoplasm. 2. pertaining to neoplasia. neoplastic pertaining to neoplasia or a neoplasm. change? Lancet 1988; 2:652-654. Cessation of smoking greatly reduces the risk for cervical neoplasia neoplasia /neo·pla·sia/ (-pla´zhah) the formation of a neoplasm. cervical intraepithelial neoplasia . A study of 91 women attending a community colposcopy Colposcopy Definition Colposcopy is a procedure that allows a physician to take a closer look at a woman's cervix and vagina using a special instrument called a colposcope. It is used to check for precancerous or abnormal areas. clinic revealed evidence that there is a dose-response relationship between the amount of cigarettes smoked and the number of Langerhans cells Langerhans cells, n.pl the cells of the pancreas that produce insulin. and natural killer cells natural killer cells, n.pl lymphocytes that are part of innate immunity that kill foreign substances and abnormal tissues. Decreased number or activi-ty has been linked to a number of diseases, including AIDS, cancer, chronic fatigue syndrome, present in cervical epithelium. Ex-smokers benefit and are at less risk of developing cervical cancer than current smokers who show a reduced immunity of the cervix due to a dose related lower count of disease fighting cells. The investigation showed that 36 of the 91 women studied had normal cytology cytology (sītŏl`əjē), in biology, the study of the structure of all normal and abnormal components of cells and the changes, movements, and transformations of such components. and no evidence of human papilloma virus human papilloma virus n. Abbr. HPV A DNA virus of the genus Papillomavirus, certain types of which cause cutaneous and genital warts in humans, including condyloma acuminatum. (HPV HPV human papillomavirus. HPV abbr. human papilloma virus Human papilloma virus (HPV) ), which is often associated with cervical precancer pre·can·cer n. A lesion from which a malignant tumor is presumed to develop in a significant number of instances and that may or may not be recognizable clinically or by microscopic changes in the affected tissue. . However, 55 women showed evidence of HPV and cervical intraepithelial neoplasia cervical in·tra·ep·i·the·li·al neoplasia n. Dysplastic changes beginning at the squamocolumnar junction in the uterine cervix that may be precursor to squamous cell carcinoma. , which is related to a lower T-cell count, in the colposcopic biopsy. A reduced amount of Langerhans cells, the greatest antigen-presenting cell antigen-presenting cell n. A cell, originating in the bone marrow and subsequently found as a dendritic cell in various locations, that facilitates the immune response by holding antigens on its surface and presenting them to lymphocytes. found in normal cervical tissue, was strongly associated with the daily intake of cigarettes. Ex-smokers' cell count fell between current smokers and that of never-smokers. This strong correlation between smoking and cervical cancer even among otherwise healthy women intensifies the need for physicians to help their patients stop smoking. * McBride CM, Scholes D, Grothaus LC, et al: Evaluation of a minimal self-help smoking cessation intervention following cervical cancer screening. Prev Med 1999; 29:133-138. Researchers postulate that smoking cessation intervention integrated into the clinical setting may increase success rates in cervical cancer screening subjects' attempts to quit smoking. Of the 4,053 women smokers who had had a Pap smear Pap smear or Papanicolaou smear Sample of cells from the vagina and cervix of the uterus for laboratory staining and examination to detect genital herpes and early-stage cancer, especially of the cervix. Developed by the Greek-born U.S. in the prior month, 580 were randomly chosen to participate in a study to evaluate smoking cessation intervention. There were 292 smokers randomized ran·dom·ize tr.v. ran·dom·ized, ran·dom·iz·ing, ran·dom·iz·es To make random in arrangement, especially in order to control the variables in an experiment. to receive usual care (UC) and 288 were to receive self-help (SH) which included three telephone counseling telephone counseling The provision of advice and verbalized moral support to a person with a particular need by a group of either volunteers or a paid staff with some level of experience and/or expertise in the area of interest; TC may include crisis calls, a reproductive health information card, and a self-help booklet. Success rates among the self-help group did not differ from the usual care group at the 6-month post-base line mark (SH 10.9% vs UC 10.5%; P= .56) or at the 15-month follow-up (SH 10.6% vs UC 15.5%; P= .17). No difference was found at the 6-month (SH 11.0% vs UC 9.8%; P= .71) or 15-month (SH 13.4% vs UC 14.6%; P= .96) follow-up for subjects with an abnormal Pap test Pap test, Pap smear, or Papanicolaou test (păp'ənē`kəlou), medical procedure used to detect cancer of the uterine cervix. . Researchers suggest that involving the physicians at the point of care may assist patie nts' attempt at cessation when they are first tested for cervical cancer. A teachable teach·a·ble adj. 1. That can be taught: teachable skills. 2. Able and willing to learn: teachable youngsters. moment like this should not be allowed to pass without intervention. * McBride CM, Scholes D, Grothaus L, et al: Promoting smoking cessation among women who seek cervical cancer screening. Obstet Gynecol 1998; 91(5 Pt 1):719-724. Gynecological gynecological /gy·ne·co·log·i·cal/ (-kah-loj´i-k'l) gynecologic. visits offer an underutilized and important opportunity for physicians to intervene with women smokers. Physicians should note that only about half of the 613 women surveyed in a study realize that smoking increases the risk for cervical cancer and 49% of these women report that their primary physician is their gynecologist gynecologist /gy·ne·col·o·gist/ (-kol´ah-jist) a person skilled in gynecology. gy·ne·col·o·gist n. A physician specializing in gynecology. . Consequently, opportunity is knocking at the door for the ob/gyn physician in the clinical setting during yearly pap tests to warn patients of the risks associated with smoking. Smoking is negatively associated with many reproductive health outcomes in women, which include infertility, pregnancy complications, and the early onset of menopause. A study was conducted by the Group Health Cooperative Group Health Cooperative, based in Seattle, Washington, is a consumer-governed nonprofit healthcare system. Established in 1947, it today provides coverage and care for about 540,000 people in Washington and Idaho and is one of the largest private employers in Washington. of Puget Sound to determine whether (1) women smokers knew of the cervical cancer risk associated with cigarette smoking, (2) to find out whether women are made aware of these risks during routine gynecologic gynecologic /gy·ne·co·log·ic/ (gi?ne-) (jin?e-kah-loj´ik) pertaining to the female reproductive tract or to gynecology. visits and (3) whether knowing of these risks have an impact on successful cessation of smoking. In the study, it was found that of the 613 women smokers surveyed, only 49% were aware of the increased risk of cervical cancer associated with smoking. Younger women aged 34 years or younger were more likely to agree that smoking is a risk factor for cervical cancer as opposed to older women smokers aged 45 years and older who were less likely to realize these risks (54% vs 40%), respectively. Young women (aged 18-26) were more motivated to quit smoking after learning of the increased risks of all kinds of cancer than older women. About half of the women surveyed reported that their primary care giver had encouraged smoking cessation. * Szarewski A, Jarvis MJ, Sasieni P, et al: Effect of smoking cessation on cervical lesion size. Lancet 1996; 347:1619-1620. Smoking cessation reduces the size of minor viral and low-grade cervical lesions. A study involving 82 women smokers with cervical intraepithelial neoplasia 1 (CIN CIN cervical intraepithelial neoplasia. Cervical intraepithelial neoplasia (CIN) A term used to categorize degrees of dysplasia arising in the epithelium, or outer layer, of the cervix. 1) or less revealed that quitting smoking now has a causal effect on the regression of early cervical abnormalities. Another study included 407 women with CIN (age range 19-59; median age 39). Researchers screened each of these women on selected days and found that of these, 61 (15%) had CIN class 1 (mild dysplasia dysplasia Abnormal formation of a bodily structure or tissue, usually bone, that may occur in any part of the body. Several types are well-defined diseases in humans. ); 75 (18%) CIN class 2 (moderate dysplasia); and 271 (67%) CIN class 3 (severe dysplasia or carcinoma in situ carcinoma in situ n. A neoplasm whose cells are localized in the epithelium and show no tendency to invade or metastasize to other tissues. Carcinoma in situ ). The control group included 323 women (age range 18-59, median age 38), with normal pap smears. Data indicate that the odds ratio for all grades of CIN increased for smokers when compared to never-smokers. CIN 3 risks increased for ex-smokers, but no elevated risk for CIN 1 or 2 was shown. However, the risks persist for high-grade lesions in smokers even after they quit. It was also shown that when the process of carcinogenesis car·ci·no·gen·e·sis n. The production of cancer. carcinogenesis production of cancer. biological carcinogenesis viruses and some parasites are capable of initiating neoplasia. has already initiated, stopping smoking has little effect, at least in the short term. Data were extrapolated from several studies conducted at the National Cancer Institute, the University of Milan The university is a member of the League of European Research Universities. Throughout Milan, the University is normally known as Statale to avoid confusion with other academic institutions in the city. and the Ospedale Maggiore of Milan. Colorectal Cancer colorectal cancer Malignant tumour of the large intestine (colon) or rectum. Risk factors include age (after age 50), family history of colorectal cancer, chronic inflammatory bowel diseases, benign polyps, physical inactivity, and a diet high in fat. * Chao A, Thun MJ, Jacobs EJ, et al: Cigarette smoking and colorectal cancer mortality in the cancer prevention study II. J Natl Cancer Inst 2000; 92:1888-1896. Early smoking cessation results in decreased risk for colorectal carcinoma. A study involving 312,332 men and 469,019 women who were cancer free in 1982 revealed that among these, 4,432 contracted colon or rectal cancer Rectal Cancer Definition The rectum is the portion of the large bowel that lies in the pelvis, terminating at the anus. Cancer of the rectum is the disease characterized by the development of malignant cells in the lining or epithelium of the rectum. and died between 1982 and 1996 as a result. Current smokers were at a higher risk than never-smokers for colorectal cancer [risk ratio (RR) = 1.32; 95% confidence interval confidence interval, n a statistical device used to determine the range within which an acceptable datum would fall. Confidence intervals are usually expressed in percentages, typically 95% or 99%. (CI) = 1.16-1.49] among men and (RR=1.41; 95% CI = 1.26-1.58) among women. Risks increased among former and current smokers in proportion to duration and pack years smoked. There was a decreased risk of colorectal cancers in former smokers which correlated with years since cessation. This study suggests that it is probable that 12% of the colorectal deaths occurring in 1997 were caused by smoking. Data for this study were derived from The Cancer Prevention Study II, a prospective nationwide mortality study involving 1,184,657 subjects conducted in 1982 and 1996. * D'Avanzo B, LaVecchia C, Franceschi S, et al: Cigarette smoking and colorectal cancer: a study of 1,584 cases and 2,879 controls. Prey Med 1995; 24:571-579. There is no relationship between smoking cessation and colorectal cancer outcomes. In a study conducted on 955 cases of colon cancer colon cancer, cancer of any part of the colon (often called the large intestine). Colon cancer is the second most common cancer diagnosed in the United States. and 629 cases of rectal cancer with 2,879 controls, researchers found no correlation between smoking and the risk for colorectal carcinoma. Ex-smokers' odds ratio (OR) for risk of colorectal cancer resembled that of current smokers (0.9 to 0.7), respectively. No dose relationship was observed (OR = 0.7 for both <15 and 15-24, and 0.8 for [greater than or equal to]25 cigarettes per day). The risk remained the same whether smoking began early or later in life or whether or not smoking cessation was achieved and its duration. All results were similar for male and female. Further Reading (1.) Harvard report on cancer prevention. Causes of human cancer. Smoking. Cancer Causes Control 1996; 7(Suppl 1):S5-S6 (2.) Seltzer V: Cancer in women: prevention and early detection. J Womens Health Gend Based Med 2000; 9:483-488 Esophageal Cancer Esophageal Cancer Definition Esophageal cancer is a malignancy that develops in tissues of the hollow, muscular canal (esophagus) along which food and liquid travel from the throat to the stomach. * Castellsague X, Munoz N, De Stefani E, et al: Smoking and drinking cessation and risk of esophageal cancer (Spain). Cancer Causes Control 2000; 11:813-818. Cessation of smoking and drinking greatly reduces the risks for esophageal cancer. A study was conducted by the International Agency for Research on Cancer The International Agency for Research on Cancer (IARC, or CIRC in its French acronym) is an intergovernmental agency forming part of the World Health Organisation of the United Nations. Its main offices are in Lyon, France. (IARC, Lyon, France) which included a total of 2,063 men (1,408 control subjects and 655 case patients) from South America to determine the benefits associated with smoking and drinking cessation. The incidence of esophageal cancer diminished with longer periods of smoking and/or drinking abstinence. Smokers who quit for at least 5 to 9 years achieved a 70% risk reduction for esophageal cancer. * Gammon MD, Schoenberg JB, Ahsan H, et al: Tobacco, alcohol, and socioeconomic status socioeconomic status, n the position of an individual on a socio-economic scale that measures such factors as education, income, type of occupation, place of residence, and in some populations, ethnicity and religion. and adenocarcinomas of the esophagus and gastric cardia cardia /car·dia/ (kahr´de-ah) 1. the cardiac opening. 2. the cardiac part of the stomach, surrounding the esophagogastric junction and distinguished by the presence of cardiac glands. . J Natl Cancer Inst 1997; 89:1277-1279. Smoking cessation may reduce the occurrence of esophageal and gastric cardia cell carcinomas by 40% after a lag time of about 30 years. In a population-based, case-control study case-control study, n an investigation employing an epidemiologic approach in which previously existing incidents of a medical condition are used in lieu of gathering new information from a randomized population. involving 554 subjects newly diagnosed with gastric cardia or esophageal carcinomas and 589 diagnosed with esophageal squamous cell cancer Squamous cell cancer A form of skin cancer that usually originates in sun-damaged areas or pre-existing lesions; at first local and superficial, it may later spread to other areas of the body. Mentioned in: Cryotherapy or other gastric adenocarcinomas, and 685 controls, odds ratios (OR) and confidence intervals (CI) were calculated for the four tumor types. Results indicated that the combined risk of esophageal and gastric cardia adenocarcinomas was elevated among current smokers (OR = 2.4; 95% CI = 1.7 - 3.4) with increasing intensity in risk correlating with the duration of smoking. Only an insignificant decline was observed up until 30 years after smoking cessation. Due to the long lag time associated with the risk for these cancers, recent decline in smoking may not yet have an impact. Further Reading (1.) Bosetti C, Franceschi S, Levi F, et al: Smoking and drinking cessation and the risk of oesophageal oesophageal see esophageal. cancer. Br J Cancer 2000; 83:689-691 Larynx Cancer * Schlecht NF, Pintos J, Kowalski LP, et al: Effect of smoking cessation and tobacco type on the risk of cancers of the upper aerodigestive tract aerodigestive tract Surgical anatomy A term that encompasses the oral cavity, sinonasal tract, larynx, pyriform sinus, pharynx, and esophagus in Brazil. Epidemiology 1999; 10:412-418. Risk of upper aerodigestive tract cancer decreases significantly over time among exsmokers, with commercial cigarette smokers receiving the most benefit. For those who have not smoked in 20 years, the relative risk is 1.98 (95% CI= 1.0-3.8) compared to non-smokers. The relative risk for those who have not used tobacco products in 10 years is 1.45 (95% CI= 0.7-3.0) for cigarettes; RR= 2.57 (95% CI= 1.4-4.6) for black tobacco; RR= 2.59 (95% CI= 0.6-11.6) for cigars; RR=3.40 (95% CI=1.3-8.8) for pipe tobacco. Data were analyzed from a study of 784 cancers of the mouth, pharynx pharynx (fâr`ĭngks), area of the gastrointestinal and respiratory tracts which lies between the mouth and the esophagus. In humans, the pharynx is a cone-shaped tube about 4 1-2 in. (11.43 cm) long. , and larynx and from 1.578 non-cancer controls in three metropolitan hospital areas in Brazil. * Falk RT, Pickle LW, Brown LM, et al: Effect of smoking and alcohol consumption on laryngeal cancer laryngeal cancer Malignant tumour of the larynx. The larynx is affected by both benign and malignant tumours. Squamous-cell carcinoma, the most common laryngeal malignancy, is associated with smoking and alcohol consumption; it is more common in men. risk in coastal Texas. Cancer Res 1989; 49:4024-4029. Risk for laryngeal cancer declines significantly after smoking cessation. Other tobacco products do not increase risk for laryngeal cancer, but the combined use of alcohol and cigarettes may create a greater risk. These data came from a review of respiratory cancer cases in the Texas Gulf Coast region from 1975 to 1980 and include 151 laryngeal cancer cases and 235 controls. All patients were white males 30 to 79 years of age. Further Reading (1.) Khuri FR, Kim ES, Lee JJ, et al: The impact of smoking status, disease stage, and index tumor site on second primary tumor primary tumor A neoplasm which, in clinical parlance, is regarded as malignant, arising in one site and capable of giving rise to metastatic or secondary tumors. See Metastasis. Cf Tumor of unknown origin. incidence and tumor recurrence in the head and neck retinoid retinoid /ret·i·noid/ (ret´i-noid) 1. resembling the retina. 2. retinal, retinol, or any structurally similar natural derivative or synthetic compound, with or without vitamin A activity. chemoprevention che·mo·pre·ven·tion n. The use of chemical agents, drugs, or food supplements to prevent disease. chemoprevention trial. Cancer Epidemiol Biomarkers Prev 2001;10:823-829 (2.) Spitz spitz Any of several northern dogs, including the chow chow, Pomeranian, and Samoyed, characterized by a dense, long coat, erect pointed ears, and a tail that curves over the back. In the U.S. MR, Fueger JJ, Chamberlain RM, et al: Cigarette smoking patterns in patients after treatment of upper aerodigestive tract cancers. J Cancer Educ 1990;5:109-113 (3.) Wynder EL, Stellman SD: Impact of long-term filter cigarette usage on lung and larynx cancer risk: a case-control study. J Natl Cancer Inst 1979; 62:471-477 Liver Cancer Liver Cancer Definition Liver cancer is a relatively rare form of cancer but has a high mortality rate. Liver cancers can be classified into two types. * Mukaiya M, Nishi M, Miyake H, et al: Chronic liver diseases for the risk of hepatocellular carcinoma hep·a·to·cel·lu·lar carcinoma n. A carcinoma derived from parenchymal cells of the liver. Also called hepatocarcinoma, malignant hepatoma. : a case-control study in Japan. Etiologic association of alcohol consumption, cigarette smoking and the development of chronic liver diseases. Hepatogastroenterology 1998; 45:2328-2332. The combination of smoking cigarettes and drinking alcohol in patients with chronic hepatitis Chronic hepatitis Long lasting inflammation of the liver due to viruses or other causes. Mentioned in: Tube Compression of the Esophagus and Stomach chronic hepatitis creates a risk for hepatocellular carcinoma (HCC HCC Hepatocellular Carcinoma (liver cancer) HCC Hertfordshire County Council (administrative region of south eastern England UK) HCC Harford Community College (Maryland) ) higher than does either habit alone. The relative risk is 17.9 compared to patients who neither drink nor smoke, and smokers who do not drink alcohol have a relative risk of 15.4. Clinicians should make individuals with chronic liver disease aware of the benefits of discontinuing use of tobacco and alcohol. This study investigated alcohol consumption and cigarette smoking in 104 Japanese males with chronic liver disease and HCC and 104 Japanese males with chronic liver disease and no HCC. * Mori M, Hara M, Wada I, et al: Prospective study of hepatitis B Hepatitis B Definition Hepatitis B is a potentially serious form of liver inflammation due to infection by the hepatitis B virus (HBV). It occurs in both rapidly developing (acute) and long-lasting (chronic) forms, and is one of the most common chronic and C viral infections, cigarette smoking, alcohol consumption, and other factors associated with hepatocellular carcinoma risk in Japan. Am J Epidemiol 2000;151:131-139. Smoking cessation may reduce the risk for hepatocellular carcinoma (HCC). A community-based prospective study designed to determine the effect of viral infections and lifestyle habits on HCC risk in Japan was conducted on 981 males and 2,078 females. The study revealed that HCC risk was significantly associated with positivity for hepatitis B surface antigen hepatitis B surface antigen n. Abbr. HBsAg An antigen derived from the surface of the hepatitis B virus that is present in the blood in active hepatitis B infection. Also called Australia antigen. (hazard ratio = 7.28; 95% confidence interval [CI] = 1.62-32.61; P<.01) and positivity for high-titer hepatitis C virus
adj. 1. Tending to multiply or capable of multiplying or increasing. 2. Having to do with multiplication. mul scale, there was a significant interaction on an additive scale for the risk of HCC development and a history of smoking. Lung Cancer lung cancer, cancer that originates in the tissues of the lungs. Lung cancer is the leading cause of cancer death in the United States in both men and women. Like other cancers, lung cancer occurs after repeated insults to the genetic material of the cell. * Dresler CM, Bailey M, Roper CR, et al: Smoking cessation and lung cancer resection. Chest 1996; 110:1199-1202. Smokers are likely to stop smoking after surgery for lung cancer. In a study of patients in a thoracic clinic, 86% of smoking patients had quit after surgery and only 13% started to smoke again. Longer cessation time before surgery results in longer postoperative cessation, and patients who do not quit before surgery usually continue to smoke postoperatively. These results are from a study of smoking cessation and relapse rate in 362 patients with an average age of 64.7 years followed up for about 1 1/2 years. * Levi F, Randimbison L, Te VC, et al: Second primary cancers in patients with lung carcinoma. Cancer 1999;86:186-190. Smoking cessation may prevent secondary carcinoma in patients diagnosed with lung cancer. A study that actively followed 5,794 patients diagnosed with lung carcinoma (4,728 men and 1,066 women) between 1974 and 1996 revealed that 175 second primary neoplasms were found occurring in 146 males and 29 females. For all cancer sites, significant excess rates were observed (standardized incidence ratio [SIR] = 1.2), cancers of the pharynx and the oral cavity oral cavity n. The part of the mouth behind the teeth and gums that is bounded above by the hard and soft palates and below by the tongue and the mucous membrane connecting it with the inner part of the mandible. (SIR = 2.7), and lung (SIR = 1.7). The esophagus (SIR = 1.8), pancreas (SIR = 1.5), bladder (SIR = 1.8), kidney (SIR = 2.3), and the female breast (SIR = 2.0) all were above unity. Tobacco-related neoplasms and excess rates for all cancer sites were systematically higher at a younger age (<60 years). At 5 and 10 years, the overall cumulative risk for lung cancer was 1.8% and 4.7%, respectively. This study was conducted by extrapolating data from the Cancer Registry of the Swiss Canton of Vaud. * Ockene JK, Kuller LH, Svendsen KH, et al: The relationship of smoking cessation to coronary heart disease coronary heart disease: see coronary artery disease. coronary heart disease or ischemic heart disease Progressive reduction of blood supply to the heart muscle due to narrowing or blocking of a coronary artery (see atherosclerosis). and lung cancer in the Multiple Risk Factor Intervention Trial (MRFIT MRFIT Multiple Risk Factor Intervention Trial Cardiology A long-term prospective study designed to analyze the effects of modifying the risk factors for heart disease ). Am J Public Health 1990; 80:954-958. The lag time for noticeable health improvement due to smoking cessation on lung cancer may take up to 20 years. The effects of smoking cessation on coronary heart disease (CHD CHD coronary heart disease. ChD abbr. Latin Chirurgiae Doctor (Doctor of Surgery) CHD, n.pr See disease, coronary heart. CHD canine hip dysplasia. ) are more rapid. Benefits of smoking cessation in relation to CHD and lung cancer were assessed after a 10.5 year follow-up study that included 12,866 men in the Multiple Risk Factor Intervention Trial. CHD patients who had quit smoking at least one year had a lower relative risk of dying of CHD (RR=0.63) than current smokers. When compared to smokers, ex-smokers who had quit smoking at least 3 years showed an even lower death rate for CHD (RR=0.38). Relative risk for lung cancer was equal for both smoker and ex-smoker at the 12-month and 3-year mark. * Peto R, Darby S, Deo H, et al: Smoking, smoking cessation, and lung cancer in the UK since 1950: combination of national statistics with two case-control studies. BMJ BMJ n abbr (= British Medical Journal) → vom BMA herausgegebene Zeitschrift 21000; 321:323-329. Stopping smoking before middle age reduces risk of lung cancer by more than 90%. For men who stop at ages 30, 40, 50, and 60, the risk of having lung cancer by age 75 is 2%, 3%, 6%, and 10%, respectively; so smoking cessation even at the age of 60 can add years to one's life. Results are from 1,465 case-control pairs in a 1950 study and 982 cases plus 3,185 controls in a 1990 study of hospital patients. The mortality rate from lung cancer among men at ages 35-54 decreased between 1950 and 1990 as smoking prevalence fell 50%. Women and older men, however; had higher lung cancer rates in 1990 than in 1950 because those who smoked in 1990 were more likely to have smoked throughout life. More importantly, former smokers of either sex have only a fraction of the lung cancer rate of continuing smokers. Further Reading (1.) Becher H, Jockel KH, Timm J, et al: Smoking cessation and nonsmoking non·smok·ing adj. 1. Not engaging in the smoking of tobacco: nonsmoking passengers. 2. Designated or reserved for nonsmokers: the nonsmoking section of a restaurant. intervals: effect of different smoking patterns on lung cancer risk. Cancer Causes Control l99l; 2:381-387 (2.) Kelly A, Blair N, Pechacek TF: Women and smoking: issues and opportunities. J Womens Health Gend Based Med 2001; 10:515-518 (3.) Khuder SA, Mutgi AB: Effect of smoking cessation on major histologic types of lung cancer. Chest 2001; 120:1577-1583 (4.) Wakai K, Seki N, Tamakoshi A, et al: Decrease in risk of lung cancer deaths in males after smoking cessation by age at quitting: findings from the JACC JACC Journal of the American College of Cardiology JACC Java Authorization Contract for Containers JACC Joint Automatic Control Conference JACC Journal Access Core Collection JACC Joint Ambulatory Care Clinic JACC joint airspace control center study. Jpn J Cancer Res 2001; 92:821-828 Oral Cancer * Gupta PC, Murti PR, Bhonsle RB, et al: Effect of cessation of tobacco use on the incidence of oral mucosal lesions in a 10-yr follow-up study of 12,212 users. Oral Dis 1995; 1:54-58. Tobacco cessation results in a decreased risk for oral cancer. In a study of lichen planus Lichen Planus Definition Lichen planus is a skin condition of unknown origin that produces small, shiny, flat-topped, itchy pink or purple raised spots on the wrists, forearms or lower legs, especially in middle-aged patients. , leukoplakia leukoplakia /leu·ko·pla·kia/ (-pla´ke-ah) 1. a white patch on a mucous membrane that will not rub off. 2. oral l. atrophic leukoplakia lichen sclerosus in females. , and other oral mucosal lesions, the incidence of several tobacco-linked lesions decreased with smoking cessation. Oral lichen lichen (lī`kən), usually slow-growing organism of simple structure, composed of fungi (see Fungi) and photosynthetic green algae or cyanobacteria living together in a symbiotic relationship and resulting in a structure that resembles neither planus-like lesion, smoker's palate smoker's palate ENT A condition caused by smoking: palatal inflammation, minor salivary gland edema, hyperkeratosis in response to tobacco , preleukoplakia, central papillary papillary /pap·il·lary/ (pap´i-lar?e) pertaining to or resembling a papilla, or nipple. papillary, adj similar to a small, nipple-shaped elevation or projection. atrophy of the tongue, leukoedema, and leukoplakia all showed little or no incidence after cessation. Oral lichen planus was not affected. These results are from a rural study in India in which 12,212 tobacco users were exposed to smoking cessation programs and were examined annually for 10 years. At the end of that period, 6.5% of men and 14.4% of women had stopped smoking. * Martin LM, Bouquot JE, Wingo PA, et al: Cancer prevention in the dental practice: oral cancer screening and tobacco cessation advice. J Public Health Dent 1996; 56:336-340. Cancer screening and smoking cessation intervention are underutilized in the dental practice. A population-based survey utilizing data from the 1992 National Health Interview Survey (NHIS NHIS National Health Interview Survey NHIS New Hampshire International Speedway NHIS National Health Insurance Scheme (Ghana) NHIS National Health Insurance System ) reveals that of the 12,035 adults (a nationally representative sample) polled in 1992, <10% reported oral cancer screening by their dentist or oral hygienist over the past 3 years. Black adults (3.2%; 95% CI = 1.9 - 4.5) and Hispanic adults (3.4%; 95% CI = 2.1 - 4.7) were three times less likely to report oral cancer screening during the past 3 years than white adults (10.1%; 95% CI = 9.3 - 10.9). Implementation of cancer screening and tobacco-cessation programs may reduce the mortality rate associated with oral cancer and other tobacco related morbidity. Pancreatic Cancer pancreatic cancer Malignant tumour of the pancreas. Risk factors include smoking, a diet high in fat, exposure to certain industrial products, and diseases such as diabetes and chronic pancreatitis. Pancreatic cancer is more common in men. * Fuchs CS, Colditz GA, Stampfer MJ, et al: A prospective study of cigarette smoking and the risk of pancreatic cancer. Arch Intern Med 1996; 156:2255-2260. Smoking cessation initiatives could eliminate 25% of the 27,000 annual deaths attributed to pancreatic cancer in the United States. A large-scale study was conducted involving 118,339 women aged 30 to 55 years and 49,428 men aged 40 to 75 years who were without a diagnosis of carcinoma at baseline. Within 2 years after smoking cessation, ex-smokers had a 48% reduction in pancreatic cancer risk. Former smokers' risk approached that of never-smokers <10 years after quitting tobacco products. * Ji BT, Chow WH, Dai Q, et al: Cigarette smoking and alcohol consumption and the risk of pancreatic cancer: a case-control study in Shanghai, China. Cancer Causes Control 1995; 6:369-376. Smoking cessation for 10 years reduces the risk of pancreatic cancer to that of never-smokers. A study consisting of 451 current smokers and 1,552 controls reveals that smoking is associated with excess risk of pancreatic carcinoma in both women (OR = 1.4; 95% CI = 0.9-2.4) and men (OR = 1.6; 95% CI = 1.1-2.2). Risks increased incrementally by dose and pack years of smoking. Of those who quit 10 years or more, risks resembled that of never-smokers. * Mulder I, van Genugten ML, Hoogenveen RT, et al: The impact of smoking on future pancreatic cancer: a computer simulation. Ann Oncol 1999; 10 (suppl 4) : 74-78. Smoking cessation could realistically eliminate 68,000 pancreatic cancer cases in the European Union European Union (EU), name given since the ratification (Nov., 1993) of the Treaty of European Union, or Maastricht Treaty, to the European Community over a quarter of a century. Through the year 2020, more than a million new cases of pancreatic cancer will be diagnosed in the European Union; if all smokers gave up smoking, this number could be reduced by 7%-17%. These results were obtained by entering into a computer simulation model the published data on pancreatic cancer incidence rate, smoking prevalence, and relative risk of smoking in ten European Union member states. Researchers simulated four scenarios for pancreatic cancer from 1994-2020: one reference scenario, one based on theoretically maximal smoking reduction, and two feasible scenarios based on WHO's Health for all targets. Renal Cancer * McCredie M, Stewart JH: Risk factors for kidney cancer Kidney Cancer Definition Kidney cancer is a disease in which the cells in certain tissues of the kidney start to grow uncontrollably and form tumors. in New South Wales--I. cigarette smoking. Eur J Cancer 1992; 28A:2050-2054. Ex-smokers have less risk of renal cell and renal pelvic cancers than do current smokers. Risk for renal pelvic cancer decreases within 12 years of smoking cessation, but renal cell cancer risk is reduced only after 25 years. Smoking before age 18 almost doubles the risk for renal pelvic cancer. These results are obtained from a population-based case-control study of 636 patients with kidney cancer and 523 controls in New South Wales New South Wales, state (1991 pop. 5,164,549), 309,443 sq mi (801,457 sq km), SE Australia. It is bounded on the E by the Pacific Ocean. Sydney is the capital. The other principal urban centers are Newcastle, Wagga Wagga, Lismore, Wollongong, and Broken Hill. during 1989-1990. * Brennan P, Bogillot O, Cordier S, et al: Cigarette smoking and bladder cancer bladder cancer Malignant tumour of the bladder. The most significant risk factor associated with bladder cancer is smoking. Exposure to chemicals called arylamines, which are used in the leather, rubber, printing, and textiles industries, is another risk factor. in men: a pooled analysis of 11 case-control studies. Int J Cancer 2000; 86:289-294. Smoking cessation is attributed to an immediate lowered risk for bladder cancer in men. This decrease was detectable in 30% of trial subjects after 1-4 years of smoking cessation and increased incrementally to 60% after 25 years of cessation. In a combined analysis of 11 case-control studies designed to measure the association between smoking and bladder cancer in men, researchers found that there is an increasing risk of bladder cancer tied to the duration and dose habit of smokers [odds ratio (OR) = 1.96 after 20 years of smoking; 95% confidence interval (CI) = 1.48-2.61; 5.57 OR after 60 years (95% CI = 4.18-7.44)]. The level of never-smokers (OR = 0.20; 95% CI = 0.17-0.24) risk was never reached for ex-smokers. CARDIOVASCULAR SYSTEM cardiovascular system: see circulatory system. cardiovascular system System of vessels that convey blood to and from tissues throughout the body, bringing nutrients and oxygen and removing wastes and carbon dioxide. * Eliasson B, Hjalmarson A, Kruse E, et al: Effect of smoking reduction and cessation on cardiovascular risk factors. Nicotine Tob Res 2001; 3:249-255. Smoking reduction for 8 weeks or more results in clinically significant improvements in established cardiovascular risk factors. An open study was conducted to determine what effects smoking cessation and reduction would have on fibrinogen Fibrinogen The major clot-forming substrate in the blood plasma of vertebrates. Though fibrinogen represents a small fraction of plasma proteins (normal human plasma has a fibrinogen content of 2–4 mg/ml of a total of 70 mg protein/ml), its conversion , hematocrit Hematocrit Definition The hematocrit measures how much space in the blood is occupied by red blood cells. It is useful when evaluating a person for anemia. Purpose Blood is made up of red and white blood cells, and plasma. , triglycerides Triglycerides Fatty compounds synthesized from carbohydrates during the process of digestion and stored in the body's adipose (fat) tissues. High levels of triglycerides in the blood are associated with insulin resistance. , hemoglobin, and cholesterol levels. Fifty-eight healthy adult smokers (smoking [greater than or equal to] cigarettes/day for at least 3 years) participated in the study and were provided nasal spray and asked to stop smoking or reduce cigarette consumption by at least 50%. After 8 weeks, researchers found the mean number of cigarettes smoked per day had decreased significantly from a baseline of 21.5 [+ or -] 0.6 to 10.8 [+ or -] 0.6 (P< .001). As a result, notable improvements occurred in fibrogen levels (2.9 [+ or -] 0.1 g/L at baseline to 2.6 [+ or -] 0.1 g/L, P = .011), white blood cell levels (7.0 [+ or -] 0.4 to 6.2 [+ or -] 0.3 x [10.sup.9]/L, P .005). High-density/low-density lipoprotein lipoprotein (lĭp'əprō`tēn), any organic compound that is composed of both protein and the various fatty substances classed as lipids, including fatty acids and steroids such as cholesterol. ratio (0.33 + or -] 0.03 to 0.37 [+ or -] 0.03, P < .005). * Goldstein MG, Niaura R: Methods to enhance smoking cessation after myocardial infarction myocardial infarction: see under infarction. . Med Clin North Am 2000; 84:63-80. Subjects who stop smoking by age 65 decrease their risk of initial or recurrent serious coronary events by 50%. Smoking cessation decreases recurrent cardiac risk by 30% in survivors of out-of-hospital cardiac arrest cardiac arrest n. Abbr. CA A sudden cessation of cardiac function, resulting in loss of effective circulation. Cardiac arrest A condition in which the heart stops functioning. . Smoking causes 17%-30% of deaths attributed to cardiovascular disease Cardiovascular disease Disease that affects the heart and blood vessels. Mentioned in: Lipoproteins Test cardiovascular disease , and smoking 1-4 cigarettes per day significantly increases risk for coronary artery disease coronary artery disease, condition that results when the coronary arteries are narrowed or occluded, most commonly by atherosclerotic deposits of fibrous and fatty tissue. . This is a review of the smoking and coronary artery disease association, cardiovascular effects of smoking/nicotine, nicotine's effects and nicotine dependence, effect of nicotine and smoking on drug metabolism Drug Metabolism/Interactions Definition Drug metabolism is the process by which the body breaks down and converts medication into active chemical substances. Precautions Drugs can interact with other drugs, foods, and beverages. , and smoking cessation intervention in myocardial infarction patients. Nicotine withdrawal is a barrier to smoking cessation. Women gain more weight than men when they quit smoking (3.8 kg vs 2.8 kg). Smoking accelerates the metabolism of many drugs, including propanolol, lidocaine lidocaine /li·do·caine/ (li´do-kan) an anesthetic with sedative, analgesic, and cardiac depressant properties, applied topically in the form of the base or hydrochloride salt as a local anesthetic; also used in the latter form as a , and theophylline theophylline /the·oph·yl·line/ (the-of´i-lin) a xanthine derivative found in tea leaves and prepared synthetically; its salts and derivatives act as smooth muscle relaxants, central nervous system and cardiac muscle stimulants, and . Healthcare providers play an important role in reducing the morbidity and mortality Morbidity and Mortality can refer to:
* Qiao Q Tervahauta M, Nissinen A, et al: Mortality from all causes and from coronary heart disease related to smoking and changes in smoking during a 35-year follow-up of middle-aged Finnish men. Eur Heart J 2000; 21:1570-1571. Kicking the habit earlier in life can prevent death attributed to smoking. A 35-year follow-up study involving 1,711 Finnish men was conducted to determine the relation of smoking and ex-smoking on early and late death. The study using Cox proportional hazards model revealed the effects of smoking on mortality for all causes were 1.62 (95% CI = 1.40-1.88) in current smokers and 1.13 (95% CI = 0.93-1.36) in ex-smokers in relation to never-smokers. The risk ratios for 35-year coronary heart disease mortality were 1.63 (95% CI = 1.24-2.13) and 1.39 (95% CI = 1.00-1.94), respectively. The results indicate a dose-response relationship. Further Reading (1.) Braunstein JB, Cheng A, Fakhry C, et al: ABCs of cardiovascular disease risk management. Cardio Rev 2001; 9:96-105 CELLULAR IMPACT * Petruzzelli S, Tavanti LM, Pulera N, et al: Effects of nicotine replacement therapy Nicotine replacement therapy A method of weaning a smoker away from both nicotine and the oral fixation that accompanies a smoking habit by giving the smoker smaller and smaller doses of nicotine in the form of a patch or gum. on markers of oxidative stress oxidative stress, n an imbalance of the prooxidant antioxidant ratio in which too few antioxidants are produced or ingested or too many oxidizing agents are produced. in cigarette smokers enrolled in a smoking cessation program. Nicotine Tob Res 2000; 2:345-350. Smoking cessation -- not smoking reduction -- is directly linked with decreased markers of oxidative stress in the plasma of current smokers. A 12-week study involving 20 asymptomatic, healthy, long-term smokers (12 female, 8 males; mean age, 43 years [+ or -] 9 years) was conducted to determine the effects of nicotine replacement therapy (NRT NRT Nicotine Replacement Therapy NRT Norm-Referenced Test NRT near real time NRT Non-Real-Time NRT National Response Team NRT Tokyo, Japan - Narita (Airport Code) NRT Net Registered Tonnage ) on plasma markers of oxidative stress. Malondialdeyde (MDA (1) (Monochrome Display Adapter) The first IBM PC monochrome video display standard for text. Due to its lack of graphics, MDA cards were often replaced with Hercules cards, which provided both text and graphics. See PC display modes and Hercules Graphics. ) and total Troloxequivalent antioxidant antioxidant, substance that prevents or slows the breakdown of another substance by oxygen. Synthetic and natural antioxidants are used to slow the deterioration of gasoline and rubber, and such antioxidants as vitamin C (ascorbic acid), butylated hydroxytoluene capacity (TEAC TEAC Tetraethylammonium Chloride TEAC Theological Education for the Anglican Communion TEAC Technology Education Association of California TEAC Turbine Engine Analysis Check TEAC Timber Export Advisory Committee TEAC Training & Education Advisory Committee ) were measured by plasma aliquots, obtained at baseline (T0) and after 12 weeks (T12) of NRT. MDA was higher in subjects who quit (n = 10) at T0 (1.08 [micro]mol/L, interquartile range 0.85-1.16) than at T12 (0.71 [micro]mol/L, range 0.32-0.92; P < 0.01). At TO, TEAC was lower (1.20 mm, range 1.11-1.31) than at T12 (1.43 mm, range 1.31-1.49; P<.05). Significant differences were not found in subjects who only reduced cigarette intake at T0 and at T12. Changes in TEAC levels also appeared insignificant (1.28 [1.05-1.50] vs. 1.25 [1.09-1.42] mm). MDA and cotin ine levels slightiy correlated in quitters at T0 (r = 0.50; P = .12) and significantly in reducers (r = 0.79; P < .05). The relationship in cotinine cotinine (kō´tinēn), n a substance that remains in body fluids after nicotine has been used. Presence of this chemical in body fluids is considered proof of recent nicotine use. and MDA was scattered in quitters and completely dispersed (r = 0.09) but still present in reducers(r = 0.70; P<.05). * Yu MW, Chen CJ, Luo JC, et al: Correlations of chronic hepatitis B virus infection and cigarette smoking with elevated expression of neu oncoprotein in the development of hepatocellular carcinoma. Cancer Res 1994;54:5106-5110. Reducing the amount of cigarettes smoked per day to <10 may decrease serum levels of neu oncoprotein in hepatocellular carcinoma patients to that of nonsmokers. A case-control study involving 9,691 male Taiwanese adult subjects was conducted to determine the potential role of neu oncogene oncogene Gene that can cause cancer. It is a sequence of DNA that has been altered or mutated from its original form, the proto-oncogene (see mutation). Proto-oncogenes promote the specialization and division of normal cells. expression in hepatocarcinogenesis. Analysis was performed on the previously collected blood samples, which were frozen at -30[degrees] C. Researchers used an enzyme-linked immunosorbent assay enzyme-linked immunosorbent assay n. ELISA. Enzyme-linked immunosorbent assay (ELISA) A diagnostic blood test used to screen patients for AIDS or other viruses. to measure neu oncoprotein levels in the stored serum. The mean level of neu oncoprotein was considerably elevated in hepatocellular carcinoma (HCC) and liver cirrhosis liver cirrhosis (sirō´sis), n a degenerative disease of the liver in which hepatic tissue is replaced with connective tissue, commonly a result of chronic alcoholism. See jaundice. cases when compared to healthy controls. An increased risk for HCC correlated with increased serum levels of neu oncoprotein (trend test, P .02). Elevated prediagnostic serum levels of neu oncoprotein were discovered in hepatocellular carcinoma subjects who smoked more than 10 cigarettes per day. After potential confounders were adjusted, the association remained marked ly significant (P = .017). The study suggests an increased expression of neu oncogene is related to both HbsAg carrier status and cigarette smoking. In the latter stages of hepatocarcinogenesis, cigarette smoking seems to play a significant role. Further Reading (1.) Hurt RD, Crogham GA, Wolter TD, et al: Does smoking reduction result in reduction of biomarkers associated with harm? A pilot study using a nicotine inhaler nicotine inhaler Nicotrol Inhaler Pharmacologic class: Cholinergic Therapeutic class: Smoking deterrent Pregnancy risk category C (gum), D (inhalation, nasal, transdermal) . Nicotine Tob Res 2000;2:327-336.DEPRESSION * Hertzberg MA, Moore SD, Feldman ME, et al: A preliminary study of bupropion bupropion /bu·pro·pi·on/ (bu-pro´pe-on) a monocyclic compound structurally similar to amphetamine, used as the hydrochloride salt as an antidepressant and as an aid in smoking cessation. sustained-release for smoking cessation in patients with chronic posttraumatic stress disorder Posttraumatic stress disorder An anxiety disorder in some individuals who have experienced an event that poses a direct threat to the individual's or another person's life. . J Clin Psychopharmacol 2001;21:94-98. Eighty percent of post-traumatic stress disorder post-traumatic stress disorder (PTSD), mental disorder that follows an occurrence of extreme psychological stress, such as that encountered in war or resulting from violence, childhood abuse, sexual abuse, or serious accident. (PTSD PTSD posttraumatic stress disorder. PTSD abbr. posttraumatic stress disorder Post-traumatic stress disorder (PTSD) ) patients quit smoking with the aid of bupropion sustained-release (SR). Fifteen veterans diagnosed with chronic PTSD who desired to stop smoking enrolled in a 12-week double-blind study double-blind study, n experimental technique in clinical research in which neither the researcher nor the patient knows whether the treatment administered is considered inactive (placebo) or active (medicinal). designed to evaluate the effectiveness of bupropion SR. A daily dose of 150 mg was administered for 3 or 4 days and increased to a total of 300 mg per day. Ten patients received bupropion SR, while the remaining five received a placebo. Nine of the subjects receiving bupropion SR were on at least one other psychotropic drug psychotropic drug Psychoactive drug Pharmacology A drug that affects brain activities associated with mental processes and behavior Categories Anti-psychotics; antidepressants; antianxiety drugs or anxiolytics; hypnotics. . Smoking cessation was achieved by 80% of the subjects at the end of the second week. Of these, 60% remained smoke-free at the study endpoint (12 weeks). Forty percent of the subjects receiving bupropion SR remained abstinent at the 6-month follow-up. Twenty percent of the placebo group (1 of 5) quit smoking and remained smoke-free at the 6-month followup. Drug interaction was observed in 1 of the 10 bupropion SR subjects, while the other 9 showed no a dverse reaction. * Pomerleau CS, Brouwer RJ, Pomerleau OF: Emergence of depression duringc early abstinence in depressed and non-depressed women smokers. J Addict Dis 2001;20:73-80. Depressed women smokers are more likely to relapse during the first-week attempt at smoking cessation than non-depressed women. A study involving 99 depressed and non-depressed women smokers was conducted to determine the relationship between the emergence of early depression in quit attempts and the ability to maintain smoking abstinence. A 21 mg nicotine patch nicotine patch Nicotine transdermal delivery system Substance abuse A device used in smoking cessation Side effects Transient burning, itching–50%, erythema–14%; contact hypersensitivity–2.4%. See Nicotine replacement therapy. with behavioral counseling was administered to all participants in the study. Results indicate that of the withdrawal symptoms Withdrawal symptoms A group of physical or mental symptoms that may occur when a person suddenly stops using a drug to which he or she has become dependent. observed, only depression expressed a significant group difference. Depression subsided within the first week for non-depressed subjects, while depressed women found it more difficult to maintain abstinence due to the increased level of depression experienced. Recognition of depressed smokers and subsequent early tailored intervention may prove to counteract the first-day effect and other difficulties confronting depressed smokers. DIABETES MELLITUS diabetes mellitus Disorder of insufficient production of or reduced sensitivity to insulin. Insulin, synthesized in the islets of Langerhans (see Langerhans, islets of), is necessary to metabolize glucose. In diabetes, blood sugar levels increase (hyperglycemia). * Canga N, De Irala J, Vara E, et al: Intervention study for smoking cessation in diabetic patients: a randomized controlled trial A randomized controlled trial (RCT) is a scientific procedure most commonly used in testing medicines or medical procedures. RCTs are considered the most reliable form of scientific evidence because it eliminates all forms of spurious causality. in both clinical and primary care settings. Diabetes Care 2000; 23:1453-1454. A difference of 14.7% (95% CI = 8.2-21.3) in smoking cessation in patients with diabetes mellitus was observed between the control group (n = 133, 2.3% quit) and the intervention group (n = 147, 17.0% quit) at the end of 6-month follow-up. The intervention plan included a 40-minute counseling session, a cessation date, and educational materials. Telephone calls, letters, and a visit were part of the follow-up regime. In this randomized controlled trial, 280 diabetic smokers (age range, 17-84 years) were recruited to determine the effectiveness of a nurse-managed smoking cessation regime. * Haire-Joshu D, Heady S, Thomas L, et al: Beliefs about smoking and diabetes care. Diabetes Educ 1994; 20:410-415. Among a group of insulin-dependent diabetes mellitus insulin-dependent diabetes mellitus n. Abbr. IDDM See diabetes mellitus. patients, those who smoke believed that cigarettes have beneficial effects on their illness and that smoking cessation may actually have negative effects on the course of diabetes mellitus. Smokers also felt that spouses or significant others were only moderately supportive of their cessation efforts. These findings are important for diabetes education and management. Results were obtained from a Diabetes and Smoking Beliefs Questionnaire and from an assessment of Attitude Toward Quitting Smoking. * Tornwall ME, Virtamo J, Haukka JK, et al: Prospective study of diet, lifestyle, and intermittent claudication Intermittent Claudication Definition Intermittent claudicationis a pain in the leg that a person experiences when walking or exercising. The pain is intermittent and goes away when the person rests. in male smokers. Am J Epidemiol 2000; 151:892-901. Smoking is one of the risk factors for claudication claudication /clau·di·ca·tion/ (klaw?di-ka´shun) limping; lameness. intermittent claudication , and cessation reduces the risk. Other risk factors include systolic blood pressure Systolic blood pressure Blood pressure when the heart contracts (beats). Mentioned in: Hypertension , serum total cholesterol, and diabetes mellitus. Serum high density lipoprotein High density lipoprotein (HDL) A fraction of total serum lipids, the so called "good" cholesterol. Mentioned in: Hypercholesterolemia cholesterol, education, leisure time, fiber, dietary carbohydrates, and n-6 polyunsaturated fatty acids were among the factors inversely associated with claudication. Additional research is needed to prove that antioxidants Antioxidants Substances that reduce the damage of the highly reactive free radicals that are the byproducts of the cells. Mentioned in: Aging, Nutritional Supplements antioxidants, n. prevent claudication. These results were obtained from a Finnish study of 26,872 male smokers 50 to 69 years of age in whom smoking status was assessed every 4 months and followed up for 4 years. Further Reading (1.) Spangler JG, Summerso JH, Bell RA, et al; Smoking status and psychosocial variables in type 1 diabetes mellitus type 1 diabetes mellitus Brittle DM, insulin-dependent DM, juvenile-onset DM Endocrinology A severe form of DM caused by ↓ endogenous insulin production by the pancreas, which comprises +– 10% of DM Clinical Extreme hyperglycemia, lability of glucose . Addict Behav 2001; 26:21-29 (2.) Wannamethee SG, Shaper AG, Perry IJ: Smoking as a modifiable risk factor for type 2 diabetes type 2 diabetes n. See diabetes mellitus. in middle-aged men. Diabetes Care 2001; 24:1590-1595 (3.) Wilkes S, Evans A: A cross-sectional study cross-sectional study n. See synchronic study. cross-sectional study, n the scientific method for the analysis of data gathered from two or more samples at one point in time. comparing the motivation for smoking cessation in apparently healthy patients who smoke to those who smoke and have ischaemic heart disease Ischaemic (or ischemic) heart disease, or myocardial ischemia, is a disease characterized by reduced blood supply to the heart. It is the most common cause of death in most western countries. Ischaemia means a "reduced blood supply". , hypertension or diabetes. Fam Pract 1999; 16:608-610 ELDERLY * Burns DM: Cigarette smoking among the elderly: disease consequences and the benefits of cessation. Am J Health Promot 2000; 14:357-361. Smoking cessation proves to be the most effective way of decreasing smoke-related disease risks for all ages, especially among those over 60 years of age. However, little evidence exists to suggest that disease consequences among the elderly decrease over time. This is due in part to the cumulative damage incurred by long-term smoking, causing mortality rates among the elderly to remain high. A review of the literature reveals that although older smokers are less likely than younger smokers to quit, older smokers are more likely to be successful in their attempt. * Salive ME, Blazer DG: Depression and smoking cessation in older adults: a longitudinal study longitudinal study a chronological study in epidemiology which attempts to establish a relationship between an antecedent cause and a subsequent effect. See also cohort study. . J Am Geriatr Soc 1993; 41:1313-1316. Contrary to earlier reports, older women who are depressed may be more likely to stop smoking. Women who display depressive symptoms have almost four times the odds of smoking cessation as those with no depression (relative odds, 3.7; 95% CI = 1.2 - 11.0; P < .05), but the association is not significant for men (relative odds, 0.6; 95% CI = 0.2 - 2.0). Depression and gender should be considered in combination for smoking intervention strategies. This study was conducted in North Carolina North Carolina, state in the SE United States. It is bordered by the Atlantic Ocean (E), South Carolina and Georgia (S), Tennessee (W), and Virginia (N). Facts and Figures Area, 52,586 sq mi (136,198 sq km). Pop. on subjects 65 years and older, with an oversampling Creating a more accurate digital representation of an analog signal. In order to work with real-world signals in the computer, analog signals are sampled some number of times per second (frequency) and converted into digital code. of African-Americans. Subjects included 511 current smokers with 3 years of follow-up. EYE DISEASES * Delcourt C, Diaz JL, Ponton-Sanchez A, et al: Smoking and age-related macular degeneration Age-related macular degeneration (ARMD) Degeneration of the macula (the central part of the retina where the rods and cones are most dense) that leads to loss of central vision in people over 60. . The POLA POLA Port of Los Angeles POLA Point-Of-Load Alliance POLA Principle of Least Authority (computer security) POLA Principle of Least Astonishment (FreeBSD) Study. Pathologies Oculaires Liees a l'Age. Arch Ophthalmol 1998; 116:1031-1035. Risk for age-related macular degeneration (ARMD Age-related macular degeneration (ARMD) Degeneration of the macula (the central part of the retina where the rods and cones are most dense) that leads to loss of central vision in people over 60. ) remains high for ex-smokers. The POLA study conducted to assess the prevalence of ARMD in 2,196 subjects revealed that former and current smokers have an increased risk for late ARMD (odds ratio [OR] = 3.2; 95% confidence interval [CI] = 1.3-7.7; OR=3.6, 95% CI = 1.1-12.4, respectively). For subjects who smoked more than 20 pack years there was an increased risk (OR = 3.0, 95% CI=0.9-9.5 for 20-39 pack years). Risk increased incrementally by pack years smoked. Even after 20 years of smoking cessation the risk remains high for late ARMD (OR = 9.0, 95% CI=3.0-27.0 for 1-9 years; OR=4.0, 95% CI=1.3-12.0 for 10-19 years; OR = 1.3, 95% CI=0.4-4.3 for 20 years or more). The late stages of ARMD and smoking are further confirmed by this study. There was no significant association between smoking and the early signs of ARMD. * Weintraub JM, Willett WC, Rosner B, et al: Smoking cessation and risk of cataract extraction among US women and men. Am J Epidemiol 2002; 155:72-79. Former smokers are 20% less likely to undergo cataract extraction when compared with current smokers (relative risk [RR] = 0.80; 95% CI=0.71-0.91). When data by cataract subtype (programming) subtype - If S is a subtype of T then an expression of type S may be used anywhere that one of type T can and an implicit type conversion will be applied to convert it to type T. were examined, the observed relation was similar (>25 years since smoking cessation vs current smoking: primarily posterior subcapsular cataract Noun 1. posterior subcapsular cataract - a cataract in the rear of the lens capsule cataract - an eye disease that involves the clouding or opacification of the natural lens of the eye , RR=0.90, 95% CI= 0.71-1.13; primarily nuclear cataract nuclear cataract n. A cataract involving only the inner dense portion of the lens. , RR=.082; 95% CI=0.68-0.97). Eye damage incurred by smoking is slow to heal and may have a causal effect on the risk of developing cataract. These conclusions are based on a review of 4,281 cases of physician-confirmed incidences of extracted cataract and 1,038,493 accumulated person-years of follow-up derived from the Nurses' Health Study Nurses' Health Study Cardiology A large cohort study that evaluated the effect of exogenous HRT on the risk of cardiovascular disease. See Estrogen replacement therapy, Osteoporosis. and the Health Professionals Follow-up Study. GASTROINTESTINAL SYSTEM gastrointestinal system: see digestive system. * Cosnes J, Carbonnel F, Carrat F, et al: Effects of current and former cigarette smoking on the clinical course of Crohn's disease Crohn's disease: see colitis. . Aliment al·i·ment n. 1. Something that nourishes; food. 2. Something that supports or sustains. v. To supply with sustenance, such as food. aliment food; nutritive material. Pharmacol Ther 1999; 13:1403-1411. Smoking cessation reduces the risk of flareup in Crohn's disease sufferers to that of nonsmokers. Risk is increased for those who smoke more than 15 cigarettes per day. Obesity, dyslipidaemia, and alcohol consumption apparently do not affect the disease. These results were obtained from a 12- to 18-month cohort study of 622 Crohn's disease patients to determine the effects of smoking on their illness. The primary outcome measure was rate of flare-up. Alcohol consumption, oral contraceptive use, body mass index, and blood lipid levels were monitored among a smoking group, an ex-smoking group, and a non-smoking group. * Parasher G, Eastwood GL: Smoking and peptic ulcer in the Helicobacter pylori era. Eur J Gastroenterol Hepatol 2000; 12:843-853. Smokers should stop smoking to guard against Helicobacter pylori infection and to reduce their risk for peptic ulcer disease Peptic ulcer disease (PUD) A stomach disorder marked by corrosion of the stomach lining due to the acid in the digestive juices. Mentioned in: Indigestion peptic ulcer disease See Duodenal ulcer, Gastric ulcer, GERD. . Ulcers are more likely to develop and recur and are harder to heal in smokers; smoking affects gastroduodenal gas·tro·du·o·de·nal adj. Relating to the stomach and the duodenum. gastroduodenal pertaining to the stomach and duodenum. motility motility /mo·til·i·ty/ (mo-til´ite) the ability to move spontaneously.mo´tile Motility Motility is spontaneous movement. , allowing harmful reflux into the stomach. By its adverse effects on antioxidants and the body's immune system, smoking reduces protection against Helicobacter pylori infection and predisposes smokers to ulcer disease. Results are from a review of the published literature. HEALTH CARE COSTS * Meenan RT, Stevens VJ, Hornbrook MC, et al: Cost-effectiveness of a hospital-based smoking cessation intervention. Med Care 1998; 36:670-678. Routine smoking cessation intervention and counseling provided to hospitalized smokers are both cost effective and relatively inexpensive. An economic analysis study by two implementing hospitals was conducted to determine the cost-effectiveness of a smoking cessation and relapse-prevention program. Included in the intervention were a 20-minute counseling session, a short video, self-help materials, and one or two follow-up calls. Costs were measured incrementally by life-year saved, per quit, and research. The cost of smoking cessation intervention at the research level was $159 per smoker. Cost per incremental quit was $3,697. The additional cost per life-year saved was between $1,691 and $7,444. These costs are justified by comparing them to other routine medical procedures. With the mass implementation of this smoking cessation program, costs would plummet 90%, making this regime both cost effective and inexpensive. * Schauffler HH, McMenamin S, Olson K, et al: Variations in treatment benefits influence smoking cessation: results of a randomized controlled trial. Tob Control 2001; 10:175-180. Insurance coverage for smoking cessation treatment may be an effective and relatively low-cost strategy for increasing smoking cessation success rates. The quit rate for subjects of a treatment group receiving full health insurance coverage for costs of smoking cessation treatment was 18% vs 13% in the control group receiving only a self-help kit. Rates of quit attempts were 55% vs 48%, and the rates of using nicotine gum or patch were 25% vs 14%. These results are based on. a randomized, controlled study of 1,204 eligible smokers randomly assigned to either a control group or treatment group. Further Reading (1.) Alterman AI, Gariti P, Mulvaney F: Short- and long-term smoking cessation for three levels of intensity of behavioral treatment. Psychol Addict Behav 2001; 15:261-264 (2.) Gosney M: Smoking cessation. Gerontology gerontology: see geriatrics. 2001; 47:236-240 INTERVENTION * Brandon TH: Behavioral tobacco cessation treatments: yesterday's news or tomorrow's headlines? J Clin Oncol 2001; 19 (Suppl 18) :64S-68S. Behavioral treatments for smoking cessation are as effective and cost-efficient as drug treatments. Behavioral intervention consists of both minimal (telephone, Internet, written) and targeted interventions (pregnant women, the heavily nicotine-dependent, depressed individuals, medical patients). Future treatments will be multidimensional, combining behavioral interventions, pharmacotherapies, and community-oriented approaches. If no specific program for cancer patients is available, healthcare providers should use the Five A's from recent Clinical Practice Guidelines clinical practice guidelines Clinical policies, practice guidelines, practice parameters, practice policies Medtalk Systematically developed statements to assist practitioner and Pt decisions about appropriate health care for specific clinical circumstances. See Psychology. : Ask, Advise, Assess, Assist, and Arrange. This article is a review of behavioral treatments for tobacco cessation and cessation treatments for cancer patients. * Cruse SM, Forster NJ, Thurgood G, et al: Smoking cessation in the workplace: results of an intervention programme using nicotine patches. Occup Med (Lond) 2001; 51:501-506. One-to-one support sessions are effective in smoking cessation treatment. Abstaining smokers who had participated in a 10-week program of sessions with a health adviser reported not smoking at all at the one-year follow-up. More than half the participants credited face-to-face contact and regular monitoring as factors most helpful in their efforts to stop smoking. Results are reported from a voluntary study of 123 pharmaceutical employees in the UK. * Easton A, Husten C, Malarcher A, et al: Smoking cessation counseling by primary care women physicians: women physicians' health study. Women & Health 2001; 32:77-91. Seventy-one percent of female physicians offer smoking cessation counseling to their patients (53% on every visit, 18% at least once a year). Pediatricians are less likely than primary care physicians to frequently counsel patients. Smoking cessation counseling by physicians is known to reduce to-bacco-related morbidity and mortality, and healthcare providers often do not provide consistent, effective counseling. Results are based on 4,501 respondents to a 1993-1994 survey of U.S. women physicians in all major specialties. * Etter JF, Perneger TV: Effectiveness of a computer-tailored smoking cessation program: a randomized trial. Arch Intern Med 2001; 161:2596-2601. Smokers who receive computer issued counseling letters are 2.6 times more effective in their attempts at quitting than those with no intervention (5.8% vs 2.2%; P < .001). These findings are based on a study designed to test the effectiveness of a computer-tailored smoking cessation program versus no such intervention. Current smokers (n = 2,934) were randomized into either the program or no intervention. Those smokers who had not previously contemplated cessation (control vs. intervention) (0.8% vs 3.8%; P = .001) at baseline faired better than their counterparts. Regardless of preconceived pre·con·ceive tr.v. pre·con·ceived, pre·con·ceiv·ing, pre·con·ceives To form (an opinion, for example) before possessing full or adequate knowledge or experience. difficulty, the program was effective in smoking cessation at baseline. Due to its ability to reach vast numbers of smokers, this program is proven to aid large populations in quitting smoking. * Griebel B, Wewers ME, Baker CA: The effectiveness of a nurse-managed minimal smoking-cessation intervention among hospitalized patients with cancer. Oncol Nurs Forum 1998; 25:897-902. Minimal intervention during attempted smoking cessation proves to be less than successful. A group of 28 adult male and female smokers were recruited from urban, academic, and tertiary-care settings to participate in a study. In the study, researchers sought to determine the effectiveness of a nurse-managed minimal smoking-cessation intervention program. The subjects were divided into two groups, intervention (n = 14) and usual care group (n = 14). Of these, 71% of the usual care group and 64% of the intervention group reported their intention to quit smoking upon hospital admission for a surgical procedure. Only 14% and 21% of the usual care group and intervention group subjects, respectively, were found to be smoke free at six weeks post-intervention. Of the intervention group, more than 90% resumed smoking within the first week of discharge. Additional intervention is necessary to reinforce learned smoking abstinence tactics. * Hays JT, Hurt RD, Rigotti NA, et al: Sustained-release bupropion for pharmacologic relapse prevention after smoking cessation: a randomized, controlled trial. Ann Intern Med 2001; 135:423-433. The use of bupropion for smoking cessation treatment delays smoking relapse and results in less weight gain. These results are based on a randomized, placebo-controlled trial of 784 healthy community volunteers motivated to quit smoking and who smoked 15 or more cigarettes per day. After a 7-week course of bupropion, participants were randomly assigned to continue receiving bupropion or a placebo for 45 weeks. At the conclusion of the medication phase, the point prevalence for abstinence among the bupropion group was 55.1% vs 42.3% in the placebo group. This difference decreased with each subsequent follow-up visit with no difference reported at week 104. The median time to relapse for the bupropion group was 156 days compared to 65 days for the placebo group. * Jaen CR, Cummings KM, Shah D, et al: Patterns of use of a free nicotine patch program for Medicaid and uninsured patients. J Natl Med Assoc 1997; 89:325-328. When used as intended, transdermal nicotine patches are effective in helping smokers to quit their habit. This was the conclusion of a study on the use and effectiveness of free nicotine patches for Medicaid and uninsured patients in five inner-city family practice offices and a nicotine dependence clinic in Western New York
Western New York refers to the westernmost region of New York State. . Patients were monitored for patterns of patch use, side effects, associated behaviors with cessation, and self-reported abstinence from smoking for 6 months. Most of the participants (90%) said the patch was helpful, and 14% did not smoke for 6 months or longer. * Kawakami M: Awareness of the harmful effects of smoking and views on smoking cessation intervention among Japanese medical students. Intern Med 2000; 39:720-726. Japanese medical students receive an unsatisfactory mark due to a lack of interest in the harmful effects of smoking and future intentions to perform smoking intervention. An anonymous questionnaire was given to second- and fifth-year Japanese medical students to clarify attitudes toward the harmful effects of smoking and to stress the importance of medical intervention. Of the 1,137 students polled in the second year, smoking prevalence was 8.8% in women and 25.1% in men, and 9.3% and 43.1%, respectively, in the fifth year. A majority of students thought that smoking is detrimental to health, but those who were current smokers were more likely to believe smoking is not as harmful as reported. Although knowledge of smoking-related diseases increased by the fifth year, < 50% of the students associated such maladies as pulmonary, emphysema emphysema (ĕmfĭsē`mə), pathological or physiological enlargement or overdistention of the air sacs of the lungs. A major cause of pulmonary insufficiency in chronic cigarette smokers, emphysema is a progressive disease that commonly , coronary heart disease, peptic ulcer, and neonatal death with smoking. Only one-third of the medical students polled stated an interest in smoking cessation counseling, but 90% stated that they would perform smoking intervention in their practice. Seventy percent of those questioned thought that, depending on the disease, physicians should carry out smoking cessation advice. Nonsmokers thought more actively than current smokers about smoking intervention. * Klesges LM, Johnson KC, Ward KD, et al: Smoking cessation in pregnant women. Obstet Gynecol Clin North Am 2001; 28:269-282. Healthcare providers can reduce the public health burden of fetal exposure to tobacco by using office-based, community-based, and pharmacologic cessation intervention programs for their pregnant patients. Pregnant women who smoke cigarettes significantly decrease the risks of fetal growth retardation, preterm preterm /pre·term/ (-term´) before completion of the full term; said of pregnancy or of an infant. pre·term adj. delivery, and perinatal mortality by smoking cessation; healthcare providers should screen and counsel every patient. Useful handouts are available for patients, as well as materials to help the provider develop an office-based intervention strategy. Women who quit smoking during pregnancy benefit from social support systems and relapse prevention methods in maintaining their long-term cessation efforts. * Orleans CT, Boyd MR, Bingler R, et al: A self-help intervention for African-American smokers: tailoring cancer information service counseling for a special population. Prev Med 1998; 27(5 Pt 2):S61-S70. Tailored cessation intervention plans prove to be successful for African-American smokers. A 2-year study designed to determine the effectiveness of culturally sensitive and tailored counseling strategies among African-American smokers (n = 1,422) was conducted using data collected from four regional Cancer Information Service (CIS Cis (sĭs), same as Kish (1.) (1) (CompuServe Information Service) See CompuServe. (2) (Card Information S ) offices. Participants were randomly assigned to receive either counseling and a guide (Pathways to Freedom) customized to the quitting needs and barriers faced by African-American smokers or the standard CIS quit smoking counseling and guide (Clearing the Air). A 12-month follow-up (n = 445) revealed a higher quit rate for tailored (25.0%, P= .034) than for standard counseling (15.4%). * Perkins KA, Gerlach D, Broge M, et al: Quitting cigarette smoking produces minimal loss of chronic tolerance to nicotine. Psychopharmacology psychopharmacology (sī'kōfär'məkŏl`əjē), in its broadest sense, the study of all pharmacological agents that affect mental and emotional functions. (Berl) 2001; 158:7-17. Smokers' tolerance to the effects of nicotine does not disappear quickly, and normal sensitivity may not return for 5 years or longer after smoking cessation. These findings are based on 3 studies of changes in men and women's responses to nicotine days, weeks, and years after smoking cessation. * Shiffman S, Elash CA, Paton SM, et al: Comparative efficacy of 24-hour and 16-hour transdermal nicotine patches for relief of morning craving. Addiction 2000; 95:1185-1195. Wearing a 21 mg nicotine patch for 24 hours Adv. 1. for 24 hours - without stopping; "she worked around the clock" around the clock, round the clock (one during the day and one at night) controls smoking craving and reduces anxiety, irritability, and restlessness better than the 15 mg/16-hour patch. The 21 mg/24-hour dosage also resulted in longer abstinence. These results are obtained from a study of 244 smokers for a week of baseline and 2 weeks after quitting smoking, recording craving and withdrawal symptoms several times each day on palm-top computers. Two over-the-counter nicotine patches were used according to instructions. * Smith SS, Jorenby DE, Fiore MC, et al: Strike while the iron is hot: can stepped-care treatments resurrect relapsing smokers? J Consult Clin Psychol 2001; 69:429-439. High-risk smokers (those who may relapse back to smoking) benefit more from motivational interviewing/supportive therapy (MIS) than cognitive-behavioral/skill training therapy (CBT (Computer-Based Training) Using the computer for training and instruction. CBT programs are called "courseware" and provide interactive training sessions for all disciplines. ). Two types of smoking cessation intervention regimes were tested and compared. Findings reveal that of the 677 smokers treated, neither MIS nor CBT regimes improved long-term abstinence from smoking relative to brief intervention (3 brief individual smoking cessation counseling sessions). The hypothesis that high-risk smokers would benefit more from MIS than CBT found minor support in this study. * Solberg LI: Tobacco: use, prevention, and cessation (guideline series). Postgrad Med 1997; 101:292-302. Healthcare providers' support of tobacco use cessation efforts will contribute more to the good health of patients than all the advances made in cancer and heart disease during the past quarter of a century. Clinical intervention includes asking patients about tobacco use at every opportunity, advising all users to stop, assisting in efforts to quit, and arranging for follow-up. An intervention system is expected to result in a 10% cessation rate, with 20% attainable. Patient education materials and prices are listed. Information is taken from Institute for Clinical Systems Integration guidelines originally published in 1993 and 1996. * Sommese T, Patterson JC: Acute effects of cigarette smoking withdrawal: a review of the literature. Aviat Space Environ Med 1995; 66:164-167. Responses to nicotine withdrawal are mostly psychological and/or physiological and can be a health hazard in some jobs. Smoking affects heart rate, arousal, vasoconstriction vasoconstriction /vaso·con·stric·tion/ (-kon-strik´shun) decrease in the caliber of blood vessels.vasoconstric´tive va·so·con·stric·tion n. , vigilance, concentration, energy, stress, and irritability. Although the severity of symptoms varies, withdrawal causes a decrease in carboxyhemoglobin carboxyhemoglobin /car·boxy·he·mo·glo·bin/ (-he´mo-glo?bin) hemoglobin combined with carbon monoxide, which occupies the sites on the hemoglobin molecule that normally bind with oxygen and which is not readily displaced from the molecule. , digit recall, serial additions/subtraction, and job satisfaction. Withdrawal also results in increased blood pressure, depression, absenteeism, caloric caloric /ca·lo·ric/ (kah-lor´ik) pertaining to heat or to calories. ca·lor·ic adj. 1. Of or relating to calories. 2. Of or relating to heat. intake, craving, aggressiveness, confusion, and impulsivity. This is a review of the literature relating to physiological, cognitive, behavioral, and psychological effects of smoking cessation on aviators before and during flight. Tonnesen P, Mikkelsen KL: Smoking cessation with four nicotine replacement regimes in a lung clinic. Eur Respir J 2000; 16:717-722. A 15 mg nicotine patch proves to be the most effective smoking cessation method when compared to three other nicotine replacement regimes. A study involving 446 smokers [>9 cigarettes per day (-1)] recruited to determine which nicotine replacement method would be the most successful, easily implemented in other lung clinics with minimal cost, took place over a 12-month period. The treatment program consisted of 4 treatment arms: a 15 mg patch, nicotine inhaler, a 15 mg patch and an inhaler inhaler /in·hal·er/ (in-hal´er) 1. an apparatus for administering vapor or volatilized medications by inhalation. 2. ventilator (2). in·hal·er n. , and a 5 mg patch ('placebo'), all of which were combined with minimal nurse-managed behavioral support. At the 12-month follow-up, smoking prevalence was 6% for the 5 mg patch ('placebo'), 16% (15 mg patch; P = .05), 9% (inhaler) and 11% (15 mg patch and inhaler). The regime with the 15 mg patch more than doubled the cessation success rate when compared to the placebo. * Ussher M, Nunziata P, Cropley M, et al: Effect of a short bout of exercise on tobacco withdrawal symptoms and desire to smoke. Psychopharmacology (Berl) 2001; 158:66-72. Ten minutes of exercise can reduce smoking desire and withdrawal symptoms in smokers attempting to give up their habit. Results are based on a study of 78 smokers who rated their desire to smoke and withdrawal symptoms before, during, and after moderate exercise on a stationary cycle compared to control groups who did not exercise. Further Reading 1. Baska T, Madar R, Straka S, et al: Pharmacotherapy pharmacotherapy /phar·ma·co·ther·a·py/ (-ther´ah-pe) treatment of disease with medicines. phar·ma·co·ther·a·py n. Treatment of disease through the use of drugs. in smoking cessation. Bratisl Lek Lek (lĕk), northern arm of the Rhine River, 40 mi (64 km) long, branching from the Neder Rijn (Lower Rhine), central Netherlands, and flowing W into the Nieuwe Maas (New Meuse) River. It is navigable for its entire length. Listy 2001; 102:298-301 2. Bohadana A, Nilsson F, Rasmussen T, et al: Nicotine inhaler and nicotine patch as a combination therapy for smoking cessation: a randomized, double-blind, placebo-controlled trial. Arch Intern Med 2000; 160:3128-3134 3. Carter CL, Key J. Marsh L, et al: Contemporary perspectives in tobacco cessation: what oncologists need to know. The Oncologist 2001; 6:496-505 4. Clark MA, Rakowski W, Kviz FJ, et al: Age and stage of readiness for smoking cessation. J Gerontol B Psychol Sci Soc Sci 1997; 52:S212-5221 5. Goldstein MG, DePue JD, Monroe AD, et al: A population-based survey of physician smoking cessation counseling practices. Prev Med 1998; 27(5 Pt 1):720-729 6. Hughes JR, Lesmes GR, Hatsukami DK, et al: Are higher doses of nicotine replacement more effective for smoking cessation? Nicotine Tob Res 1999; 1:169-174 7. Hymowitz N, Cummings KM, Hyland A, et al: Predictors of smoking cessation in a cohort of adult smokers followed for five years. Tob Control 1997;6 (Suppl 2):S57-S62 8. Jorenby DE, Fiore MC: The agency for health care policy and research smoking cessation clinical practice guideline: basics and beyond. Prim Care 1999; 26:513-528 9. Kadowaki T, Watanabe M, Okayama A, et al: Effectiveness of smoking-cessation intervention in all of the smokers at a worksite in Japan. Ind Health 2000; 38:396-403 10. Killen JD, Fortmann SP, Schatzberg AF, et al: Nicotine patch and paroxetine paroxetine /par·ox·e·tine/ (pah-rok´se-ten) a selective serotonin uptake inhibitor used as the hydrochloride salt to treat depression and obsessive-compulsive, panic, and social anxiety disorders. for smoking cessation. J Consult Clin Psychol 2000; 68:883-889 11. Lerman C, Gold K, Audrain J, et al: Incorporating biomarkers of exposure and genetic susceptibility into smoking cessation treatment: effects on smoking-related cognitions, emotions, and behavior change. Health Psychol 1997; 16:87-99 12. McVey D, Stapleton J: Can anti-smoking television advertising affect smoking behaviour? Controlled trial of the Health Education Authority for England's anti-smoking TV campaign. Tob Control 2000; 9:273-282 13. Mendez D, Warner KE, Courant Cou`rant´ a. 1. (Her.) Represented as running; - said of a beast borne in a coat of arms. n. 1. A piece of music in triple time; also, a lively dance; a coranto. 2. PN: Has smoking cessation ceased? Expected trends in the prevalence of smoking in the United States. Am J Epidemiol 1998; 148:249-258 14. Ossip-Klein DJ, McIntosh S, Utman C, et al: Smokers ages 50+: who gets physician advice to quit? Prey Med 2000; 31:364-369 15. Pickworth WB, Fant RV, Nelson RA, et al: Pharmacodynamic effects of new de-nicotinized cigarettes. Nicotine Tob Res 1999; 1:357-364 16. Pomerleau OF, Pomerleau CS, Marks JL: Abstinence effects and reactivity to nicotine during 11 days of smoking deprivation. Nicotine Tob Res 2000; 2:149-157 17. Royce JM, Ashford A, Resnicow K, et al: Physician-and nurse-assisted smoking cessation in Harlem. J Natl Med Assoc 1995; 87:291-300 18. Serraino D, Franceschi S, Tassan M, et al: Cigarette smoking recidivism recidivism: see criminology. after participation in the Five-Day Plan to Stop Smoking in northeastern Italy. Prev Med 1993; 22:272-283 19. van den Berkmortel FW, Bootsma GP, Heijdra YF, et al: Smoking cessation: which aids are worthwhile? Neth J Med 2000; 57:198-205 20. Westmass JL, Nath V, Brandon TH: Contemporary smoking cessation. Cancer Control 2000; 7:56-62 MORTALITY * Enstrom JE, Heath CW Jr: Smoking cessation and mortality trends among 118,000 Californians, 1960-1997. Epidemiology 1999; 10:500-512. The impact of smoking cessation on population death rates appears to be less than expected. A 38-year follow-up cohort study involving 66,751 women and 51,343 men was conducted to assess the impact of smoking cessation on mortality. Subjects enrolled in the 1959 American Cancer Society American Cancer Society, n.pr established in 1913, this national volunteer-based health organization is committed to the elimination of cancer through prevention and treatment and to diminishing cancer suffering through advocacy, scholarship, research, Cancer Prevention Study were followed through 1997. The age-adjusted death rate was calculated as deaths per 1,000 person-years. Death rates were compared among all participants who were smoking at the time the study began (many had quit smoking as of 1997) with that of never-smokers. The death rate for all causes among men who smoked fell from 20.67 during 1960-1969 to 18.68 during 1960-1997. Never-smokers' death rate also declined from 10.51 to 9.46. There was an increase in lung cancer death rates among men smokers. (1.558 to 1.728) and never-smokers (0.127 to 0.133). Female smokers' death rates climbed from 9.54 to 10.14 and declined from 6.95 to 6.44 in never-smokers. There was a significant increase in lung cancer death r ates for women smokers (0.208 to 0.806), while never-smokers increased from 0.094 to 0.116. In this large cohort there appeared to be no significant decline for either the relative or absolute death rates for lung cancer or for all causes, in spite of the increased degree of smoking cessation observed. This indicates that although smoking cessation greatly reduces mortality risks among long-term former smokers, it has not displayed significant changes in overall population mortality rates. * Van Domburg RT, Meeter K, van Berkel DF, et al: Smoking cessation reduces mortality after coronary artery bypass surgery Coronary artery bypass surgery, also coronary artery bypass graft surgery, and colloquially heart bypass or bypass surgery is a surgical procedure performed to relieve angina and reduce the risk of death from coronary artery disease. : a 20-year follow-up study. J Am Coll Cardiol 2000; 36:878-883. Former smokers who do not smoke after coronary artery bypass graft coronary artery bypass graft n. Abbr. CABG A surgical procedure in which a section of vein or other conduit is grafted between the aorta and a coronary artery below the region of an obstruction in that artery. (CABG CABG coronary artery bypass graft. CABG abbr. coronary artery bypass graft CABG Coronary artery bypass graft, see there ) surgery increase their probability of survival 3% at 5 years and 14% at 15 years. They are also less likely to require additional CABG surgery or percutaneous coronary angioplasty procedures (RR = 1.41; 95% CI=1.02-1.94). Patients who continue to smoke after CABG surgery have a greater relative risk of death from all causes (RR = 1.68; 95% CI=1.33-2.13) and from cardiac death (RR = 1.75; 95% CI=1.30-2.37). Smoking status before surgery did not affect mortality rate. These conclusions are based on a study of 1,041 patients who had CNBG surgery during 1971-1980. * Yu GP, Ostroff JS, Zhang ZF, et al: Smoking history and cancer patient survival: a hospital cancer registry study. Cancer Detect Prev 1997; 21:497-509. Cancer survival rates increase for patients who kick the habit. A study involving 25,436 individuals diagnosed with cancer (12,447 males and 12,989 females) reveals that cancer mortality rates The introduction to this article provides insufficient context for those unfamiliar with the subject matter. Please help [ improve the introduction] to meet Wikipedia's layout standards. You can discuss the issue on the talk page. jump to 1.55 times for males and 1.43 for females who smoke when compared to never-smokers. White and nonwhite patients with oral or breast cancer had a better prognosis than black patients when associated with smoking. A dose-response effect was observed between never-smoking and cancer survival. The study suggests that smoking cessation is a potential means of improving cancer patient outcomes especially from pancreatic, oral, breast and prostatic cancers. MUSCULOSKELETAL musculoskeletal /mus·cu·lo·skel·e·tal/ (-skel´e-t'l) pertaining to or comprising the skeleton and muscles. mus·cu·lo·skel·e·tal adj. Relating to or involving the muscles and the skeleton. SYSTEM/OSTEOPOROSIS * Cornuz J, Feskanich D, Willett WC, et al: Smoking, smoking cessation, and risk of hip fracture in women. Am J Med 1999; 106:311-314. It takes 10 years for the risk of hip fracture to decrease in former smokers. In a study of more than 100,000 women, smoking habits and hip fractures were correlated. Smokers' relative risk of hip fracture is 1.3 (95% CI= 1.0-1.7) compared to non-smokers, and smoking 25 or more cigarettes per day increases the relative risk to 1.6 (95% CI=1.1-2.3). Relative risk is reduced by adjusting for factors such as body mass index, menopausal status, estrogen use, physical activity, and calcium/alcohol/caffeine consumption. This research project examined smoking habits and incidence of hip fractures among 116,229 female nurses 34-59 years of age followed for up to 12 years. * Ward KD, Klesges RC: A meta-analysis of the effects of cigarette smoking on bone mineral density bone mineral density n. See bone density. bone mineral density A measurement of bone mass, expressed as the amount of mineral–in grams divided by the area scanned in cm2. See Bone densitometry. . Calcif Tissue Int 2001; 68:259-270. Smoking cessation may at least partially reverse bone loss and fracture risk. After controlling for several confounding variables, the bone mass of smokers is lower than that of non-smokers. The difference is particularly pronounced at the hip. The bone mass of former smokers is in between that of current smokers and that of never-smokers, suggesting that smoking cessation is associated with an increased bone mass. Effects of smoking on bone mass are seen most commonly in men and in the elderly. Smoking increases the lifetime risk of vertebral ver·te·bral adj. 1. Of, relating to, or of the nature of a vertebra. 2. Having or consisting of vertebrae. 3. Having a spinal column. fracture by 32% in men and by 13% in women. Lifetime possibility of hip fracture is even greater, with risks of 40% in men and 31% in women. This article reviews the published literature examining the association between cigarette smoking and bone mass and includes data on 40,753 subjects from 86 studies. Further Reading 1. Lahad A, Malter AD, Berg AO, et al: The effectiveness of four interventions for the prevention of low back pain. JAMA JAMA abbr. Journal of the American Medical Association 1994; 272:1286-1291 NEUROLOGICAL SYSTEM * Glassman SD, Anagnost SC, Parker A, et al: The effect of cigarette smoking and smoking cessation on spinal fusion. Spine 2000; 25:2608-2615. Patients who stop smoking after lumbar surgery significantly improve their spinal fusion outcome. While the nonunion rate for never-smokers is 14.2%, the rate for smokers is 26.5% (P < .05). Abstaining from smoking for more than 6 months after surgery decreases the nonunion rate to 17.1%. Seventy-five percent of quitters who maintained tobacco cessation for more than 6 months after surgery were able to return to work, as opposed to 53% of smokers. These results are based on a study of 357 patients who had a posterior instrumented fusion at L4-L5 or L4-S1 between 1992 and 1996. * Kawachi I, Colditz GA, Stampfer MJ, et al: Smoking cessation and decreased risk of stroke in women. JAMA 1993; 269:232-236. Smoking is associated with an increased risk of strokes in women, and smoking cessation reduces this risk by about half. The relative risks for current smokers compared to never-smokers and to former smokers are 2.58 (95% CI=2.08-3.19) and 1.34 (95% CI=1.04-1.73) respectively. Within two to four years after smoking cessation, the excess risks are essentially back to baseline. Number of cigarettes smoked, age at starting, and other risk factors appear to have no effect on the declining stroke risk after cessation. These are the results of a 12-year study of 117,006 female registered nurses 30-55 years of age and free of coronary heart disease, stroke, and cancer at baseline. ORAL DISEASES * Brothwell DJ: Should the use of smoking cessation products be promoted by dental offices? an evidence-based report. J Can Dent Assoc 2001; 67:149-155. A review of the current literature reveals that smoking cessation positively affects periodontal outcomes and that quitting is beneficial to dental health. There is strong evidence that smoking cessation intervention plans incorporated into routine patient care will benefit patients who are attempting to quit. * Gelskey SC: Tobacco-use cessation programs and policies at the University of Manitoba's faculty of dentistry The Faculty of Dentistry of Alexandria University was founded in 1971. It is the dental school that serves the city of Alexandria, Egypt, located in El Azareta near the famous Alexandria Library. . J Can Dent Assoc 2001; 67:145-148. Smoking cessation intervention and counseling can help achieve quit rates of 15%-20%. Unfortunately, many dentists do not offer tobacco-use cessation counseling because of inadequate training. The University of Manitoba Location The main Fort Garry campus is a complex on the Red River in south Winnipeg. It has an area of 2.74 square kilometres. More than 60 major buildings support the teaching and research programs of the university. has overcome this barrier by implementing smoking cessation training classes into the curriculum. Along with a provincial fee code, the faculty at the University of Manitoba has provided graduate students' training to prescribe bupropion HCI (Human Computer Interaction) Refers to the design and implementation of computer systems that people interact with. It includes desktop systems as well as embedded systems in all kinds of devices. (Zyban), in consultation with the patient's primary provider. PREGNANCY * Hartmann DE, Thorp JM Jr, Pahel-Short L, et al: A randomized controlled trial of smoking cessation intervention in pregnancy in an academic clinic. Obstet Gynecol 1996; 87:621-626. A physician-based smoking cessation intervention for pregnant women who smoke proves to be not only successful but both cost effective and easy to implement. In a controlled study, 250 pregnant patients who smoked took part in a randomly assigned smoking intervention program. Of these, 20% of the patients receiving intervention succeeded in their attempts to quit smoking and 10% of the control group achieved smoking cessation, both of which were confirmed by CO level (P=.052). Fifty-one percent of the intervention group decreased their cigarette consumption by half compared to 30% of the control group (P= .002). Faculty of the North Carolina Women's Hospital conducted this study. * Lumley J, Oliver S, Waters E: Interventions for promoting smoking cessation during pregnancy. Cochrane Database Syst Rev 2000; CD001055. A review of the literature reveals that smoking cessation during pregnancy reduces the occurrence of low birth weight and preterm births. Of the 44 trials identified in the review, 37 studies provided statistical data on 16,916 women for smoking cessation and/or perinatal outcomes. There was a significant amount of success in smoking reduction for women randomized in the intervention group, (odds ratio = 0.53; 95% CI=0.47 to 0.60), revealing a difference of 6.4% of women who continued to smoke after intervention. Eight trials were identified with confirmed smoking cessation and high quality score; a high intensity intervention revealed an OR of 0.53, 95% CI=0.44 to 0.63 and a total difference in sustained smoking of 8.1%. A reduction in low birth weight was observed in the subset of trials on fetal outcome (OR=0.80; 95% CI=0.67 to 0.95). A reduction in preterm births was also reported (OR=0.83; 95% CI=0.69 to 0.99). Mean birth weight increased by 28 g (95% CI=9 to 49). No effect for very low birth weight or p erinatal mortality was detected. There was no indication of the effect on continued smoking and adjusted mean birth weight. Information for this review was extrapolated from the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Tobacco Addiction Group trials register. * Wisborg K, Henriksen TB, Jespersen LB: Nicotine patches for pregnant smokers: a randomized controlled study. Obstet Gynecol 2000; 96:967-971. Compared to placebos, nicotine patches administered to pregnant women who smoke more than 10 cigarettes per day may be associated with increased birth weight. A randomized study involving 250 pregnant women smokers (>10 cigarettes/day) was conducted to determine the effect of nicotine on birth weight and preterm delivery, and the effect nicotine patches had on pregnant women who smoked. The intervention group (n = 124) received 15 mg nicotine patches for 8 weeks and 10 mg patches for 3 weeks, while the control group (n = 126) received placebos. Collectively, 26% of the subjects quit smoking, of which 14% were still smoke-free at the 1-year follow-up, with no difference observed between the placebo and nicotine groups. The mean birth weight of the nicotine group was higher than that of the placebo group, 186 g (95% CI=35 g - 336 g). Preterm deliveries displayed no difference when the placebo and nicotine groups were compared. Nicotine patches proved to be an ineffective smoking cessation intervention for pregn ant women. Further Reading 1. Grimley DM, Bellis JM, Raczynski JM, et al: Smoking cessation counseling practices: a survey of Alabama obstetrician-gynecologists. South Med J 2001; 94:297-303 2. Lindqvist R, Aberg H: Who stops smoking during pregnancy? Acta Obstet Gynecol Scand 2001; 80:137-141 RESPIRATORY/PULMONARY SYSTEMS * Kanner RE, Connett JE, Williams DE, et al: Effects of randomized assignment to a smoking cessation intervention and changes in smoking habits on respiratory symptoms in smokers with early chronic obstructive pulmonary disease chronic obstructive pulmonary disease n. Abbr. COPD A chronic lung disease, such as asthma or emphysema, in which breathing becomes slowed or forced. : the Lung Health Study. Am J Med 1999; 106:410-416. Smokers with early chronic obstructive pulmonary disease (COPD COPD chronic obstructive pulmonary disease. COPD abbr. chronic obstructive pulmonary disease Chronic obstructive pulmonary disease (COPD) ) can expect significant reductions in coughing, phlegm phlegm humor effecting temperament of sluggishness. [Medieval Physiology: Hall, 130] See : Laziness production, wheezing Wheezing Definition Wheezing is a high-pitched whistling sound associated with labored breathing. Description Wheezing occurs when a child or adult tries to breathe deeply through air passages that are narrowed or filled with mucus as a , and shortness of breath Shortness of Breath Definition Shortness of breath, or dyspnea, is a feeling of difficult or labored breathing that is out of proportion to the patient's level of physical activity. within a year if they quit smoking. Behavior modification, ipratropium bromide inhaler, and nicotine chewing gum are effective in maintaining smoking cessation. These conclusions are based on a 5-year study of 5,887 male and female smokers with early COPD 35-60 years of age. At the end of the study, 22% of the intervention subjects had sustained smoking cessation, compared with 5% in the usual-care group, who were only advised to stop smoking. The smoking cessation group also exhibited fewer respiratory symptoms. * Mapel DW, Hurley JS, Frost FJ, et al: Health care utilization in chronic obstructive pulmonary disease. Arch Intern Med 2000; 160:2653-2658. Smoking cessation reduces rates of respiratory symptoms and infections, overall decline in pulmonary function, risk of coronary artery disease, respiratory and nonrespiratory tract cancers, and neurovascular disease in chronic obstructive pulmonary disease (COPD). In spite of the data, managed care organizations often do not provide smoking cessation treatment. In the study group, cases were significantly more likely to be current or former cigarette smokers; 46% of cases vs 13.5% of controls were current smokers. Results are based on a case-control study examining inpatient, outpatient, and pharmacy utilization for 1,522 COPD patients enrolled in a health maintenance organization during 1997. Further Reading 1. Godtfredsen NS, Lange P, Prescott E, et al: Changes in smoking habits and risk of asthma: a longitudinal population based study. Eur Respir J 2001; 18:549-554 2. Hecht SS, Carmella SG, Chen M, et al: Quantitation of urinary metabolites Metabolites Substances produced by metabolism or by a metabolic process. Mentioned in: Interactions of a tobacco-specific lung carcinogen carcinogen: see cancer. carcinogen Agent that can cause cancer. Exposure to one or more carcinogens, including certain chemicals, radiation, and certain viruses, can initiate cancer under conditions not completely understood. after smoking cessation. Cancer Res 1999; 59:590-596 3. Scanlon PD, Connett JE, Waller LA, et al: Smoking cessation and lung function in mild-to-moderate chronic obstructive pulmonary disease. The Lung Health Study. Am J Respir Crit Care Med 2000; 161(2 Pt 1):381-390 SURGERY * Moller AM, Villebro N, Pedersen T, et al: Effect of preoperative pre·op·er·a·tive adj. Preceding a surgical operation. preoperative preceding an operation. preoperative care the preparation of a patient before operation. smoking intervention on postoperative complications: a randomized clinical trial randomized clinical trial, n a clinical study where volunteer participants with comparable characteristics are randomly assigned to different test groups to compare the efficacy of therapies. . Lancet 2002; 359:114-117. Smoking cessation reduces complications following surgery. Patients who stop smoking or reduce smoking by 50% have significantly fewer postoperative problems than do their smoking counterparts. Effects are evident in reduction of wound-related complications (5% vs 31%, P=.001), cardiovascular complications (0% vs 10%, P=.08), and secondary surgery (4% vs 15%, P=.07). Results are reported from 120 patients in Denmark randomly assigned to a control or intervention group and monitored for occurrence of cardiopulmonary, renal, neurological, or surgical complications and for duration of hospital admittance Admittance The ratio of the current to the voltage in an alternating-current circuit. In terms of complex current I and voltage V, the admittance of a circuit is given by Eq. (1), and is related to the impedance of the circuit Z by Eq. (2). . * Woodside JR: Female smokers have increased postoperative narcotic requirements. J Addict Dis 2000; 19:1-10. Although smoking cessation unquestionably un·ques·tion·a·ble adj. Beyond question or doubt. See Synonyms at authentic. un·ques  tion·a·bil delivers a number of
health benefits, it does not decrease the need for narcotics in
controlling pain after surgery. Smokers and former smokers require about
2 mg more narcotics per 12 hour period than do non-smokers (13.1 mg,
13.0 mg, and 10.9 mg, respectively). These results were obtained from a
study of 169 female patients who had pelvic surgery. A telephone survey
provided information about tobacco use, and hospital charts were sources
of information about postoperative narcotic use.
* Please see also under Neurological: Glassman SD, Anagnost SC, Parker A, et al: The effect of cigarette smoking and smoking cessation on spinal fusion. Spine 2000; 25:2608-2615. TEENS AND ADOLESCENTS * Derman U, Demir G, Akan P: Is awareness of its risk enough to stop people from smoking? J Cancer Educ 1995; 10:68-70. Family members and environment are more important influences on smoking behavior than is risk awareness. In a study of male and female medical school students, 99% knew that smoking increases the risk for lung and laryngeal cancers; 44% believed that smoking cessation could reduce the number of lung cancers by one-half. Yet only 58.3% of smokers would discourage younger siblings from smoking; 87.5% of nonsmokers stated they would try to discourage the habit among family members. About twice as many mothers and siblings of the smoking group were smokers, and half the fathers in both groups were smokers. Information was collected from 100 graduating medical school students at the Cerrahpasa Medical School of Istanbul in 1993. * Edvardsson I, Hakansson A: Development of school children's smoking habits: questionnaire studies in intervention and control groups. Acta Paediatr 2000; 89:1257-1261. Smoking cessation intervention in the classroom reduces prevalence of smoking among sixth-graders by 33%. In a study of Swedish school children followed from sixth to eighth grade, girls' smoking increased from 1% to 12% and boys' smoking from 2% to 7% if no intervention was introduced. At the two-year follow-up, the proportion of those who continued to smoke in the intervention group was two-thirds that of those who were in the control group. This research examined 2,000 school children's smoking habits during 1994-1996 in which 59 schools had two visits of 80 minutes each from a smoking cessation campaigner and 21 schools had no visits. Further Reading 1. Klein JD, Levine LJ, Allan MJ: Delivery of smoking prevention and cessation services to adolescents. Arch Pediatr Adolesc Med2001; 155:597-602 URINARY SYSTEM * Kasiske BL, Klinger D: Cigarette smoking in renal transplant recipients. J Am Soc Nephrol 2000; 11:753-759. Smoking cessation leads to plummeting disease and death rates for renal transplant patients. A study involving 1,334 patients who were smokers receiving a transplant between 1963 and 1997 revealed smoking more than 25 pack-years is associated with a 30% higher risk for graft failure when compared to subjects smoking less than 25 packyears or never-smokers (relative risk [RR]=1.30; 95% CI=1.04 to 1.63; P=.021). Of those who quit 5 years prior to transplantation, the RR dropped to 0.66 (95% CI=0.52 to 0.85; P<.001). Smoking 11 to 25 packyears before transplant increased the risk for major cardiovascular disease events by 1.56 (95% CI=1.06 to 2.31; P=.024). Smoking more than 25 pack-years almost doubled the cardiovascular disease risk (RR=2.14; 95% CI=1.49 to 3.08; P<.001). The invasive malignancy ratio was 1.91 (95% CI= 1.05 to 3.48; P= .032). The study concluded that smoking effects appear to dissipate 5 years after smoking cessation. Study data was extrapolated from Hennepin County Medical Center Hennepin County Medical Center (HCMC) is a Level I trauma center based in Minneapolis, Minnesota, the county seat of Hennepin County. The primary 422-bed facility is located on five city blocks across the street from the Hubert H. (Minn) recor ds. * Ostroff J, Garland J, Moadel A, et al: Cigarette smoking patterns in patients after treatment of bladder cancer. J Cancer Educ 2000; 15:86-90. Bladder cancer patients who are diagnosed in the early stages of disease are more likely to continue smoking than patients who are diagnosed in later stages. A study involving 224 previously treated bladder cancer patients revealed that in spite of the risks associated with continued smoking, 69% of the patients admitted they had smoked after being diagnosed. Of these, 45% stated they had smoked at the time of evaluation. Diagnosis at early stages correlated closely with continued patient smoking. Conversely, those who were diagnosed later in the disease stages were more likely to abstain from smoking (95% CI=1.08-7.25). It is important to assess the smoking status of patients who have bladder cancer and to determine the probability of continued smoking. Smoking increases the risk for treatment-related complications, second primary malignancies, recurrence, morbidity, and death. WEIGHT GAIN * Burke JP, Hazuda HP, Stern MP: Rising trend in obesity in Mexican-Americans and non-Hispanic whites: is it due to cigarette smoking cessation? Int J Obes Relat Metab Disord2000; 24:1689-1694. Smoking cessation increases body mass index. Mexican-Americans are twice as likely as non-Hispanic whites to become overweight or obese following smoking cessation: 7.4% vs 3.1%. Data was collected from 1,930 Mexican-Americans and 1,126 non-Hispanic whites in the San Antonio Heart Study, a population-based study of diabetes and cardiovascular disease. * Ferrara CM, Kumar M, Nicklas B, et al: Weight gain and adipose tissue metabolism after smoking cessation in women. IntJ Obes Relat Metab Disord2001; 25:1322-1326. Metabolic factors that determine the balance between fat storage and fat utilization contribute to weight gain associated with smoking cessation. In a study of 10 premenopausal pre·me·no·paus·al adj. Of or relating to the years or the stage of life immediately before the onset of menopause. premenopausal adjective women in a smoking cessation program, body weight had increased after 4 weeks (P < .05) with no change in waist/hip measurements or resting energy expenditure. Although no changes occurred in basal or stimulated lipolysis lipolysis /li·pol·y·sis/ (li-pol´i-sis) the splitting up or decomposition of fat.lipolyt´ic li·pol·y·sis n. pl. li·pol·y·ses The hydrolysis of lipids. in gluteal gluteal /glu·te·al/ (gloo´te-al) pertaining to the buttocks. glu·te·al adj. Of or relating to the buttocks. gluteal pertaining to the buttocks. or abdominal fat depots, gluteal adipose tissue lipoprotein lipase (AT-LPL) activity increased nearly threefold. Heightened LPL LPL - List Programming Language. LISP-like language with ALGOL-like syntax, for IBM 360. "LPL - LISP Programming Language", F.W. Blair et al, RC 3062, IBM TJWRC, Sep 1970. activity is the factor that may affect weight gain after smoking cessation. * Hill AL, Roe DJ, Taren DL, et al: Efficacy of transdermal nicotine in reducing post-cessation weight gain in a Hispanic sample. Nicotine Tob Res 2000; 2:247-253. Weight gain is often a deterrent for smoking cessation, especially in women. Along with minimizing craving, nicotine patches reduce weight gain in females trying to quit smoking. In a 10-week study of 108 Hispanic smokers and quitters, females (P .047) who received a nicotine transdermal patch gained weight at a slower rate than males (P=.87). * Perkins KA, Marcus MD, Levine MD, et al: Cognitive-behavioral therapy to reduce weight concerns improves cessation outcome in weight-concerned women. J Consult Clin Psychol 2001; 69:604-613. Women receiving cognitive-behavioral therapy (CBT) to reduce weight-gain concerns had higher continuous abstinence rates for smoking cessation at post-treatment and at 6 and 12 months of follow-up (56%, 28%, and 21%, respectively) compared to those receiving weight control therapy (44%, 18%, 13%, respectively) or standard counseling (31%, 12%, 9%, respectively). Reducing weight concerns will improve smoking cessation outcome in women concerned about gaining weight after quitting. These findings are based on a randomized clinical trial of 219 healthy women aged 18-65 years, smoking 10 cigarettes per day, and motivated to quit smoking but concerned about the weight gain associated with smoking cessation. They were assigned to one of three treatment groups: weight control, CBT, or standard counseling. * Russ CR, Fonseca VP, Peterson AL, et al: Weight gain as a barrier to smoking cessation among military personnel. Am J Health Promot 2001; 16:79-84. In some occupations, weight standards that need to be maintained may discourage smoking cessation. In an assessment of the relationships between active military duty, weight standards, weight gain, and smoking relapse, active military personnel are more likely to be concerned about weight gain associated with quitting smoking and also have a greater chance of relapse after quitting (odds ratio = 3.6; 95% CI=1.3-9.8). Results are based on a hospital-based tobacco cessation study of 250 men and women, 43% of whom were on active military duty. * Please see also under Intervention: Hays JT, Hurt RD, Rigotti NA, et al: Sustained-release bupropion for pharmacologic relapse prevention after smoking cessation: a randomized, controlled trial. Ann Intern Med 2001; 135:423433. Further Reading 1. Borrelli B, Spring B, Niaura R, et al: Influences of gender and weight gain on short-term relapse to smoking in a cessation trial. J Consult Clin Psychol 2001; 69:511-515. WOMEN'S ISSUES * Allen SS, Hatsukami D, Christianson D, et al: Effects of transdermal nicotine on craving, withdrawal and premenstrual premenstrual /pre·men·stru·al/ (pre-men´stroo-al) occurring before menstruation. pre·men·stru·al adj. Of or occurring in the period just before menstruation. symptomatology symptomatology /symp·to·ma·tol·o·gy/ (simp?to-mah-tol´ah-je) 1. the branch of medicine dealing with symptoms. 2. the combined symptoms of a disease. symp·to·ma·tol·o·gy n. in short-term smoking abstinence during different phases of the menstrual cycle. Nicotine Tob Res 2000; 2:231-241. Ovarian hormones may play a role in regard to nicotine withdrawal, sensitivity, and symptomatology in premenstrual women. A study was conducted to determine the effect of ovarian hormones in association with a transdermal nicotine patch. Thirty women were randomized and tested in different phases of their menstrual cycle (late luteal luteal /lu·te·al/ (loo´te-al) pertaining to or having the properties of the corpus luteum or its active principle. lu·te·al adj. Of, relating to, or involving the corpus luteum. or follicular phase) during 7 days of acute smoking abstinence. Premenstrual symptomatology and nicotine withdrawal symptoms were more severe in the late luteal phase. For women on the transdermal patch (as opposed to the placebo patch), premenstrual pain, water retention, and nicotine craving symptoms were diminished and the effect was greatest in the late luteal phase. Conversely, the greatest weight gain was reported in women during late luteal phase who were assigned the placebo patch. The nicotine transdermal patch appears to be more effective in reducing premenstrual symptoms and cravings in women during the late luteal phase than in the follicular phase of their menstrual cycle. Information for this study was extrapolated from dependent measures that included scores from the Minnesota Nicotine Withdrawal Scale, Questionnaire on Smoking Urges and Premenstrual Assessment Form, as well as weight. * Kos J, Hasenfratz M, Battig K: Effects of a 2day abstinence from smoking on dietary, cognitive, subjective, and physiologic parameters among younger and older female smokers. Physiol Behav 1997; 61:671-678. Tobacco cessation results in a greater caloric intake for housewives when compared to working women. A field study involving 59 women aged 25-35 and 55-65 years was conducted to determine the effects of smoking abstinence on dietary, cognitive, subjective, and physiologic parameters. Smoking cessation was associated with lower blood pressure, heart rate, and saliva cotinine levels. Subjectively, greater levels of negative strain, sleepiness, and craving for cigarettes were reported. The Stroop task test revealed that mental performance was unaffected by smoking abstinence. There was no change in the percentage of macronutrient macronutrient /mac·ro·nu·tri·ent/ (-noo´tre-ent) an essential nutrient required in relatively large amounts, such as carbohydrates, fats, proteins, or water; sometimes certain minerals are included, such as calcium, chloride, or sodium. intake. However, total intake of energy increased by 182 kcal/day. Employment status played a key role on excess caloric intake. During smoking abstinence, a greater craving for cigarettes and food was observed than in non-abstinence days and more so in housewives than in working women. No correlation between saliva cotinine, respiratory carbon monoxide and caloric intakes was observed. The availability of food products appeared to be the most important moderator of heightened dietary intake after smoking cessation, more so than any pharmacologic systemic effect of nicotine. * Morabia A, Costanza MC, Bernstein MS, et al: Ages at initiation of cigarette smoking and quit attempts among women: a generation effect. Am J Public Health 2002; 92:71-74. Young female smokers are more apt than older women to quit smoking. In this study of 3,676 females aged 35-74 years in Geneva Geneva, canton and city, Switzerland Geneva (jənē`və), Fr. Genève, canton (1990 pop. 373,019), 109 sq mi (282 sq km), SW Switzerland, surrounding the southwest tip of the Lake of Geneva. , Switzerland, those younger than 55 were more likely to be current or former smokers, to smoke more cigarettes per day than older women, and to have begun smoking before age 20. This same group was more likely to have tried to quit smoking before the age of 35 years. Healthcare providers should play an active role in reducing tobacco use by encouraging young smokers to quit and trying to prevent nonsmokers from starting. * Oncken CA, White WB, Cooney JL, et al: Impact of smoking cessation on ambulatory blood pressure Ambulatory blood pressure monitoring (ABPM) measures blood pressure at regular intervals throughout the day and night. It is believed to be able to reduce the white coat hypertension effect. and heart rate in postmenopausal post·men·o·paus·al adj. Of or occurring in the time following menopause. postmenopausal Change of life Gynecology adjective Referring to the time in ♀ when menstrual periods stop for ≥ 1 yr women. Am J Hypertens 2001; 14:942-949. Daytime systolic blood pressure and heart rates drop significantly after smoking cessation in postmenopausal women. Using a 3:1 randomization randomization (ranˈ·d  ·m scheme, researchers assigned 66 women to an immediate
smoking cessation group or to a wait list control group. The study was
designed to determine the impact of smoking cessation on ambulatory and
clinic blood pressure (BP) and heart rate (HR) in stage 1 hypertensive hypertensive /hy·per·ten·sive/ (-ten´siv)1. characterized by increased tension or pressure. 2. an agent that causes hypertension. 3. a person with hypertension. and normotensive normotensive /nor·mo·ten·sive/ (-ten´siv) 1. characterized by normal tone, tension, or pressure, as by normal blood pressure. 2. a person with normal blood pressure. postmenopausal women. Ambulatory and clinic 24-hr urinary catecholamine catecholamine (kăt'əkôl`əmēn), any of several compounds occurring naturally in the body that serve as hormones or as neutrotransmitters in the sympathetic nervous system. concentrations and BP and HR were taken at baseline and at 6 weeks. In the treated subjects who quit smoking (n=19) awake SBP SBP Spontaneous bacterial peritonitis, see there decreased by 3.6 +/- 1.9 mm Hg. Conversely, BP increased 1.7 +/- 2.4 mm Hg (P = .045) in subjects who continued to smoke (n=15). Daytime HR decreased in the smoking cessation group by 7 +/- 1 beats/min. However, no change occurred (0 +/- 1 beat/min) in the control group (P=.001). * Please see also under Intervention: Easton A, Husten C, Malarcher A, et al: Smoking cessation counseling by primary care women physicians: women physicians' health study. Women & Health 2001; 32:77-91. Further Reading 1. Mueller L, Ciervo CA: Smoking in women. J Am Osteopath osteopath /os·teo·path/ (os´te-o-path?) a practitioner of osteopathy. os·te·o·path or os·te·op·a·thist n. A physician practicing osteopathy. Assoc 1998; 98(Suppl 12) :S7-S1O |
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