Apparent underreporting of cigarette consumption among Mexican American smokers.

To determine the accuracy of self-report of cigarette consumption among Mexican American smokers, we compared self-reported cigarette use and serum cotinine concentrations in a sample of 547 participants in the Hispanic Health and Nutrition Examination Survey (HHANES). We defined underreporting of cigarette use as a cotinine to cigarette-per-day ratio of greater than 0.142 microM/l which represented a substantial discrepancy between self-reported consumption and serum cotinine. Of the 98 men and 97 women who reported smoking one to nine cigarettes/day, 20.4 percent and 24.7 percent, respectively, underreported their cigarette consumption. Underreporting was less common among men and women smoking 10 to 19 cigarettes/day (8.3 percent and 10.8 percent, respectively) and 20 or more cigarettes/day (2.2 percent and 2.9 percent, respectively). Comparison of underreporters to other smokers by demographic characteristics within sex and cigarettes/day categories showed no differences. Differences in cotinine metabolism and extremely efficient smoking are alternative explanations that can not be ruled out with these data. We believe, however, that a proportion of Mexican American light smokers may underreport the quantity of cigarettes smoked per day, and may truly be moderate or heavy smokers.     

Clustering of risk behaviors with cigarette consumption: A population-based survey

OBJECTIVE: This study assessed clustering of multiple risk behaviors (i.e., low leisure-time physical activity, low fruits/vegetables intake, and high alcohol consumption) with level of cigarette consumption. METHODS: Data from the 2002 Swiss Health Survey, a population-based cross-sectional telephone survey assessing health and self-reported risk behaviors, were used. 18,005 subjects (8052 men and 9953 women) aged 25 years old or more participated. RESULTS: Smokers more frequently had low leisure time physical activity, low fruits/vegetables intake, and high alcohol consumption than non- and ex-smokers. Frequency of each risk behavior increased steadily with cigarette consumption. Clustering of risk behaviors increased with cigarette consumption in both men and women. For men, the odds ratios of multiple (> or =2) risk behaviors other than smoking, adjusted for age, nationality, and educational level, were 1.14 (95% confidence interval: 0.97, 1.33) for ex-smokers, 1.24 (0.93, 1.64) for light smokers (1-9 cigarettes/day), 1.72 (1.36, 2.17) for moderate smokers (10-19 cigarettes/day), and 3.07 (2.59, 3.64) for heavy smokers (> or =20 cigarettes/day) versus non-smokers. Similar odds ratios were found for women for corresponding groups, i.e., 1.01 (0.86, 1.19), 1.26 (1.00, 1.58), 1.62 (1.33, 1.98), and 2.75 (2.30, 3.29). CONCLUSIONS: Counseling and intervention with smokers should take into account the strong clustering of risk behaviors with level of cigarette consumption.     

A multiple discriminant analysis of smoking status and health-related attitudes and behaviors

Using multiple discriminant analysis, we examined several health-related attitudes and behaviors (HABs) simultaneously across groups of university students differing by smoking status (n = 1,077). Nine HABs were considered: health responsibility, exercise, nutrition, interpersonal support, stress management, alcohol consumption, drug use, caffeine consumption, and safety practices. Overall, the findings indicated that HABs, particularly those involving substance use, differed among the smoking and nonsmoking groups. Furthermore, current smokers, former smokers, and nonsmokers represented a continuum of less healthful to more healthful attitudes and behaviors. In general, compared to men, women exhibited more positive HABs with respect to interpersonal support, health responsibility, alcohol consumption, and drug use, but less positive HABs with respect to stress management. More complex relationships emerged in comparisons of occasional and regular smokers, light and heavy smokers, and consonant and dissonant smokers. We discuss implications of the findings for smoking intervention programs.     

Physical, psychological, and sociodemographic differences among smokers, exsmokers, and nonsmokers in a working population

Nonsmokers, exsmokers, cigarette smokers, and other smokers were compared for a variety of psychological, physiological, and sociodemographic characteristics. A total of 183 white men and 284 white women, 17 to 65 years of age, who were home office employees of the Liberty Life Insurance Company participated in the study. Age-adjusted comparisons indicated that nonsmokers differed from smokers in that they attended church more frequently and had more education; were less likely to have spouses who smoked; were less active physically on the job; were more likely to eat breakfast and desserts; consumed fewer soft drinks, alcoholic beverages, and coffee; and had lower pulse rates (men only) and thinner skinfolds. The differences among smoking categories for job-related factors, coping techniques, leisure time physical activity, and personality characteristics were generally unremarkable. In light of the numerous comparisons made, it was surprising how few differences were observed. Although the discriminant function was only modestly successful in classifying smokers and nonsmokers (78% accuracy), differences in diet, behavior, spouse characteristics, religious habits, and health orientations may prove useful in designing smoking prevention and cessation programs.     

Alcohol, smoking, coffee, and cirrhosis.

Since most heavy drinkers do not develop alcoholic cirrhosis, other causes or predisposing factors are probable. The authors studied traits of 128,934 adults who underwent health examinations at the Oakland and San Francisco, California, facilities of the Kaiser Permanente Medical Care Program from January 1978 to December 1985 in relation to subsequent hospitalization or death from cirrhosis of the liver. In analyses adjusted for nine covariates, past and current alcohol drinking were strongly related to cirrhosis risk, but usual choice of alcoholic beverage had no independent relation. Cigarette smoking was independently related to risk of alcoholic cirrhosis, with cigarette smokers of a pack or more per day at trebled risk compared with lifelong nonsmokers. Coffee drinking, but not tea drinking, was inversely related to alcoholic cirrhosis risk, with persons who drank four or more cups per day at one-fifth the risk of noncoffee drinkers. This inverse relation between coffee consumption and risk of alcoholic cirrhosis was consistent in many subsets, including persons free of gastrointestinal disease and those with 5 or more years before hospitalization or death. Cigarette smoking and coffee consumption were not consistently related to risk of hospitalization or death for nonalcoholic cirrhosis. These data could mean that cigarette smoking promotes alcoholic cirrhosis and that coffee drinking might be protective.     

Correlates of cigarette smoking among selected Southwest and Northern plains tribal groups: the AI-SUPERPFP Study

OBJECTIVES: We describe the prevalence and correlates of cigarette smoking in 2 American Indian tribal groups. METHODS: We performed multinomial logistic regression on epidemiological data from a population-based, cross-sectional study of Southwest and Northern Plains American Indians aged 15 to 54 years. RESULTS: We found that 19% of Southwest men, 10% of Southwest women, 49% of Northern Plains men, and 51% of Northern Plains women were current smokers. Male gender and younger age were associated with higher odds of smoking in the Southwest tribe, whereas current or former marriage and having spent less time on a reservation were associated with higher odds of smoking in the Northern Plains population. Alcohol consumption was strongly associated with higher odds of smoking in both groups. CONCLUSIONS: Cigarette smoking is a major public health concern among American Indians. Because correlates and smoking patterns vary among different tribal groups, each group's unique characteristics should be considered when designing and implementing comprehensive, culturally appropriate interventions in American Indian communities.     

Parkinson's disease risks associated with cigarette smoking, alcohol consumption, and caffeine intake

A reduced risk for Parkinson's disease (PD) among cigarette smokers has been observed consistently during the past 30 years. Recent evidence suggests that caffeine may also be protective. Findings are presented regarding associations of PD with smoking, caffeine intake, and alcohol consumption from a case-control study conducted in western Washington State in 1992-2000. Incident PD cases (n = 210) and controls (n = 347), frequency matched on gender and age were identified from enrollees of the Group Health Cooperative health maintenance organization. Exposure data were obtained by in-person questionnaires. Ever having smoked cigarettes was associated with a reduced risk of PD (odds ratio (OR) = 0.5, 95% confidence interval (CI): 0.4, 0.8). A stronger relation was found among current smokers (OR = 0.3, 95% CI: 0.1, 0.7) than among ex-smokers (OR = 0.6, 95% CI: 0.4, 0.9), and there was an inverse gradient with pack-years smoked (trend p < 0.001). No associations were detected for coffee consumption or total caffeine intake or for alcohol consumption. However, reduced risks were observed for consumption of 2 cups/day or more of tea (OR = 0.4, 95% CI: 0.2, 0.9) and two or more cola drinks/day (OR = 0.6, 95% CI: 0.3, 1.4). The associations for tea and cola drinks were not confounded by smoking or coffee consumption.     

Coffee consumption and the risk of cancer of the exocrine pancreas: a case-control study in a low-risk population.

Data from a population-based, case-control study of 149 cases of cancer of the exocrine pancreas (excluding insulinomas) and 363 controls were used to test the hypothesis that coffee consumption increased the risk of cancer of the exocrine pancreas. Because of the high mortality from cancer of the pancreas, all information was obtained from proxy respondents for cases and controls. Increased risk was present for coffee drinkers [odds ratio (OR) = 2.38], cigarette smokers (OR = 2.27), and alcohol users (OR = 1.60), but the effect for alcohol disappeared after adjustment for cigarette use. Risk increased with the amount of coffee drunk with an OR of 2.38 in the those having at least 50,000 lifetime cups. This gradient was present in both men and women, and in cigarette smokers and nonsmokers. Increased risk was present for users of regular and decaffeinated coffee, but the risk was higher for users of decaffeinated coffee than users of regular coffee. Cigarette smoking, after controlling for coffee consumption, was an independent risk factor for pancreatic cancer, with odds ratios in the heaviest smokers of 2.71 (95% confidence interval = 1.41-5.21.     

Cigarette smoking and sick leave in an industrial population in Shanghai, China.

A study of cigarette smoking and sick leave was conducted at a large petrochemical complex in Shanghai, China in 1988. Among a random sample of 1856 men the smoking prevalence was 80% with the highest rate (84%) occurring in the age group 25-34 years. Only 53% of smokers and 76% of nonsmokers said they believed smoking was harmful to health and knowledge of which diseases were associated with smoking was poor. Retrospective data were also collected on sick leave in 1986 and 1987. In 1986 13% of men took sick leave and in 1987 12%; the mean duration of sick leave was 3 days per year. In 1986 the odds ratios (OR) for taking sick leave were 2.37 for heavy smokers and 1.45 for light smokers compared to unity for nonsmokers; the corresponding OR for 1987 were 1.70 and 1.28 for heavy and light smokers compared with nonsmokers. Smoking was positively associated with sick leave even after adjustment for age, consumption of alcohol and exposure to chemicals; OR = 1.56 (95% confidence interval (Cl): 1.06-2.31) in 1986 and OR = 1.32 (95% Cl: 0.90-1.95) in 1987. Demonstration of this association even in a young population with low sick leave rates illustrates yet again the adverse effects of smoking on health and the urgent need to reduce the very high prevalence of smoking in China.     

Excess mortality among cigarette smokers: changes in a 20-year interval.

OBJECTIVES: This study was undertaken to examine changes in smoking-specific death rates from the 1960s to the 1980s. METHODS: In two prospective studies, one from 1959 to 1965 and the other from 1982 to 1988, death rates from lung cancer, coronary heart disease, and other major smoking-related diseases were measured among more than 200,000 current smokers and 480,000 lifelong non-smokers in each study. RESULTS: From the first to the second study, lung cancer death rates (per 100,000) among current cigarette smokers increased from 26 to 155 in women and from 187 to 341 in men; the increase persisted after current daily cigarette consumption and years of smoking were controlled for. Rates among nonsmokers were stable. In contrast, coronary heart disease and stroke death rates decreased by more than 50% in both smokers and nonsmokers. The all-cause rate difference between smokers and nonsmokers doubled for women but was stable for men. CONCLUSIONS: Premature mortality (the difference in all-cause death rates between smokers and nonsmokers) doubled in women and continued unabated in men from the 1960s to the 1980s. Lung cancer surpassed coronary heart disease as the largest single contributor to smoking-attributable death among White middle-class smokers.     

Cigarette smoking and fat distribution in 21,828 British men and women: a population-based study

OBJECTIVE: To examine the relationship between cigarette smoking habits and fat distribution in a population-based cohort of men and women. RESEARCH METHODS AND PROCEDURES: We analyzed cross-sectional data from 21,828 men and women who were 45 to 79 years of age, residents in Norfolk, United Kingdom, and were recruited between 1993 and 1997. Cigarette smoking habits and other lifestyle factors were assessed using self-reported questionnaires. Anthropometric measures were obtained during a health examination. RESULTS: Waist-hip ratio was highest among current smokers and least among never smokers after adjusting for age, BMI, alcohol intake, total energy intake, physical activity, and education. Higher waist-hip ratio was directly associated with higher smoking pack-years in current and former smokers and inversely with duration since quitting smoking in former smokers. Adjusting for age, BMI, and other covariates, current smokers had higher waist circumference but lower hip circumference compared with former or never smokers. DISCUSSION: Cigarette smoking habits seem to influence fat distribution patterns. Although smokers have lower mean BMI compared with nonsmokers, they have a more metabolically adverse fat distribution profile, with higher central adiposity. The explanation for this association may help elucidate the mechanisms underlying the adverse health consequences of cigarette smoking and abdominal obesity.     

Effects of nativity, age at migration, and acculturation on smoking among adult Houston residents of Mexican descent

OBJECTIVES: We investigated differences in smoking behaviors between US-and Mexican-born ever smokers and examined the influence of US culture on smoking initiation. METHODS: Participants were 5030 adults of Mexican descent enrolled in an ongoing population-based cohort in Houston, Tex. RESULTS: More men than women reported current smoking; rates among US-born women were higher than those among Mexican-born women. Smoking rates among US-born men were higher than earlier published rates among Hispanics and non-Hispanic Whites but similar to rates among African Americans. Current smoking rates among Mexican-born women were lower than published rates for Hispanics, non-Hispanic Whites, and African Americans. Older age, male gender, a higher level of acculturation, more than a high school education, and residing in a census tract with a higher median age predicted history of smoking among US-born participants. Among Mexican-born participants, older age, male gender, a higher level of acculturation, and younger age at migration predicted history of smoking. CONCLUSIONS: Smoking interventions for people of Mexican descent should be tailored according to gender, nativity, and acculturation level and should target all ages, not just young people.     

Cigarette smoking, alcohol consumption, and screening mammography among women ages 50 and older

BACKGROUND: The associations among cigarette smoking and alcohol consumption with recent screening mammograms were evaluated among women ages 50 years and older. METHODS: The sample included 946 white and African-American women ages 50 years and older from the 1995 Maryland Behavioral Risk Factor Survey. Bivariate and logistic regression analyses were performed to evaluate the associations between current cigarette smoking and alcohol consumption in the past month (none, 1-7 drinks, >7 drinks) with obtaining a screening mammogram in the past 2 years (recent mammogram), controlling for sociodemographic and health variables. RESULTS: Seventy-eight percent of respondents had recent mammograms, 15% smoked cigarettes, 18% reported 1-7 drinks, and 12% reported >7 drinks in the past month. Smokers had lower mammography rates than nonsmokers (odds ratio (OR) = 0.47, 95% confidence interval (CI) = 0.30-0.75). Women who drank alcoholic beverages had higher mammography rates than nondrinkers (OR = 1.37, 95% CI = 1.03-1.83). Smokers had the lowest mammography rates, regardless of their consumption of alcohol. An interaction was observed among white but not African-American women: nonsmokers who consumed moderate amounts of alcohol (1-7 drinks) had the highest mammography rates in this subgroup. CONCLUSIONS: To reduce breast cancer mortality, it is important to increase screening mammography among all women over age 50 and especially among smokers and the oldest women.     

Importance of smoking habits for longitudinal and age-matched changes in body mass index: a cohort study of Swedish men and women

BACKGROUND: Previous longitudinal studies of smoking and BMI have focused on smoking cessation. The aim of the present study was to disentangle the effects of long-term smoking on longitudinal changes and age-matched BMI differences (time period effects) in a nation-wide Swedish cohort. METHODS: Men and women (n = 4349) ages 18-73 years reported height, weight, and smoking status for a baseline survey in 1980-1981. Eight and 16 years after baseline, follow-up surveys were conducted for 3244 (75%) of the 4349 subjects. Long-term smokers and long-term nonsmokers were compared with respect to longitudinal changes and age-matched BMI differences. RESULTS: For middle-age adults, the longitudinal increases in BMI were smaller among long-term smokers than long-term nonsmokers regardless of gender. Among the elderly, the longitudinal decrease in BMI was greatest among long-term smokers. Among men, age-matched BMI differences between surveys were smaller for long-term smokers than for nonsmokers. Among women, however, age-matched BMI differences were greater for long-term smokers than for nonsmokers. CONCLUSIONS: In middle-age subjects, longitudinal BMI increases are smaller among smokers than nonsmokers. During old age, the BMI of smokers decreases more than that of nonsmokers. Unknown factors related to gender contribute to larger time period effects of smoking in women than in men.     

Interdependence of associations of physical activity, smoking, and alcohol and coffee consumption with serum high-density lipoprotein and non-high-density lipoprotein cholesterol--a population study in eastern Finland

The interdependence of the associations of physical activity, smoking, and consumption of alcohol and coffee with serum high-density lipoprotein and non-high-density lipoprotein cholesterol concentrations was studied in 9,347 persons ages 25-64 years from east and southwest Finland. In covariance analyses with corrections for age, body mass index, saturated fat index, and fasting time, the mean adjusted serum high-density lipoprotein to non-high-density lipoprotein cholesterol ratio was high among physically active male non-smokers but not among smokers (P = 0.024 for two-way interaction). The cholesterol ratio was lower among both men (P = 0.010 for two-way interaction) and women (P = 0.030 for two-way interaction) reporting no or very little use of alcohol, and this association was stronger among smokers and women with high coffee consumption (P less than 0.001 for two-way interaction). Our data suggest that the elevating effect of regular physical exercise on serum high-density lipoprotein cholesterol may be absent in smokers, whereas that of alcohol is greater in smokers than nonsmokers. High coffee consumption associates with decreased serum high-density lipoprotein cholesterol levels in smokers but increased levels in non-smokers.     

Coffee and cholesterol, an Italian study

In the present study, conducted in northern Italy between 1986 and 1989, the authors investigated the possible association between coffee consumption and serum cholesterol levels in 8,983 subjects, 7,432 men and 1,551 women, managers and employees aged 18-65 years, who were examined during a program of preventive medicine upon an agreement between various companies and the Centro Diagnostico Italiano. Analysis of covariance was used to compare the serum cholesterol levels of the subjects subdivided according to coffee consumption, along with age, body mass index, alcohol consumption, cigarette smoking, and physical activity. An important relation was demonstrated between coffee intake and cholesterol, particularly in the men, the differences in serum cholesterol in the coffee users compared with the nonusers being 6.1 +/- 1.4 (standard error) mg/dl for consumers of 1-3 cups/day (3.4 +/- 1.4 mg/dl after adjustment for age, body mass index, alcohol and cigarette consumption, and physical activity), 9.9 +/- 1.6 mg/dl for those drinking 4-5 cups/day (5.8 +/- 1.6 mg/dl after adjustment), and 14.8 +/- 2.0 mg/dl for those drinking over 5 cups/day (9.6 +/- 2.0 mg/dl after adjustment). This relation remained substantially unvaried when nonsmokers and smokers were analyzed separately. It has been suggested that it is coffee prepared by boiling rather than other methods that has a hypercholesterolemic effect. Our observations demonstrate an interesting relation between coffee and cholesterol, even though the coffee drunk in Italy is mainly filtered and nonboiled. However, our finding is not necessarily in disagreement with the above hypothesis since, when coffee is prepared in the Italian way (with the mocha method), ground coffee is preheated by steam and more importantly, the water passes through the ground coffee at a higher temperature than with the other brewing methods.     

Differences in dietary intake with smoking, alcohol, and education.

Differences in the frequency of consumption of 30 selected foods and in the estimated intake of total calories and selected nutrients in relation to alcohol drinking, tobacco smoking, and education were described using information obtained from 1,774 controls of a case-control study of digestive tract cancers conducted in northern Italy. Heavy alcohol consumption, tobacco smoking, and lower level of education were associated with a diet poorer in several aspects, including lower consumption of fresh fruit and green vegetables and higher intake of specific indicator foods, such as sausages and canned meat. For instance, the mean number of portions of fresh fruit per week was 10.5 among male nondrinkers vs. 9.0 among heavy drinkers, 10.4 among male nonsmokers vs. 8.1 among heavy smokers, and 8.8 in less educated individuals vs. 10.7 among those more educated. Consequently, intake of beta-carotene, ascorbic acid, and calcium tended to be inversely related to alcohol and tobacco and directly related to education. Most associations were stronger in males, for whom alcohol consumption was also more common in less educated individuals. Calorie intake was directly related to alcohol consumption, largely reflecting calories provided by alcohol itself. However, alcohol drinking was also directly related to fat consumption. In both sexes, there was a strong positive correlation between cigarette smoking and coffee drinking. These results provide quantitative documentation that alcohol drinking, tobacco smoking, and education, three of the major determinants of cancer risks, were also correlates of dietary patterns and, hence, may exert an important confounding or modifying effect on the diet and cancer relationship.     

Cigarette, alcohol, and coffee consumption and spontaneous abortion.

We analyzed data from a survey of occupational factors and pregnancy outcome to examine the effects of cigarette, alcohol, and coffee consumption on pregnancy outcome. Clear and statistically significant associations were found between cigarette and alcohol consumption and spontaneous abortion. There was a weaker but statistically significant association with coffee consumption: If the associations were casual, 11% of the spontaneous abortions could be attributed to smoking, 5% to alcohol, and 2% to coffee.     

Coffee consumption, diet, and lipids

Recent reports suggest that coffee consumption is associated with increased serum cholesterol and triglyceride concentrations. The authors examined the association between serum lipids and coffee consumption and other caffeinated beverages as part of a population-based study of 1,228 women and 923 men, aged 25-64 years, in San Antonio, Texas, studied between October 1979 and November 1982. The study confirmed a positive relationship between coffee consumption and both total and low density lipoprotein cholesterol in both sexes which persisted after adjustment for age, ethnicity, obesity, cigarette smoking, and alcohol consumption. Neither tea nor cola consumption was associated with changes in serum lipids, suggesting that caffeine alone does not exert a direct effect on lipid levels. The possibility was examined that the coffee-cholesterol relationship might be due to a more atherogenic diet consumed by heavy coffee drinkers. In men, per cent calories from both total and saturated fat and dietary cholesterol intake increased with increased coffee consumption. Similar trends were not observed in women, however. The positive relationship between coffee and cholesterol may therefore be due to confounding effects of other aspects of the diet.     

Smoking,heavy drinking,and depression among U.S. middle-aged and older adults

ObjectiveTo examine the relationship between smoking, heavy drinking and depression among U.S. middle-aged and older adults.MethodIndividual-level data came from 1992–2012 waves of the Health and Retirement Study. Smoking was ascertained from self-reported cigarette smoking status at the time of interview. Heavy drinking was defined as one or more drinks per day on average or four or more drinks on any occasion in the past three months for women, and two or more drinks per day on average or four or more drinks on any occasion in the past three months for men. Depression was defined as scoring three and above on the eight-item Center for Epidemiologic Studies Depression Scale. Cox proportional hazards regressions were performed to examine the relationship between smoking, heavy drinking and depression.ResultsCompared to non-smokers, smokers free from depression and heavy drinking at baseline were 20% (95% confidence interval: 12–28%) and 34% (20–50%) more likely to develop depression and engage in heavy drinking during follow-up period, respectively. Compared to non-depressed participants, participants with depression who were nonsmokers and non-heavy drinkers at baseline were 41% (14–74%) and 18% (6–31%) more likely to smoke and engage in heavy drinking during follow-up, respectively. Compared to non-heavy drinkers, heavy drinkers who were nonsmokers at baseline were 60% (26–104%) more likely to smoke during follow-up.ConclusionHealth promotion programs in midlife and older age should be mindful of the associations between smoking, heavy drinking and depression in order to improve intervention effectiveness.