非吸烟女性肺癌危险因素病例对照研究

目的 探讨浙江省非吸烟女性患肺癌的危险因素。方法 采用1∶2配对的病例对照研究,收集浙江省30个县（区）2005年11月-2008年12月期间发病的新发非吸烟女性肺癌病例229例;配对对照选取患者,女性邻居、年龄＆#177;3岁、无吸烟史。通过面访调查收集有关危险因素的暴露史,采用单因素及多因素 Logistic 回归模型进行拟合,筛选肺癌的主要危险因素。结果 单因素分析发现有15个暴露因素与非吸烟女性肺癌的发生有关。多因素及因子分析发现,被动吸烟（OR ＝1.598,95％CI：1.016～2.512）、家族肿瘤史（OR ＝5.359,95％CI：1.658～17.326）、呼吸道病史（OR ＝24.427,95％CI：6.111～97.642）、精神心理因素不良（OR ＝2.622,95％CI：1.149～5.983）、人际关系不佳（OR ＝3.041,95％ CI：1.534～6.032）、做饭时自感油烟重（OR ＝1.856,95％CI：1.043～3.301）、常食用腌晒食品（OR ＝1.724,95％CI：1.205～2.466）和初潮年龄晚（OR ＝1.565,95％CI：1.086～2.253）等因素是肺癌发生的危险因素;收入水平高（OR ＝0.650,95％CI：0.484～0.873）和常食用新鲜蔬菜（OR ＝0.683,95％CI：0.504～0.926）是肺癌的保护因素。趋势性检验发现,非吸烟女性被动吸烟与肺癌的相对危险度之间存在一定剂量反应关系。结论 针对非吸烟女性肺癌的相关危险因素,需采取综合干预措施,以降低肺癌的发生率。     

云南省白族居民归因于吸烟和被动吸烟的脑卒中经济负担研究

目的 分析云南省白族居民脑卒中与吸烟/被动吸烟的关系,估算出归因于吸烟/被动吸烟的脑卒中经济负担。方法 采用多阶段分层随机抽样方法,于2018年4-5月在云南省大理州剑川县抽取2501名≥35岁白族居民进行面对面问卷调查和体格检查。脑卒中直接经济负担的测算采用直接法,间接经济负担测算采用人力资本法 ,并与归因危险度 (PAR) 相结合测算归因于吸烟/被动吸烟的疾病经济负担。结果 云南省白族居民脑卒中患者的人均直接和间接负担分别为8720.33元和152.28元,总经济负担为101.653百万元,其中男性患者的人均直接经济负担高于女性（t=2.288, P=0.027）;多因素logistic回归分析结果显示,现在吸烟者和被动吸烟者患脑卒中的风险为非吸烟者和非被动吸烟者的3.596倍（OR=3.596,95%CI=2.468～5.238）和3.361倍（OR=3.361,95%CI=2.266～4.983）;归因于吸烟的脑卒中经济负担为44.920百万元,归因于被动吸烟的为33.802百万元。结论 云南省白族居民归因于吸烟和被动吸烟的脑卒中经济负担较重。采取有效措施减少吸烟和被动吸烟率,可进一步降低脑卒中的疾病经济负担。     

被动吸烟增加患癌危险

据英国的一份科学报告说,被动吸烟增加患肺癌的危险性。报告估计,从长远看,与吸烟者生活在一起的人比不与吸烟者生活在一起的人患肺癌的危险性高２６％,患心血管病的危险高２３％。父母吸烟的婴儿患致命综合症的危险性比非吸烟父母的高两倍,而患呼吸器官疾病的危险高...     

不同来源的被动吸烟与肺癌关系的研究

作者对１０４名非吸烟肺癌和１６３名对照进行了非条件ＬＯＧＩＳＴＩＣ回归分析以估计不同来源的被动吸烟对非吸烟肺癌的危险性。分析发现在不同来源的被动吸烟中，父母吸烟和工作场所接触吸烟者均对患肺癌无明显的影响；而暴露于配偶吸烟可使非吸烟者患肺癌危险性增加１．７７倍。结果提示，在不同来源的被动吸烟中，暴露于配偶的被动吸烟是导致非吸烟者尤其是女性肺癌的主要危险因素。     

吸烟与心电图改变关系的调查分析

本文对2504名年龄为16～60岁不同吸烟状况的男性工人进行了心电图改变的调查分析。结果发现吸烟者异常心电图的OR值为1.72(95%CI=1.40～2.11),吸烟指数与异常心电图危险呈剂量—反应关系。按照年龄、体重及饮酒状况分层分析后,心电图异常危险与吸烟之间的联系依然存在。吸烟者ST-T改变、传导阻滞及心律失常显著性增加,其OR值分别为2.94(95%CI=1.88～4.59)、2.18(95%CI=1.32～3.59)和1.75(95%CI=1.14～2.68)。戒烟者异常心电图危险低于吸烟者。提示吸烟是心血管病尤其是冠心病形成的独立危险因素,戒烟则是降低心血管病的保护因素之一。     

吸烟与结核病发病风险及戒烟后复吸的相关因素研究

目的 探讨吸烟与结核病发病风险和戒烟后复吸的危险因素.方法 对613例肺结核病例和1226例健康对照采用结构化问卷调查表进行调查.吸烟与结核病患病风险的关联采用Logistic回归分析,并用OR及其95％CI表示.戒烟者中复吸的危险因素采用Cox回归模型进行分析,并用风险比(hazard ratio,HR)及其95％ CI表示.Kaplan-Meier生存曲线用于比较不同治疗史和不同教育背景的病人戒烟后复吸风险的差异,并采用Log-rank法进行检验.结果 病例组中有吸烟史者(54.6％)高于对照组(45.1％),调整OR=1.93(95％ CI:1.51～2.48).尽管54.9％的结核病人在获知其结核病诊断后停止吸烟,但仍有18.4％的戒烟者在随访期内复吸,复吸高发于戒烟后6～9个月(6％)和12 ～15个月(11％).与受教育程度高和有过结核病治疗史的患者比较,受教育程度低和初治患者戒烟后复吸的风险增加,调整HR分别为3.48 (95％CI:1.28～9.47)和4.30(95％ CI:1.01～18.30).结论 吸烟是中国人群结核病预防和控制工作的一个重要因素,应当将控烟干预指导纳入现行的直接督导短程化疗(directly observed therapy shortcourse,DOTS)策略中去.     

老年人吸烟、饮酒与脑卒中的流行病学研究

目的 研究吸烟、饮酒及其他危险因素与脑卒中及其分型的关系。方法 对象为北京市万寿路地区60岁以上老年人群的分层随机抽样样本。共调查2096人，分析吸烟、饮酒及其他危险因素与脑卒中的关系。结果 单因素分析时吸烟的OR值为1.17(95％CI:1.01～1.35)。饮酒在男性脑卒中及脑梗塞的OR值(95％CI)分别是0.69(0.51～0.94)、0.71(0.52～0.98)；调整其他主要因素后，吸烟致脑卒中、脑出血的相对危险性OR值(9596CI)分别为1.19(1.02～1.39)、1.53(1.03～2.27)；饮酒似为脑卒中的保护因素，OR值(95％CI)为0.78(0.61～0.99)。另外与脑卒中有显著相关的危险因素包括年龄、收缩压、高密度脂蛋白、高血压、冠心病、糖尿病、高血脂、脑卒中家族史。结论 吸烟是脑卒中的危险因素，适量饮酒对其似有保护作用。     

妇女被动吸烟的健康影响

目的探讨被动吸烟对妇女的健康影响.方法于2002-2004年采用病例-对照的研究方法,对妇女被动吸烟与肺癌的关系、孕妇被动吸烟与足月出生小于胎龄儿的关系进行研究.妇女被动吸烟与肺癌的病例-对照研究收集北京、上海和成都指定医院经病理诊断确诊的肺癌新发住院病例157例,以1(肺癌病例):2(医院对照 人群对照)配对;孕妇被动吸烟与足月出生小于胎龄儿的病例-对照研究收集北京市足月分娩小于胎龄儿产妇155例,以1:1配对.结果妇女被动吸烟显著增加发生肺癌的相对危险性(OR=2.95),在24岁以前开始被动吸烟者发生肺癌的相对危险性显著增加(OR=4.12),经常吃动物内脏(OR=1.91)、职业接触有害物(OR=3.16)、职业接触粉尘(OR=3.41)、工作场所通风不良(OR=4.02)为非吸烟女性发生肺癌的危险因素.常吃蔬菜(OR=0.24)、常喝牛奶(OR=0.53)、经常服用维生素(OR=0.53)为非吸烟女性发生肺癌的保护因素.趋势性χ2检验显示,随着被动吸烟指数和被动吸烟年限的增加,肺癌的发生显著增加(P＜0.001).多因素条件Logistic逐步回归分析显示,被动吸烟指数≥50人·年、经常吃动物内脏、职业接触粉尘、工作场所通风不良是非吸烟女性发生肺癌的主要危险因素;常吃蔬菜、经常服用维生素是非吸烟女性发生肺癌的保护性因素.病例组与对照组在孕期体重增加少、孕期被动吸烟、工作场所通风不良、配偶身高较低和孕期进行胎教等方面的差异均有统计学意义(P＜0.01),产妇和配偶文化程度高、产妇孕前体重指数高、家庭总月收入高和孕期进行胎教等可能是足月出生小于胎龄儿的保护因素.多因素条件Logistic回归分析显示,产妇孕前体重低(OR=2.08)、孕期体重增加少(OR=2.83)、被动吸烟(OR=3.42)及孕期饮茶(OR=2.72)、孕期及怀孕之前3个月内进行染发、烫发或焗油(OR=5.67)、配偶身高较低(OR=2.92)等因素均使足月出生小于胎龄儿的相对危险性显著增加,是足月出生小于胎龄儿的主要危险因素;产妇孕前体重指数高使足月出生小于胎龄儿的相对危险性显著降低(OR=0.41),是足月出生小于胎龄儿的保护因素.结论被动吸烟是非吸烟女性发生肺癌的主要危险因素.孕期被动吸烟是足月出生小于胎龄儿的主要危险因素.     

吸烟与饮酒对肺癌发病的影响及交互作用

目的探讨吸烟与饮酒及其交互作用对肺癌发病的影响。方法在肿瘤高发地区开展以人群为基础的病例对照研究,通过调查问卷收集主要人口学、吸烟和饮酒等相关信息,采用非条件logistic回归分析计算比值比(OR)及95%CI,并分析吸烟与饮酒在肺癌发病中的交互作用。结果调整相关因素(包括饮酒)后,与不吸烟者相比,吸烟者患肺癌的风险增加(P0.05),吸烟≥40年者患肺癌的风险是不吸烟者的4.79倍,每日吸烟≥20支者患肺癌的风险是不吸烟者的4.44倍,吸烟至肺部者患肺癌风险是不吸烟者的4.44倍(P值均0.001)。调整变量(包括吸烟)后,饮酒和饮酒年限与肺癌发病之间无统计学关联(P0.05)。吸烟和饮酒相乘交互作用的OR值(95%CI)为0.90(0.47~1.70)。吸烟和饮酒相加交互作用的超额相对危险度(RERI)值及其95%CI为0.36(-0.92~1.64),交互作用归因比(AP)值及95%CI为0.09(-0.22~0.40),交互作用指数(SI)值及95%CI为1.13(0.71~1.80)。结论吸烟是肺癌发病的主要危险因素,且该风险随吸烟年限、吸烟量、吸烟深度的增加而显著增加,现有证据并不支持饮酒与肺癌发病之间存在关联,吸烟和饮酒在肺癌发病中也未见交互作用。     

吸烟及烟碱型乙酰胆碱受体亚单位α5基因rs17486278位点多态性对肺癌的交互作用

目的 探讨在中国男性人群中吸烟、烟碱型乙酰胆碱受体亚单位α5(CHRNA5)基因多态性与肺癌的关联及其交互作用.方法 采用成组病例对照研究设计,收集男性原发性肺癌病例204例,正常健康对照者821例.采用结构式问卷调查社会人口学特征、吸烟行为及健康状况等,采集静脉血检测CHRNA5 SNP位点rs17486278的多态性.应用多因素logistic回归模型分析吸烟、CHRNA5的基因多态性与肺癌的关系及其交互作用.结果 控制潜在混杂因素后,每天吸烟量＞15支者发生肺癌的风险高于不吸烟者(OR=3.49,95％CI:2.29～ 5.32),未发现CHRNA5上的rs17486278多态性与肺癌有统计学关联.进一步交互作用分析显示,每天吸烟量1～15支并携带rs17486278纯合变异基因型(CC)者对肺癌的发生存在正交互作用(OR=16.13,95％CI:1.27～205.33).根据rs17486278多态性和吸烟行为进行分层分析,与不吸烟并携带rs17486278野生基因型(AA)者相比,每天吸烟量1～15支并携带纯合变异基因型(CC)者、每天吸烟量＞15支并携带野生基因型(AA)者和每天吸烟量＞15支并携带杂合变异基因型(AC)者发生肺癌风险增高,OR直分别为8.14(95％CI:1.17 ～ 56.56)、3.84(95％CI:1.30～ 11.40)和5.32(95％CI:1.78 ～ 15.93).结论 在中国男性人群中CHRNA5的基因多态性与吸烟行为对肺癌的发生存在正交互作用.     

Household smoking restrictions and adolescent smoking

PURPOSE: To examine the association between household smoking restrictions and adolescent smoking, controlling for parental smoking, peer smoking, and tobacco marketing. DESIGN: Cross-sectional analysis of 1999 data from the Growing Up Today Study, a longitudinal cohort of adolescents. SETTING: Self-report questionnaire. SUBJECTS: 10,593 adolescents aged 12 to 18 years. MEASURES: The dependent variable was established smoking (smoking > or = 100 cigarettes). Variables of interest were household smoking restrictions, parental smoking, peer smoking, and tobacco promotional item (TPI) possession. RESULTS: Four percent of participants reported that their households permitted smoking. Parental smoking, peer smoking, and TPI possession were significantly associated with established smoking In logistic regression models adjusted for age, gender, peer smoking, and TPI possession, adolescent smoking was inversely related to the presence of a restrictive household policy (odds ratio [OR] = 0.67, 95% confidence interval [CI] = 0.48-0.93); however, when parental smoking was added to this model, the association was attenuated (OR = 0.94, CI = 0.65-1.35). When only one parent in the household smoked, smoking restrictions were more common when this parent was the father. CONCLUSIONS: Although household smoking restrictions offer health benefits, they do not appear to be associated with adolescent smoking after accounting for other factors. Prior studies did not include parental smoking, peer smoking, and marketing influences. This analytic difference may explain apparent contradictions in the literature.     

Household smoking bans and adolescents' perceived prevalence of smoking and social acceptability of smoking

OBJECTIVES: Household smoking bans might decrease the visibility of cigarette smoking and communicate nonsmoking social norms and parental attitudes to youths, which may serve as mediators to reduce smoking initiation. Whether they have these effects even if parents smoke or do not otherwise communicate strong disapproval of smoking to their children is not clear. We tested these hypotheses in multi-level analyses. METHODS: A telephone survey of a random sample of 3831 Massachusetts adolescents (12-17 years) assessed respondents' perceptions of smoking prevalence and attitudes about the social acceptability of smoking in their community. The association of these outcomes with the presence of a smoking ban in the youths' home was tested in multivariate analyses that adjusted for town-level clustering and individual and environmental characteristics. RESULTS: A household smoking ban was reported by 71% of all youths and 49% of youths who lived with smokers. In multivariate models, youths who had a household smoking ban were more likely to perceive a lower adult smoking prevalence (OR 2.1; 95% CI 1.7-2.5; P < 0.001), greater adult disapproval of adult smoking (OR 2.0; 1.5-2.6; P < 0.001) and of teen smoking (OR 1.5; 95% CI 1.2-1.9; P = 0.001). CONCLUSIONS: Among adolescents, a household smoking ban was associated with a lower perceived prevalence of adult smoking in their communities and more negative attitudes about the social acceptability of smoking, two factors that affect the likelihood of smoking initiation. Household smoking bans had these effects even in the presence of two parental factors known to encourage adolescent smoking initiation (parental smoking and lack of perceived parental disapproval of youth tobacco use). This provides an additional rationale for promoting household smoking bans to parents.     

Adolescent smoking

Most smokers start experimenting with cigarettes in early adolescence. This paper describes the factors which influence the development of the smoking habit. Methods of intervention, both in and out of the classroom, are discussed. Recommendations for further legislation and increased taxation on tobacco are supported.     

Excessive smoking

Ohne Zusammenfassung

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«La fumée du tabac en dose exagérée»

     

Berlin's medical students' smoking habits, knowledge about smoking and attitudes toward smoking cessation counseling

Background  

Diseases associated with smoking are a foremost cause of premature death in the world, both in developed and developing countries. Eliminating smoking can do more to improve health and prolong life than any other measure in the field of preventive medicine. Today's medical students will play a prominent role in future efforts to prevent and control tobacco use.     

Attitudes towards smoking policies and tobacco control measures in relation to smoking status and smoking behaviour

BACKGROUND: To examine support for various smoking policies and tobacco control measures among lifetime smokers in a country with weak anti-smoking legislation and an underdeveloped anti-smoking climate. METHODS: Current (n = 624) and former smokers (n = 131) from a general population survey filled in the 30-item Smoking Policy Index (SPI). Structural equation modelling was used to confirm the SPI factorial structure and to test whether smoking status and smoking behaviour variables were related to the six dimensions of the SPI. RESULTS: The dimension with the highest support was penalties for sales to minors. Sanctions against smokers had the lowest support. Current smokers compared with former smokers showed lower support on the taxes/fees, public education, and environmental restrictions dimensions while controlling for gender, age, and social status. Within current smokers, unfavourable smoking behaviours were associated with lower support. CONCLUSION: Even in a country with poor tobacco control conditions, lifetime smokers including smokers with highly unfavourable smoking behaviours strongly support smoking policies and tobacco control measures concerning penalties and advertising/promotion. These measures should be used to promote anti-smoking legislation, and strict law enforcement of these measures is expected to be accepted by all smokers. For measures that are not supported by all lifetime smokers, interventions may be useful to increase acceptability. A limitation of the present study is the absence of never-smokers as a comparison group.     

Meanings of smoking and adolescent smoking across ethnicities.

PURPOSE: To develop insight into population-specific meanings of smoking in our highly multicultural middle schools in order to provide effective and appropriate tools for smoking prevention efforts. METHODS: We used focus group interviews to develop the Meanings of Smoking Index (MSI), a nine-item scale that uses a "mark all that apply" strategy to assess what smoking means to children who have tried smoking as well as to those who are susceptible to smoking. In 24 public and parochial middle schools in the greater Los Angeles area, 2336 7th graders (1483 Latino, 565 Asian/ Pacific Islander and 288 white, 55.2% of the sample was female) completed the MSI as part of a school-based trial of culturally-targeted smoking prevention strategies. Items were rank ordered according to salience (rate of endorsement) and relevance (strength of relationship with lifetime smoking) across the entire sample and separately for Hispanic/Latino, Asian/Asian-American and white respondents. Spearman correlation coefficient was used to compare results between ethnicities. RESULTS: The most frequently endorsed meanings were similar across ethnicities. Magnitude of associations between smoking behaviors and meanings were dissimilar across ethnicities. The meaning with the strongest relationship to lifetime smoking for whites and Latinos was "it helps me study" (OR 3.4 and 2.6 respectively), and for Asians was "don't want to make another smoke alone" (OR 5.4). CONCLUSIONS: We have shown previously that interventions on meanings of eating behaviors changed dietary behaviors in adolescents. The present findings suggest that meanings are powerful determinants of adolescent smoking in culturally diverse populations and could offer powerful intervention tools to prevent adolescent smoking.     

Association of smoking status, cumulative smoking, duration of smoking cessation, age of starting smoking, and depression in Korean adults

ABSTRACT: BACKGROUND: Many previous studies did not sufficiently control for several confounding factors that may affect the association between smoking and depression, such as socioeconomic status. We investigated the association between depression and smoking status, smoking exposure, duration of smoking cessation, and age of starting smoking while controlling for socioeconomic factors. METHODS: This study was based on a community health survey performed in Jeollanam-do, South Korea, between September and November 2009. In total, 20,084 subjects (9,128 males and 10,966 females) were included in the analysis. Information on smoking characteristics, such as smoking status, pack-years of smoking, and age of starting smoking, was collected using a standardized questionnaire. Depression was defined using the Korean CES-D score. RESULTS: The odds ratios (ORs) of depression were 1.35 (0.92-1.98) for former smokers and 1.77 (1.27-2.48) for current-smokers among males, and 2.67 (1.38-5.16) for former smokers and 3.72 (2.11-6.54) for current-smokers among females, after adjusting for other confounding factors. Compared to light smoking, heavy smoking was significantly associated with depression in males [OR = 3.97, 95% confidence interval (CI) = 1.42-11.14], but not in females (OR = 1.24, 95% CI = 0.73-2.09). No significant associations between depression and age of starting smoking and duration of smoking cessation were observed among former smokers. CONCLUSIONS: Our data demonstrate that smoking is strongly associated with depression, particularly among females. These findings suggest that depression prevention may need to be combined with smoking prevention and that different strategies may be needed for males and females.