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BackgroundResearch is inconclusive on the effectiveness of electronic nicotine delivery systems (ENDS) as cigarette cessation aids compared with nicotine replacement therapy (NRT) or non-NRT medication. This study compared the cigarette cessation rates for ENDS, NRT and non-NRT medication.MethodPopulation Assessment of Tobacco and Health Study wave 3 cigarette-only users who used ENDS, NRT or non-NRT medication (varenicline and bupropion) to quit smoking between wave 3 and 4 were included. ‘Cessation’ was defined as being a former cigarette smoker in wave 4. χ2, logistic regression, and a sensitivity analysis with Bayes factor assessed the association between quitting smoking and method used.ResultsAmong 6794 cigarette-only users, 532 used ENDS (n=75), NRT (n=289), non-NRT medication (n=68), or a combination of NRT and non-NRT medication (n=100) to quit smoking between wave 3 and 4. The percentages of quitting smoking among those who used ENDS, NRT, non-NRT medication, and a combination of NRT and non-NRT medication were 16.2% (n=14), 16.1% (n=47), 17.7% (n=13), and 14.8% (n=12), respectively (p=0.97). None of the cigarette-only users who used ENDS to quit smoking became ENDS-only users in wave 4; 37.6% became dual users of ENDS and cigarettes.ConclusionNo differences were found when cessation rates of ENDS, NRT or non-NRT medication were compared. Given uncertainty about the long-term health effect of ENDS and the likelihood of becoming dual users, people who smoke and need assistance quitting should be encouraged to use current Food and Drug Administration-approved cessation methods until more effective methods are developed.

Case Presentation A 48-year-old man presented with 6 months of progressive shortness of breath, intermittent exertional left-sided chest pain, and bilateral lower extremity edema. During the 2 days before admission, he experienced new onset confusion, fatigue, and malaise that prompted evaluation. He denied fever, chills, cough, or sputum production. He used anabolic steroids for 20 years as part of his bodybuilding hobby. Recently, he also began injecting mineral oil into his pectoral, bicep, and shoulder muscles for an improved muscular appearance. Additionally, he had a history of provoked DVT after traumatic fracture, schizophrenia, hypertension, and epilepsy. He was a former cigarette smoker with 2.5 pack-year history, having quit 10 years earlier. The patient’s occupation was construction, installing aluminum gutters. He specifically denied exposures to sand-blasting, coal, beryllium, hard metals, silicone, and fine particles. He had no recent travel, sick contacts, or animal exposures.

Case Presentation A 41-year-old man presented to our institution with shortness of breath for 1 day, and nausea, vomiting, and diarrhea for 10 days. He has a medical history of gastroesophageal reflux disease, migraines, and anxiety. He is a 10 pack-year former cigarette smoker and an active vaper. He quit smoking cigarettes in 2013 but reports vaping flavored nicotine from 2013 to 2018. Since 2018, he has been vaping tetrahydrocannabinol products of different flavors and brands. A few weeks prior to admission, the subject had changed the brand of his vaping product to "Cookies High Flyers" with a "Biscotti" flavor. The new product contains 1,000 mg (883 mg tetrahydrocannabinol and 117 mg cannabidiol) in a 0.04 oz cartridge. He vapes five times a day, taking two to three puffs every time. He had recently traveled to Texas and had a sick contact with his 18-month-old daughter. She recently recovered from a diarrheal illness of presumed viral origin. Prior to admission, the subject tested negative for influenza and completed outpatient antibiotic treatment, with no improvement.

BackgroundChildren's overall tobacco smoke exposure (TSE) consists of both inhalation of secondhand smoke (SHS) and ingestion, dermal uptake, and inhalation of thirdhand smoke (THS) residue from dust and surfaces in their environments.ObjectivesOur objective was to compare the different roles of urinary cotinine as a biomarker of recent overall TSE and hand nicotine as a marker of children's contact with nicotine pollution in their environments. We explored the differential associations of these markers with sociodemographics, parental smoking, child TSE, and clinical diagnoses.MethodsData were collected from 276 pediatric emergency department patients (Median age=4.0 years) who lived with a cigarette smoker. Children's hand nicotine and urinary cotinine levels were determined using LC-MS/MS. Parents reported tobacco use and child TSE. Medical records were reviewed to assess discharge diagnoses.ResultsAll children had detectable hand nicotine (GeoM=89.7ng/wipe; 95% CI=[78.9; 102.0]) and detectable urinary cotinine (GeoM=10.4ng/ml; 95%CI=[8.5; 12.6]). Although hand nicotine and urinary cotinine were highly correlated (r=0.62, p&nbsp

Background Uric acid (UA) contributes to beneficial extracellular antioxidant defense activities in the airways. However, pro-oxidant powers of UA can be a potential risk factor for gouty arthritis in chronic obstructive airway disease (COPD). Objectives To investigate the proper causation (antioxidant/pro-oxidant) and correlation between UA indices and COPD and whether the associations were modified by smoking. Is serum uric acid (SUA) concentration a reliable biomarker to predict COPD severity? Patients and methods A prospective cohort study enrolled 45 male patients, who were divided into COPD smoker group I, cigarette smoker group II, and apparently healthy participants, serving as a control group III. SUA concentration and creatinine (Cr) level, arterial blood gases, radiographic imaging, and postbronchodilator spirometric measurements were performed. Results SUA was significantly elevated in COPD smoker and cigarette smoker groups than control one. SUA/Cr ratios were significantly increased in COPD smoker than in other groups. Overall, 8/20 (40%) patients were diagnosed with gouty arthritis in COPD smoker group, 1/15 (6.7%) in non-COPD cigarette smoker group, and none in control group. There were statistical significant differences among three groups (P=0.010). There were significantly higher number of patients with severe to very severe COPD (6/8) than patients with mild to moderate COPD (2/8) (P=0.028). There were significant positive correlations between SUA and smoking index (P=0.033), COPD grading (P=0.011), and partial arterial carbon dioxide tension (P=0.028) and also negative correlations with forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC) (P=0.029), partial arterial oxygen tension (P=0.001), and O2 saturation (P=0.001) in COPD smoker group I. In cigarette smoker group II, there were statistically significant positive correlations between SUA level and FVC% (P=0.033), FEV1 (P=0.017), and FEV1/FVC (P=0.010). Receiver operating characteristic curves for the evaluation of performance of serum uric acid/serum creatinine ratio in the diagnosis of severity of chronic obstructive airway disease. Conclusion SUA had pivotal antioxidant and pro-oxidant inflammatory effects (gouty arthritis) in COPD. Cigarette smoking is an independent risk factor that influences SUA in COPD. SUA and SUA/Cr ratio increase with rising severity of COPD. UA/Cr ratio is the proper biomarker in the assessment of COPD grading, with higher sensitivity and specificity.

Aims Compared to the general U.S. population, military veterans and those living in rural areas disproportionately smoke cigarettes at higher rates, leading to increased health consequences. In the current study, prevalence and severity of cigarette smoking in Iraq and Afghanistan era veterans was assessed across rural and urban areas and comorbid mental health disorders. Method Iraq/Afghanistan era veterans who participated in the Post-Deployment Mental Health study from 2005 to 2017 (N = 3229) were cross-sectionally assessed for the probability of being a current cigarette smoker based on locality status and psychiatric comorbidity. Multivariate logistic and linear regressions, adjusted for demographic characteristics, were used to model the odds of being a current smoker and the severity of nicotine dependence, respectively. Results Veterans residing in rural regions, veterans with psychiatric comorbidities, and the interaction of locality and psychiatric disorders were significantly associated with smoking rates. Those veterans living in extremely rural areas and, independently, those living with psychiatric comorbidities were also more severely dependent on nicotine compared to urban veterans and veterans without psychiatric conditions. Conclusions Rural veterans and veterans with psychiatric comorbidities are at increased risk of smoking and are more severely dependent on nicotine than urban veterans. These findings underscore the need to reduce barriers for treatment both for smoking cessation and mental healthcare for veterans residing in the most rural areas.

Objectives: Cigarette and Shisha smoking is becoming a common practice in young generation worldwide. Since, this is a growing threat to public health, our study aims to investigate the cognitive function responses of cigarette and Shisha inhalation in adolescents. Methods: This retrospective cross sectional study comprised three groups, cigarette smoker, Shisha smoker, and nonsmoker control group (each n=25). All the participants were apparently healthy male volunteers aged 21-24 years. Cognitive functions were assessed by employing “Cambridge Neuropsychological Test Automated Battery”. The cognitive functions outcome variables were response time tasks (attention switching task (AST) and the percentage of correct answers pattern recognition memory (PRM) task. Results: Cigarette and Shisha smokers exhibited a considerable decline in cognitive performance parameters, AST mean correct latency (p=0.001), AST mean correct latency (congruent) (p=0.001), AST mean correct latency (incongruent) (p=0.001) and AST mean correct latency (switching) (p=0.001) compared to matched control group. Conclusions: Cigarette and Shisha smokers exhibited significant impairment in their cognitive functions. The present study findings convince that cigarette and Shisha smokers should quit smoking. doi: https://doi.org/10.12669/pjms.36.5.2251 How to cite this:Bashir S, Murtaza G, Meo SA, Al-Masri A. Effect of Cigarette and Shisha smoking on cognitive functions impairment: A cross sectional study. Pak J Med Sci. 2020;36(5):1042-1047. doi: https://doi.org/10.12669/pjms.36.5.2251 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

BACKGROUND: Electronic cigarette (E-cigarette) is an electronic nicotine delivery device that has been advocated as a safe alternative for cigarette smokers. Since the introduction of E-cigarette internationally and in the Kingdom of Saudi Arabia (KSA), it gained popularity, particularly among the youth and young adults. Moreover, many nonsmoker (nicotine-naïve) youth started to use E-cigarette as a new social habit. Recent researches have casted shadows on the E-cigarette safety profile. OBJECTIVE: The aim of this study is to assess the prevalence of E-cigarette use among students of health science colleges in Jeddah-KSA. It also assesses E-cigarette effectiveness as a smoking cessation method and its possible addictiveness. METHODS: The study is an epidemiological, cross-sectional study, which was conducted between November 2017 and December 2017 in three different universities in Jeddah. A self-administered online questionnaire related to E-cigarette and the conventional cigarette was used. RESULTS: A total of 1007 completed an electronic survey which was distributed to 3000 health sciences colleges' students. Of the participants 14.1% were cigarette smoker, 46% of them smoke regularly. Students who smoke half a pack per day and above were 22% of the smokers. More college students use the E-cigarette (27.7%). Moreover, one-fifth of the E-cigarettes users were using it on the regular daily basis. The study found that 42.7% of E-cigarettes users have used it as a tool to quit smoking. Interestingly, more than half (56.7%) of the students who used it to stop smoking has succeeded. However, only 46% of E-cigarettes users who tried to quit vaping have succeeded. Young aged, students believed that smoking is more addictive than vaping or recommended E-cigarette for smoking cessation found to have a higher chance of quitting smoking in the univariate regression analysis. While, in the multivariate analysis, students who believed that conventional smoking is more addictive than E-cigarettes; students started vaping to quit smoking, or used E-cigarettes with fruit flavor found to have significantly higher chance of quitting. CONCLUSION: The E-cigarettes vaping is more prevalent than conventional cigarette smoking among health sciences students in Jeddah-KSA. E-cigarettes are used as a tool to help smoking cessation in less than half of the user. E-cigarettes help some smokers to quit smoking. However, it seems as addictive to the users as conventional cigarette smoking.

2019 has been a landmark year in the world of electronic nicotine delivery systems (ENDS), specifically e-cigarette and vaping. Numerous state health departments across the United States have voiced their concerns in the growing number of lung injury cases from e-cigarettes and vaping. Over the past few decades, many agencies have brought into light the harmful effects of smoking cigarettes, and despite popular belief, a growing movement has started to recognize the harmful effects of ENDS. The Centers for Disease Control and Prevention have released recommendations and provided health practitioners a methodology to identify and diagnose e-cigarette, or vaping, product use-associated lung injury (EVALI). EVALI is a diagnosis of exclusion and comprises a variety of respiratory illnesses, with intubation rates nearing 32%. The most critical risk factor remains product use in the preceding 90 days, although a timeline on the development of symptoms or notable structural changes remains unknown. We present a case of acute lung injury in a traditional cigarette smoker that evolved within hours of switching to e-cigarettes.

Case Presentation An 80-year-old man presented with a 5-day history of hemoptysis, mild shortness of breath on exertion, fatigue, and malaise. He denied chest pain or fever. He had a history of hypertension, congestive heart failure, and left nephrectomy for renal cancer 10 years earlier; he was a former cigarette smoker with a 50 pack-year history, having quit 5 years prior to presentation. The patient did not report any recent travel history or occupational or animal exposures, and he did not have gastroesophageal reflux. Medications included diltiazem hydrochloride, irbesartan, hydrochlorothiazide, and ranitidine.

Background: Cigarette smoking is associated with various forms of acute cardiac events such as myocardial infarction and ventricular fibrillation etc.Objective: To observe immediate impact of cigarette smoking on power spectral measures of heart rate variability (HRV) in current apparently healthy male regular cigarette smokers.Methods: This study was carried out on 120 apparently healthy male current regular cigarette smoker aged 20-55 years. To watch the intense impacts, data were recorded 5 and 30 min after completing a full stick of cigarette. Power spectral measures of HRV were recorded by a RMS digital polyrite D. Statistical analysis was done by paired sample t test.Results: LF power, LF nu & LF/HF ratio were significantly increased and HF power & HF nu were significantly decreased from their corresponding baseline value just 5 minutes after smoking and returned close to their baseline value after 30 minutes of smoking.Conclusion: The result of the study concludes that acceleration of sympathetic activity with simultaneous withdrawn of cardiovascular vagal adjustment happens quickly in the wake of smoking a cigarette.J Bangladesh Soc Physiol. 2018, June; 13(1): 8-12

Using cigarettes and alternative tobacco products (ATPs) is associated with negative oral health outcomes, and dental health professionals are poised to help patients quit. The aim of this study was to determine dental, dental hygiene, and advanced dental students' use, knowledge, and beliefs about cigarettes and ATPs, including perceptions about their education in tobacco dependence treatment and counseling experience. All 1,783 students enrolled in the dental, dental hygiene, and postdoctoral dental programs at the New York University College of Dentistry were invited to participate in the survey in 2016. A total of 708 students at least partially completed the survey, for a response rate of 39.7%. In the results, 146 of the students (20.1%) reported ever using cigarettes, while 253 (35.7%) reported ever using any ATP. Regarding tobacco use intervention, the students reported they had not received enough training on ATPs, were neutral about cigarettes, and were somewhat confident and not so confident counseling a cigarette smoker or ATP user, respectively. By their fourth year, 77.8% of the dental students reported they had counseled someone to stop smoking cigarettes, but only 40.7% had counseled someone to stop using ATPs. Overall, all groups of students reported feeling more confident and had received more education on interventions for cigarettes than for ATPs (p

Case Presentation A 44-year-old woman was referred for evaluation of dyspnea on exertion and multiple nodular opacities on a chest CT scan. She had a medical history of autoimmune encephalitis, diabetes mellitus, hypertension, migraines, and allergic rhinitis. Ten years earlier, the patient was admitted to an outside institution with symptoms of shortness of breath. She was found to have multiple pulmonary nodules and was diagnosed empirically with and treated for sarcoidosis. She was told that her pulmonary nodules had improved on follow up. However, she continued to have symptoms of dyspnea. Due to progressive symptoms of shortness of breath, she was referred to pulmonology. She reported a weight gain of 80 pounds over the last year. She denied fever, chills, hemoptysis, night sweats, joint swelling, or skin rash. She is a former cigarette smoker with a 15 pack-year smoking history, quit smoking in 2005. She denied alcohol or drug use. She resided in Arkansas and Texas over the past decade. She previously worked as a teacher and is currently unemployed. She had no other relevant exposures. She denied a family history of autoimmune diseases or malignancies.

Background Sleep problems are common in the general population. Cigarette smoking is common in the general population of China. Examinations of the prevalence of poor sleep quality among Chinese smokers and nonsmokers are still lacking. This study was designed to examine sleep quality and sleep disturbances among cigarette smokers and nonsmokers in the general population in central China. Methods In this population-based sampling project, we used a multi-stage sampling method to recruit survey participants from September 2012 to October 2012 in rural and urban areas of Hunan province, China. A total of 27,300 subjects were sampled from the general population and 26,282 completed the self-report of cigarette smoking characteristics. Cigarette smoker was defined as having smoked ≥100 cigarette in a lifetime and smoked during the last 28 days. Cigarette smoking characteristics were obtained from smokers, including cigarettes per day, years of smoking, quit attempts, and smoking cravings. The Pittsburgh Sleep Quality Index (PSQI) was applied to assess quality of sleep and sleep disturbances (PSQI score > 5). Results Significantly more smokers than nonsmokers demonstrated poor sleep quality and sleep disturbances. Among smokers, linear regression analyses showed that poor sleep was inversely associated with cigarettes per day, and positively associated with years of smoking, quit attempts, and smoking craving. Logistic regression analysis showed that quit attempts and smoking cravings were associated with higher odds of sleep disturbances. Conclusions Sleep disturbances were more prevalent among cigarette smokers than nonsmokers. Smokers also varied in sleep problems on the basis of the characteristics of their smoking. Smokers should be informed about the link between cigarette smoking and poor sleep quality, and should be advised that one of several important health benefits from smoking cessation could be the improvement of sleep quality. Sleep therapy should be recommended as an adjunctive treatment for smoking cessation.

Smoking is one of the leading causes of death worldwide. Smokers have higher risk for coronary heart disease, atherosclerosis, acute myocardial infarction, hypertension, clotting disorders, inflammation, respiratory diseases, cancers, etc. A cigarette smoker is exposed to a number of harmful substances. In this study we hypothesized that smoking causes inflammatory reactions and induces hyperthrombic state in the body which may be reflected in erythrocyte sedimentation rate (ESR), total leucocyte count (TLC), differential leucocyte count (DLC) and platelet count values. The purpose of the study was to study the effects of cigarette smoking on erythrocyte sedimentation rate, total leucocyte count and platelet count in adult male smokers and to compare the results with non-smokers and to establish a relationship between the duration and quantity of smoking with the change in ESR, TLC, DLC and platelet count. A cross sectional study was conducted in the department of Pathology on 86 healthy male subjects (smokers=43 and non-smokers=43). ESR was estimated using Westergrens method. TLC, DLC and platelet counts were estimated using HORIBA Pentra ES60 autoanalyzer. TLC and basophil counts were significantly higher in smokers than in non-smokers (p

Introduction E-cigarette use is controversial worldwide. The majority of previous studies on e-cigarette use were not gender specific. This study aimed to identify the predictors of e-cigarette use among young Australian women. Methods This study used cross-sectional data from the 1989–1995 cohort of the Australian Longitudinal Study on Women's Health. In 2015, study participants (N=8,915) aged 19–26 years completed an online survey. Multivariable logistic regression was used to identify predictors of e-cigarette use. Data were analyzed in 2018. Results The prevalence of ever and past-year e-cigarette use among young Australian women was 11.1% and 6.4%, respectively. More than a quarter of past-year and ever e-cigarette users were never cigarette smokers. Use of e-cigarettes in the past year was associated with younger age (AOR per year increase=0.87, 95% CI=0.82, 0.93); financial difficulty (AOR=0.68, 95% CI=0.54, 0.87); being an ex-smoker (AOR=5.05, 95% CI=3.64, 7.01) or current cigarette smoker (AOR=10.01, 95% CI=7.77, 12.89); drinking at a level of lifetime risk of harm from alcohol-related disease or injury (AOR=1.23, 95% CI=1.01, 1.53). Ever e-cigarette use showed similar associations and was also associated with rural residence (AOR=0.74, 95% CI=0.60, 0.91) and intimate partner violence (AOR=1.44, 95% CI=1.17, 1.76). Conclusions The high prevalence of e-cigarette use among never cigarette smokers has significant public health implications. Interventions to curb the use of e-cigarettes among young Australian women should focus on risk factors, such as early age, cigarette smoking, alcohol use, and intimate partner violence.

The use of contraband cigarettes is a serious public health problem. We present a case of atrial fibrillation in a healthy adolescent suspected to be caused by smoking contraband cigarettes. A 15-year-old man was admitted to our emergency department experiencing syncope and palpitations. He was a cigarette smoker, but he had never smoked any illicit tobacco products before. He had finished a pack of counterfeit cigarettes (20 pieces) in 1.5 h. His electrocardiogram showed atrial fibrillation with a rapid ventricular response and irregular RR intervals. The patient had no history of alcohol use, surgery, palpitations, hypertension, chronic bronchitis, or any infectious diseases. His atrial fibrillation was converted to a normal sinus rhythm after the cardioversion treatment. Our patient was discharged from the pediatric cardiology service and advised to quit smoking cigarettes, strictly warning against illicit tobacco products. In conclusion, intensive smoking of counterfeit cigarettes may lead to occurrences of atrial fibrillation.

Background: Cigarette smoking induced increased sympathetic activity is one of the major independent risk factor for cardiac morbidity and mortality. Objective: To assess acute effects of smoking on neuro cardiovascular regulation by analysis of time domain measures of HRV in current regular healthy male cigarette smoker. Methods: This comparative analytical study was conducted in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka from July 2011 to June 2012. 120 apparently healthy male current regular cigarette smoker aged 20-55 years were participated in the study group. Age and BMI matched 70 apparently healthy male non smoker subjects were studied as control. To observe the acute effects data were recorded 5 and 30 min after finishing a cigarette. Time domain measures of HRV were recorded by a RMS digital polyrite D. Statistical analysis was done by independent sample t test and paired sample t test. Results: Resting pulse rate, SBP, DBP, mean heart rate were significantly higher (p

Introduction : Pulmonary function is compromised in most smokers. Yet it is unknown whether exercise training improves pulmonary function and aerobic capacity in cigarette and hookah smokers and whether these smokers respond in a similar way as do non-smokers. Aim : To evaluate the effects of an interval exercise training program on pulmonary function and aerobic capacity in cigarette and hookah smokers. Methods : Twelve cigarette smokers, 10 hookah smokers, and 11 non-smokers participated in our exercise program. All subjects performed 30 min of interval exercise (2 min of work followed by 1 min of rest) three times a week for 12 weeks at an intensity estimated at 70% of the subject’s maximum aerobic capacity ( ). Pulmonary function was measured using spirometry, and maximum aerobic capacity was assessed by maximal exercise testing on a treadmill before the beginning and at the end of the exercise training program. Results : As expected, prior to the exercise intervention, the cigarette and hookah smokers had significantly lower pulmonary function than the non-smokers. The 12-week exercise training program did not significantly affect lung function as assessed by spirometry in the non-smoker group. However, it significantly increased both forced expiratory volume in 1 second and peak expiratory flow (PEF) in the cigarette smoker group, and PEF in the hookah smoker group. Our training program had its most notable impact on the cardiopulmonary system of smokers. In the non-smoker and cigarette smoker groups, the training program significantly improved (4.4 and 4.7%, respectively), v (6.7 and 5.6%, respectively), and the recovery index (7.9 and 10.5%, respectively). Conclusions : After 12 weeks of interval training program, the increase of and the decrease of recovery index and resting heart rate in the smoking subjects indicated better exercise tolerance. Although the intermittent training program altered pulmonary function only partially, both aerobic capacity and life quality were improved. Intermittent training should be advised in the clinical setting for subjects with adverse health behaviors. Keywords: cigarette smokers; hookah smokers; pulmonary function; aerobic capacity; interval training (Published: 17 February 2015) Citation: Libyan J Med 2015, 10 : 26680 - http://dx.doi.org/10.3402/ljm.v10.26680

An environment-wide association study (EWAS) may be useful to comprehensively test and validate associations between environmental factors and peripheral arterial disease (PAD) in an unbiased manner.Data from cross-sectional cohorts from the US National Health and Nutrition Examination Survey (1999-2004) were randomly 50:50 split into training set and testing set. A value of ankle-brachial index (ABI)1.0 or1.4 defined PAD. We performed multiple linear regression analyses associating each of the 417 environmental and self-reported factors with PAD in the training set (false discovery rate5%). Significant findings were validated in the testing set (p0.05) and entered into a logistic regression model with penalized likelihood based on the Akaike Information Criterion (AIC).Overall, 6819 participants40 years old were included. The validated factors comprised positive associations with smoking-associated factors (cigarette smoker, family smoker and smoked100 cigarettes, urinary cotinine), cadmium, urinary albumin, C-reactive protein, blood o-xylene and thyroxine 4, and inverse associations with α-carotene and trans-/cis-β-carotene for PAD. Finally, only 4 of these factors were nominally significant in the AIC-selected model: cadmium (OR 1.27, 95% CI 1.12-1.45), cis-β-carotene (OR 0.81, 95% CI 0.72-0.91), CRP (OR 1.19, 95% CI 1.03-1.38) and urinary albumin (OR 1.20, 95% CI 1.04-1.38).Our systematic evaluation provides new knowledge on the complex array of environmental correlates of PAD. These identified correlates need to be probed in further observational and interventional studies.

A young male clove cigarette smoker experienced spontaneous pneumothorax and later paraseptal emphysema was detected on high-resolution computed tomography (HRCT) scan without respiratory symptoms. Smoking is a known risk factor for emphysema. Paraseptal emphysema is a type of emphysema that rarely causes respiratory symptoms, nevertheless, usually accompanied by spontaneous pneumothorax. Interleukin 33 (IL-33) is an alarmin cytokine that belongs to the IL-1 family. The effects of IL-33 depend on its structure. In its mature form, it is a cytokine alarmin that binds to ST2 (suppression of tumorigenicity) receptors on the surface of macrophages and innate immune cells to drive Th1/Th2 immune responses, causing oxidative stress, and increased IL-33 production causes polarization of alveolar macrophages to an M2 phenotype. In this study, long-term exposure to clove cigarette smoke caused an increased serum level of IL-33 (43.72 pg/mL) and paucigranulocytic airway inflammation. In paucigranulocytic inflammation, IL-33 is involved in lung parenchymal damage presumably through oxidative stress, activation of alveolar macrophage and increased MMP12 secretion, resulting in alveolar destruction and airspace enlargement.

Background: Use of cigarette is a great cause of preventable morbidity and mortality. The blood vessel system effects of cigarette smoke are mediated by nicotine (alkaloid). Alkaloid increases heart rate and the myocardial pump activity. Aims and Objectives: This study aims to detect and compare autonomic function tests in male cigarette smoker and non-smoker healthy control subjects. Materials and Methods: The study was conducted in the Department of Physiology, Sawai Man Singh Medical (SMS) College and Hospital, Jaipur, Rajasthan, on 30 male cigarette smokers between the age group of 20 and 40 years, selected among employees of SMS Medical College, Jaipur, from various departments along with 30 healthy age-matched non-smokers. Results: Heart rate response to deep breathing (30:15 ratio), expiration/inspiration ratio, and Valsalva ratio were significantly decreased in smokers. Cigarette users have increase in systolic blood pressure (BP) and diastolic BP, but no significance difference was found in our study, BP response to standing shows decrease in systolic BP and sustained handgrip test (SHG) test response is also decrease in diastolic BP in cigarette users than the control healthy subjects. Conclusion: Our study results can be concluded that cigarette smoking causes increase sympathetic and reduced parasympathetic activity when compared with control healthy subjects.

Patient Initials or Identifier Number Mr. S. ### Relevant Clinical History and Physical Exam A 39 years old man has worsening chest tightness and exertional dyspnea for months. He was a cigarette smoker and amphetamine abuser. He also has dyslipidemia and hypertension. Furthermore, he was

BACKGROUND This study examines the relationship between circulating advanced glycated end products (AGEs) level and erythrocyte osmotic fragility in smokers. METHODS Forty-eight smokers (aged 45 ± 5 years) and fifty healthy nonsmokers (aged 42 ± 6 years) were selected in this study. All subjects were analysed according to serum AGEs, osmotic fragility (H50, the NaCL concentration producing 50% hemolysis), malondialdehyde (MDA) and advanced oxidation protein products (AOPP). RESULTS The data show that the serum AGEs, H50, MDA and AOPP levels were significantly higher for smokers than that of nonsmokers (p < 0.01). The serum AGEs correlated with H50 in smokers (r = 0.7703, p < 0.01). MDA levels correlated with H50 in smokers (r = 0.7584, p < 0.01). CONCLUSIONS This study demonstrated that serum AGEs and MDA levels positively correlated with osmotic fragility in smokers.

Introduction: Many factors have been put forward for adolescents engagements in smoking; influence of peers, the need to conform, low self-esteem, need for approval, and family influences have been identified. Also, knowledge of health problems associated with smoking is a major reason for not smoking by never smoked adolescents. It is against this background that this study becomes relevant, also, coupled with the fact that no previous study on cigarette smoking has been conducted among out-of-school adolescents in Sokoto. Methodology: The study was conducted among out-ofschool adolescents in sokoto metropolis. The study site consisted of the commercial motor-parks, central and other market sites as well as busy roads in sokoto metropolis where out of school adolescents frequent. A total of 213 study participants were recruited using a 2- staged sampling technique and subsequently interviewed using an interviewer administered structured questionnaire. Data was entered and analysed with IBM version 21 statistical software package. Level of significance was set at 5% and all tests were conducted using 2 tails. Result: Most of the respondents had good knowledge of health hazard of cigarette smoking, 11.3% of respondents had ever smoked cigarette and 3.3% were current cigarette smoker. There was an association between respondents ever smoking cigarette with respondentsâ educational status (X2=9.575, p=0.002), age group (X2=17.548, p=0.000), fathers smoking cigarette (X2=5.655, p=0.02, OR=2.78), mother smoking cigarette (X2=12.162, p=0.000, OR=13.36). Main determinant of respondent ever smoking was their perception that smokers should be allowed to smoke in public [OR=17.026, p=0.002, CI= (2.82-102.807]. Conclusion: Eleven percent of respondents had ever smoked cigarette, 3.3% were currently smoking cigarette. Most of the adolescents had good knowledge of health hazards of cigarette smoking. Main determinant of respondents ever smoking was the perception that people should be allowed to smoke in public. Sustained antismoking campaigns targeting out-of school adolescents may go a long way in reducing cigarette use among this group of adolescents.

INTRODUCTION: Although hematogenous acute epididymo-orchitis complicating Gram negative bacteremia, tuberculosis and brucellosis have been reported in medical literature, there is paucity of report on acute epididymo-orchitis complicating Streptococcus pneumoniae bacteremia. CASE REPORT: We report the case of hematogenous acute epididymo-orchitis from S. pneumoniae bacteremia in an adult chronic cigarette smoker and alcoholic with community acquired pneumonia. CONCLUSION: We recommend that acute epididymo-orchitis should be remember as a sequel of S. pneumoniae bacteremia especially in adult males with immune suppression DOI: http://dx.doi.org/10.3126/ijim.v1i2.7411 Int J Infect Microbiol 2012;1(1):80-83

China, with 20% of the world's population, produces and consumes about 30% of the world's cigarettes, and already suffers about a million deaths a year from tobacco. This is more than in any other country, and the hazards are expected to increase substantially during the next few decades, over and above the effects of demographic changes, as a delayed effect of the large increase in cigarette use between the 1950s and 1990s and of a further sharp increase in cigarette consumption since 1999. In developed countries cigarette smoking became popular during the first half of the twentieth century, but the main increase in tobacco deaths was not seen until several decades later, during the second half of the century. In the US, mean cigarette consumption per adult in 1910, 1930 and 1950 was 1, 4 and 10 a day, respectively, after which it remained fairly constant for a few decades. As a delayed result of this increase in cigarette smoking, the proportion of all US deaths at ages 35-69 attributed to tobacco rose over the next few decades from ''only'' about 12% in 1950 to 33% in 1990. In Chinese men, the pattern of increase in cigarette smoking that had been seen between 1910 and 1950 in the US was repeated 40 years later between 1952 and 1992. In most parts of China women now smoke far less than men. Mean cigarette consumption per Chinese man in 1952, 1972 and 1992 was 1, 4 and 10 per day, respectively, after which it leveled off for a few years, then continued to rise. Nationwide retrospective and prospective studies in China indicate that by 1990 tobacco already caused about 12% of all male deaths at ages 35-69, and by 2030 it will probably cause about one third of them, unless there is widespread cessation among those who already smoke. Although the overall hazard per cigarette smoker may be about the same in China as elsewhere, the chief diseases by which tobacco caused death in the 1990s were very different in China, with about half of the tobacco deaths involving emphysema rather than cardiovascular disease. The patterns of tobacco death also differed between one region and another, and may change substantially over time as a result of changes in diet and other factors. Large prospective epidemiological studies are now in place to monitor the evolution of the growing tobacco epidemic in China and elsewhere over the next few decades. © 2008 World Heart Federation.

Introduction Waterpipe smoking has become increasingly popular in adolescents. We examined the association of waterpipe smoking with cigarette smoking susceptibility and nicotine dependence among adolescents in Hong Kong. Methods We analyzed the data of School-based Survey on Smoking among Students 2012/13 from a representative sample of 45,857 secondary school students (US grades 7–12) in Hong Kong. Among never cigarette smokers ( n = 37,740), we conducted chi-square test to compare cigarette smoking susceptibility by current (past 30-day) waterpipe smoking status, and used multivariate logistic regression to examine the association between current waterpipe smoking and cigarette smoking susceptibility controlling for age, sex, peer cigarette smoking, and living with a cigarette smoker. Then we conducted chi-square test and multivariate logistic regression among current cigarette smokers ( n = 1694) to examine the relationship of current waterpipe smoking with two nicotine dependence outcomes, including heavier smoking (≥ 5 cigarettes/day) and first cigarette within 30 min of waking, controlling for demographics and the number of smoking days in the past 30 days. Results Among never cigarette smokers, current waterpipe use was associated with cigarette smoking susceptibility (adjusted odds ratio [AOR] = 3.58, 95% confidence interval [CI]: 1.61–7.97). Of current cigarette smokers, waterpipe use was associated with heavier smoking (AOR = 1.56, 95% CI: 1.00–2.43) and first cigarette within 30 min of waking (AOR = 2.08, 95% CI: 1.35–3.19). Conclusions Surveillance, prevention, and intervention programs should address waterpipe use in addition to cigarette smoking. Educational programs need to inform youth about the harmful and addictive effects of waterpipe smoking. Public health campaigns deglamourizing waterpipe use may help reduce waterpipe smoking among youth.

Background: Smoking is a major risk factor for cot death. Many infants smoke passively as a result of parental smoking. This paper reports on infants exposed to a smoking environment and how they accumulate metabolites of cigarette smoke, such as cotinine, which may be physiologically harmful. Aim: To assess cotinine levels in infants of smoking parents. Method: Cotinine excretion in urine was assessed in 104 infants, of whom 71 had smoking parents and 33 had non-smoking parents. All cotinine levels were measured at approximately 12 weeks of age. The subjects were selected from a database of infants in developmental physiological studies which assessed the impact of various factors on early postnatal development. Results: On average babies with at least one parent who was a current cigarette smoker excreted 5.58 (95% CI 3.4 to 9.5) times as much cotinine in the urine as did the babies of non-smoking parents. Maternal smoking was the largest contributing factor. Co-sleeping (p = 0.037) and the minimum room temperature (p = 0.028) were significant contributory factors. Conclusion: Infants from smoking households accumulate cotinine, a metabolite of nicotine, which may have a detrimental effect on the cardiorespiratory system.

We report a case of a previously healthy 17-year-old male with a history of cigarette smoking, who presented with acute development of respiratory distress. Computed tomography demonstrated cystic pulmonary changes. A lung biopsy confirmed Langerhans cell histiocytosis (LCH). The definitive diagnosis was isolated pulmonary LCH, a disorder that is infrequently found in adults, and rarely in children. We know of only one other case of a previously healthy adolescent cigarette smoker who developed isolated pulmonary LCH. The etiology of pulmonary LCH is unknown, but smoking has been considered as a risk factor.

We analysed the prevalence of cigarette smoking among subsequent birth cohorts of Spanish males and females. Data were drawn from the Spanish NHIS conducted in 1993 ( = 26 400), 1995 ( = 8300) and 1997 ( = 8300). From the original computer files, the three surveys were pooled to obtain a single sample. A total of 33 223 subjects (16 036 men and 17 187 women) born between 1900 and 1979, >/= 16 years old, were directly interviewed and with complete information on the history of smoking included for analysis. Based on each respondent's sex and calendar year of birth, the person was classified into a particular sex-birth cohort in the decades from 1900-09 to 1970-79. For each year from date of birth to date of survey, respondents were further classified as either cigarette smoker or nonsmoker. The prevalence of cigarette smoking among successive cohorts of Spanish men and women was estimated, with correction for excess mortality of smokers. In men, the peak in smoking was reached in the 1950-59 birth cohort (prevalence rate of 68% at ages 20-29), after increases during the previous calendar years. Smoking among women was rare until 1960. Female smoking prevalence rates increased progressively among subsequent cohorts until 1980. The age distribution of smoking prevalence in women in 1990 mimics that observed in men 40 years earlier. A substantial delay in the spread of the tobacco epidemic among men is apparent. In women, the delay in the initiation of the smoking epidemic ended with a quick diffusion of the habit.

Reactive oxygen species (ROS) induced by exogenous toxicants are suggested to be involved in carcinogenesis by oxidative modification of DNA. 8-Hydroxyl-2-deoxyguanosine (8-OHdG) has been considered as a reliable biomarker for oxidative DNA damage both in vivo and in vitro studies. But the effect of smoking on oxidative damage has not yet been fully elucidated. Wistar rats were exposed to cigarette smoke at concentrations of 20 and 60 % for 30 min, twice/day for 45 weeks. Then the histopathology of lung tissues, levels of ROS, 8-OHdG, and total antioxidant (T-AOC), expression of DNA repair enzymes, e.g. 8-oxyguaine DNA glycosylase (OGG1), and MutThomolog 1 (Oxidized Purine Nucleoside Triphosphatase, MTH1) were determined in urine, peripheral blood lymphocytes, and lung tissue. The results showed that long-term cigarette smoke exposure can cause obvious damages of lung tissue in rats. In addition, a significant and cigarette smoke concentration-dependent increase in ROS and 8-OHdG were observed compared with the non-exposed control rats. In contrast, the expression of OGG1 and MTH1, and T-AOC levels were obviously decreased after long-term exposure to cigarette smoke. These findings indicate that long-term exposure to cigarette smoker increases ROS levels, decreases total antioxidant capacity, and interferes DNA repair capacity that eventually induces oxidative DNA damage, which appears to play an important role in cigarette smoke-induced lung injury in rats, and determination of 8-OHdG levels might be a useful method for monitoring oxidative damage in cigarette smokers.

Introduction Tobacco smoking is the leading cause of cardiovascular morbidity and mortality and quitting tobacco use should be fundamental for cardiovascular patients. Varenicline is a smoking cessation pharmacological therapy able to improve the possibilities to successfully achieve this result. In 2011 the US Food and Drug Administration issued a safety announcement that varenicline may be associated with an increased risk of certain cardiovascular adverse events in patients who have cardiovascular disease. Following studies found no significant increase in cardiovascular serious adverse events associated with varenicline. For the first time in the literature, we describe the case of a cardiopathic hard smoker who received varenicline for 9 months without any side effect. By describing this case we want to underline the safety of varenicline, to illustrate the setting and the method that we used to support him and to underline the importance of promoting smoking cessation in heart patients. Case presentation Varenicline was used to promote smoking cessation in a 52-year-old Caucasian man who smoked 40 cigarettes per day, despite two ischemic cardiovascular events. He asked for a consultation in a pharmacy’s smoking cessation service and after the assessment phase varenicline was prescribed. Due to his difficulty to quit smoking and given his good tolerance of the drug, we extended the treatment with varenicline to 9 months in order to achieve and maintain a complete smoking abstinence; intensive behavioural counselling was combined with the pharmacological therapy. By using exhaled carbon monoxide measurement we assessed smoking abstinence up to 2 years. Conclusions The use of varenicline for a period longer than 6 months has not been described in the literature, particularly in heart patients. The extended varenicline therapy was clinically monitored and allowed the patient to consolidate his abstinence; the intensive behavioural counselling helped him to overcome his strong psychological dependence. Promoting smoking cessation in people who have cardiovascular disease is crucial. Currently available medications, such as varenicline, increase the chances of success and the risk of possible side effects is outweighed by the lifetime benefits and we hope that clinicians use them more frequently and confidently.

Background Individuals in recovery from alcohol use disorders (AUDs) frequently continue to smoke cigarettes. The purpose of this study was to examine the relationship between cigarette smoking status and risk of AUD relapse in adults with remitted AUDs among adults in the United States. Methods Data were drawn from Wave 1 (2001 to 2002) and Wave 2 (2004 to 2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. Analyses included the subsample of respondents who completed both waves of data collection reported a history of alcohol abuse and/or dependence prior to Wave 1 (N = 9,134). Relationships between Wave 1 cigarette smoking status (nonsmoker, daily cigarette smoker, and nondaily cigarette smoker) and Wave 2 alcohol use, abuse, and dependence were examined using logistic regression analyses. Analyses were adjusted for Wave 1 demographics; mood, anxiety, and substance use disorders; nicotine dependence; and AUD severity. Results Both daily and nondaily cigarette smoking at Wave 1 were significantly associated with a lower likelihood of alcohol use and a greater likelihood of alcohol abuse and dependence at Wave 2 compared to Wave 1 nonsmoking. These relationships remained significant after adjusting for demographics, psychiatric disorders, substance use disorders, AUD severity, and nicotine dependence. Conclusions Among adults with remitted AUDs, daily and nondaily use of cigarettes was associated with significantly decreased likelihood of alcohol use and increased likelihood of alcohol abuse and alcohol dependence 3 years later. Concurrent treatment of cigarette smoking when treating AUDs may help improve long-term alcohol outcomes and reduce the negative consequences of both substances.

Aim.To evaluate the acute effects of cigarette smoking on photopic and mesopic pupil sizes and wavefront aberrations.Methods.Cigarette smoker volunteers were recruited in the study. Photopic and mesopic pupil sizes and total ocular aberrations were measured before smoking and immediately after smoking. All volunteers were asked to smoke a single cigarette containing 1.0 mg nicotine. Pupil sizes and total ocular aberrations were assessed by optical path difference scanning system (OPD-Scan II ARK-10000, NIDEK). Only the right eyes were considered for statistical analysis. The changes of pupil size and total ocular aberrations after smoking were tested for significance by Wilcoxon signed ranks test.Results.Mean photopic pupil size decreased from 3.52 ± 0.73 mm to 3.29 ± 0.58 mm(P=0.001)after smoking. Mean mesopic pupil size was also decreased from 6.42 ± 0.75 mm to 6.14 ± 0.75 mm after smoking(P=0.001). There was a decrease in all the measured components of aberrations (total wavefront aberration, higher-order aberration, total coma, total trefoil, total tetrafoil, total spherical aberration and total higher-order aberration) after smoking; however the differences were insignificant for all(P>0.05).Conclusion.Our results indicate that pupil constricts after smoking. On the other hand, smoking does not alter ocular aberrations.

Background Measuring eCo is rapid, non-invasive and inexpensive tool and correlate correctly with carboxyhemoglobin levels in blood. The aim of this study was to evaluate and compare the increase in end tidal carbon monoxide (eCO) levels in exhaled breath of passive smokers and healthy smokers after cigarette and shisha smoking. Methods In a cross sectional study eCO levels were measured in 70 subjects (24 cigarette smokers, 20 shisha smoker, 26 passive smokers) by use of portable device. Smokers were asked to smoke shisha for 30 mins in shisha cafe or to smoke 5 cigarettes in 30 mins in a restaurant. eCo levels were measured at baseline (30 mins), 35 mins, 60 mins and 90 mins in all groups after entry to the venue. The baseline mean eCO level among cigarette smokers was 3.5 +/- 0.6 ppm (part per million), passive cigarette smokers 3.7+/-1.0 ppm, shisha smokers 27.7+/-4.9 ppm and passive shisha smokers 18.3+/-8.4 ppm .The mean increase in eCO after 90 min among smokers was 9.4+/-4.6 (p

Prevention strategies that delay the onset of asthma may improve clinical outcomes. To identify early life environmental exposures associated with asthma age-of-onset and potential genetic modifiers of these exposures, we studied 1085 subjects with physician-diagnosed asthma and disease onset at or after age two. Subjects reported retrospectively on their exposure to 17 environmental factors before the age of two. The presence of individual or combinations of these early life exposures was then tested for association with variation in asthma age-of-onset. For exposures significantly associated with age-of-onset, we tested if 26 single nucleotide polymorphisms (SNP) with an established association with allergic disease significantly modified the effect of the exposure. Five environmental exposures were significantly associated with variation in asthma age-of-onset after correction for multiple testing: carpet at home (P = 6 × 10(-5)), a serious chest illness (P = 10(-4)), father a cigarette smoker (P = 6 × 10(-4)) and direct exposure to father's smoking (P = 3 × 10(-4)). Individuals with early childhood asthma onset, between the ages of two and six, were 1.4-fold (CI 1.1-1.9) more likely to report having lived in a house with carpet and 2.1-fold (CI 1.3-3.5) more likely to report suffering a serious chest illness before the age of two, than asthmatics with later disease onset. We further found these individual risks to increase to 3.2-fold (CI 1.7-6.0) if carpet exposure and suffering a serious chest illness co-occurred before age two. Paternal smoking exposures were less likely to be reported by asthmatics with early when compared to later disease onset (OR 0.5, CI 0.3-0.7). There were no significant SNP interactions with these environmental exposures after correction for multiple testing. Our results suggest that disease onset in individuals at a high-risk of developing asthma can potentially be delayed by avoiding exposure to carpet at home and preventing serious chest illnesses during the first 2 years of life.

[Purpose] Cigarette smoking increases oxidative stress, which is a risk factor for several diseases. Moreover, strenuous exercise has been shown to induce plasma and pulmonary oxidative stress in young cigarette smokers. However, no previous reports have demonstrated whether plasma and pulmonary oxidative stress occur after moderate-intensity exercise. Therefore, the aim of this study was to clarify whether moderate-intensity exercise induces pulmonary and plasma oxidative stress in smokers. [Subjects] Ten young male smokers and 10 young male nonsmokers participated in this study. [Methods] Plasma hydroperoxide concentrations were measured at baseline and then immediately and 15 min after moderate-intensity exercise. Hydrogen peroxide concentrations in exhaled breath condensate were measured at baseline and after exercise. [Results] No significant interactions were found between smokers and nonsmokers in terms of hydroperoxide or hydrogen peroxide concentrations following moderate-intensity exercise at any time point. [Conclusion] These findings suggested that moderate-intensity exercise did not induce plasma or pulmonary oxidative stress in young cigarette smokers.

A 77-year-old man presented with slowly progressive fatigue, muscle weakness, daytime somnolence, hoarseness, and wheezing. He noted also a chronic cough especially with the ingestion of food and liquid. These symptoms had accelerated over the last several years. Poliomyelitis was diagnosed at 11 years of age, but he never had required ventilatory support. The patient maintained an active business career up until the time of his most recent hospital admission. He was a current one-half pack per day cigarette smoker with a total of 50 pack-years.

Cigarette smoking is a major public health problem that is associated with high morbidity and mortality. This study was designed to investigate the relationship between cigarette smoking and concentration of testosterone in the urine. Forty young men age between 23 to 31 years were used for this study. The subjects were divided into two groups of 20 controls (noncigarette smoker) and 20 experimental groups (cigarette smoker). 5ml of mid-stream urine was collected from each subject at 0700 hour and urine testosterone concentration was estimated using enzyme immunoassay method. The result showed that the urinary testosterone concentration of non-cigarette smokers was 4.35±0.52 ng/ml, while the concentration in cigarette smokers was 2.81±0.38 ng/ml with p

Waterpipe smoking among Danish, Swedish, and German youth is increasing dramatically, indicating the emergence of a new health threat. This study assessed the association between waterpipe smoking and progression to regular cigarette smoking among Danish continuation school students during 2004-2005. All participants (N = 762) had smoked cigarettes on a nonregular basis at baseline. Among boys, waterpipe smoking frequency was predictive of being a regular cigarette smoker at follow-up eight months later. Further research should examine waterpipe smoking as a potential predictor of cigarette smoking. The study's limitations are noted.

Background Tobacco use is a leading cause of preventable morbidity and mortality. In the developed nations where the burden from infectious diseases is lower, the burden of disease from tobacco use is especially magnified. Understanding the factors that may be associated with adolescent cigarette smoking may aid in the design of prevention programs. Methods A secondary analysis of the 2004 United States National Youth Tobacco Survey was carried out to estimate the association between current cigarette smoking and selected smoking-related variables. Study participants were recruited from middle and high schools in the United States. Logistic regression analysis using SUDAAN software was conducted to estimate the association between smoking and the following explanatory variables: age, sex, race-ethnicity, peer smoking, living in the same household as a smoker, amount of pocket money at the disposal of the adolescents, and perception that smoking is not harmful to health. Results Of the 27727 respondents whose data were analysed, 15.9% males and 15.3% females reported being current cigarette smokers. In multivariate analysis, compared to Whites, respondents from almost all ethnic groups were less likely to report current cigarette smoking: Blacks (OR = 0.52; 95% CI [0.44, 0.60]), Asians (OR = 0.45; 95% CI [0.35, 0.58]), Hispanic (OR = 0.81; 95% CI [0.71, 0.92]), and Hawaii/Pacific Islanders (OR = 0.69; 95% CI [0.52, 0.93]). American Indians were equally likely to be current smokers as whites, OR = 0.98 [95% CI; 0.79, 1.22]. Participants who reported living with a smoker were more than twice as likely to smoke as those who did not live with a cigarette smoker (OR = 2.73; 95% CI [2.21, 3.04]). Having friends who smoked was positively associated with smoking (OR = 2.27; 95% CI [1.91, 2.71] for one friend who smoked, and OR = 2.71; 95% CI [2.21, 3.33] for two or more friends who smoked). Subjects who perceived that it was safe to smoke for one or two years were more likely to smoke than those who thought it was definitely not safe to do so. There was a dose-response relationship between age and the amount of money available to the respondents on one hand, and current smoking status on the other (p-value < 0.001). Conclusion We found that White non-Hispanic adolescents were as likely to be current smokers as American Indians but more likely to be smokers than all other racial/ethnic groups. Older adolescents, increase amounts of pocket money, and perception that smoking was not harmful to health. The racial/ethnic differences in prevalence of smoking among America youth deserve particular exploration.

Objective: To identify childhood psychiatric symptoms as antecedents of cigarette smoking at age 18. Methods: In 1989, a general population sample of 2946 8-year-old boys born in Finland in 1981 was assessed using the Rutter’s parent and teacher questionnaires, and the Child Depression Inventory. This birth cohort was followed up in 1999, when the subjects reported for their obligatory military service at age 18. Information about cigarette smoking frequency was obtained from 78% (n = 2307) of the boys attending the study in 1989. Results: Childhood hyperactivity and self-reported depressive symptoms correlated with moderate daily (1–10 cigarettes), and heavy daily (>10 cigarettes) smoking at age 18. Conduct problems correlated with heavy daily smoking. A high level of childhood depressive symptoms, particularly in conjunction with a low educational level of the father, increased the risk of daily smoking. Emotional problems decreased the risk of smoking at age 18. In general, teacher reports had a better predictive power than parent reports for subsequent smoking. Conclusion: Future developmental studies with special focus on interaction between individual and environmental factors are warranted to reveal the mechanisms underlying the association between childhood psychopathology and adult smoking. In particular, the associations between childhood depression and future smoking need more clarification.

Background: Anecdotal reports suggest waterpipe smoking is becoming common in students in western countries. The aim was to examine prevalence, risk factors, symptoms of addiction, and smoke intake. Methods: This was a cross-sectional survey of students with subsidiary survey of regular waterpipe user and survey of exhaled carbon monoxide (CO) before and after waterpipe smoking in customers of a waterpipe café. 937 students of Birmingham University completed the initial survey with a follow up of 21 regular waterpipe smokers. 63 customers of a waterpipe café near the University completed the study of CO intake. Results: 355 (37.9%, 95% confidence intervals (CI) 34.8 to 41.1%) students had tried waterpipes, the prevalence of trying rising with duration at University. 75 (8.0%, 95%CI 6.4 to 10.0%) were regular smokers, similar to the prevalence of cigarette smoking (9.4%). Although cigarette smoking was the major risk factor for being a regular waterpipe smoker, odds ratio (95%CI) 2.77 (1.52 to 5.06), 65% of waterpipe smokers did not smoke cigarettes. Seven of 21 (33.3%) regular waterpipe smokers experienced cravings. Nearly all regular waterpipe users thought it less harmful than smoking cigarettes. The mean (standard deviation) rise in CO was 37.4 (25.8)ppm, nearly twice as high as a typical cigarette smoker seeking cessation treatment. Conclusion: Waterpipe smoking is a common part of student culture in one British university, as in the Middle East and in the United States. It poses a potential threat to public health, with evidence of dependence and high smoke intake.

A 22-year-old male attended a nurse-led walk-incentre (WiC) complaining of waking with a foreign body (FB) sensation to his throat. He looked in the mirror and noticed that he had a swollen uvula. He had woken an hour earlier choking and gagging with what he thought was a FB in his throat. He stated that the sensation eased on sitting forward and standing. On lying down or holding his head in the normal anatomical position he developed audible stridor. He denied any pain, sore throat, or recent illnesses. He was a cigarette smoker and drank alcohol on a regular basis. He admitted to snorting cocaine for the first time the previous night, but denied other illicit drug usage. He had no past medical history, took nomedications (prescribed or over-the-counter) and had no known allergies. There was no relevant family history.

Acute respiratory tract infections (ARI) were studied during a 2-year period in 521 preschool children living in a marginal area of Guatemala City. There were 3,646 episodes of ARI detected during 26,329 child-weeks at risk, for an incidence of 14 per 100 child-weeks or 7.2 episodes per child per year. The median duration of ARI episodes was 11 days. The highest incidence of ARI was observed in children 6-23 months old. Boys had more respiratory tract illnesses than did girls; the presence of a cigarette smoker in the household was associated with higher morbidity. Acute lower respiratory tract illnesses (ALRI) were more common among younger infants 0-5 months old, with nutritional status having no apparent effect. Parental formal education and crowding in households were found to be directly related to the incidence of ALRI. In general, ARI morbidity interfered with appropriate physical growth.

Introduction: Cigarette smoking is a leading cause of global morbidity and mortality. Interest in developing countries smoking prevalence has been growing since 1999. Objectives: To estimate the prevalence of current cigarette smoking and associated factors among school-age adolescents in Kafue, Zambia. Methods: A cross sectional study was conducted using standard Global Youth Tobacco Survey (GYTS) methodology. Frequencies and odds ratios were obtained to assess the association between selected factors and current cigarette smoking. Results: Data on current smoking were available for 1872 adolescents, of whom 891 (47.6%) were males and 981 females. Overall 154 (8.2%) adolescents were current cigarette smokers, while 93 (10.4%) males and 61 (6.2%) females were current smokers (p

Methods: The serum concentrations of receptor activator of nuclear factor κB ligand (RANKL) and osteoprotegerin (OPG) in age- and sex-matched groups of smokers and non-smokers with almost identical levels of periodontal disease were determined by an enzyme-linked immunosorbent assay (ELISA). We ensured that the 35 smokers were gender, age and clinically matched with a group of 35 non-smokers (confirmed by cotinine immunoassay) from the same population of maintained patients with susceptibility to periodontitis. Results: Cigarette smoker patients tended to have lower serum concentrations of RANKL and OPG than non-smoker patients. While no statistically significant difference was observed for RANKL, there were significant differences in the median serum concentration of OPG (smokers 23.76 pM, non-smokers 59.28 pM) and the ratio of serum concentrations of RANKL and OPG. Concentrations of OPG in the smoker patients also had a statistically significant negative correlation with tobacco consumption. Conclusion: Bone loss in smoker-related periodontitis patients may be partially explained by suppression of OPG production.