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We examined the extent to which nicotine dependence and daily smoking might vary by age at first cigarette. The potential confounding effects of sex, race and history of childhood behaviour problems were examined as well. A sample of 1200 was randomly selected from the subset of 21-30-year-old members of a large HMO in the Detroit SMSA; 1007 (84%) agreed to participate. Personal interviews were conducted in respondents' homes, using the NIMH-DIS to elicit information on DSM-III-R diagnoses, including nicotine dependence. Controlling for sex and race, persons who smoked their first cigarette at 14 to 16 years of age were 1.6 times more likely to become dependent than those who initiated smoking at an older age (P = 0.03). The association was unchanged when history of childhood behaviour problems was also controlled. Smoking initiation before age 14 was not associated with increased probability of dependence. Persons who initiated smoking before age 14 had a longer lag time to daily smoking and a lower likelihood of progressing to daily smoking, compared to persons who initiated smoking later on. The findings suggest that, among persons who have ever smoked, there might be two distinct groups in whom the chances of developing dependence are considerably reduced. The first comprises persons who delayed first use until age 17. The second comprises persons who smoked their first cigarette before age 14, a group in whom the progression to daily smoking might be markedly slower than in persons who initiated smoking when they were older.

Fahad Alkherayf1,2,3, Eugene K Wai4,5,6, Eve C Tsai1,3,4,6, Charles Agbi1,3,41University of Ottawa, Division of Neurosurgery, Ottawa, Ontario; 2University of Ottawa, Department of Clinical Epidemiology, Ottawa, Ontario; 3The Ottawa Hospital, Civic campus, Division of Neurosurgery, Ottawa, Ontario; 4The Ottawa Hospital, Civic Campus, Spine Unit Ottawa, Ontario; 5The Ottawa Hospital, Civic Campus, Division of Orthopedic Surgery, Ottawa, Ontario; 6The Ottawa Hospital Research Institute, Ottawa, Ontario, CanadaBackground: Lower back pain (LBP) is one of the primary causes of disability in the Canadian community. However, only a limited number of studies have addressed the association between daily smoking and LBP in Canada. Of the studies that have explored this association, many had small sample sizes and failed to control for confounders.Objective: The primary objective of the study was to determine if daily smoking is associated with an increased risk of having LBP. The secondary objectives were to assess the risk for LBP among occasional smokers and to determine the prevalence of LBP in relation to different covariates.Data and study design: Using the Canadian Community Health Survey (cycle 3.1) data, 73,507 Canadians between the ages of 20 and 59 years were identified. LBP status, smoking level, sex, age, body mass index (BMI), level of activity and level of education were assessed in these subjects.Methods: Stratified analysis and logistic regression analysis were used to detect effect modifications and to adjust for covariates. Population weight and design were taken into consideration.Results: The prevalence of LBP was 23.3% among daily smokers and 15.7% among non-smokers. Age and sex were found to be effect modifiers. The association between LBP and daily smoking was statistically significant in all ages and genders; this association was stronger for younger age groups. The adjusted odds ratio for male daily smokers aged 20 to 29 was 1.87 (95% CI = 1.62, 2.17); findings were similar for women. Occasional smoking slightly increased the odds of having back pain.Conclusion: Young Canadian daily smokers are at higher risk for LBP. This study also suggests a positive correlation between smoking dose and the risk of LBP. These findings indicate that smoking behavioral modification may have an impact on reducing back pain especially among young adults.Keywords: lower back pain, smoking, Canadian Community Health Survey, sex, adult Canadians

ObjectiveThe aim of the study was to evaluate smoking habits among Lithuanian adult smokers, according to gender, age and education.MethodsThe study analyses data from the Lithuanian adult population health behavior survey carried out in 2008. The national random sample of 3000 inhabitants aged 20-64 was taken from the National Population Register. The study material was collected through mailed questionnaires covering smoking habits, social status. In 2008 daily smokers were 38,8 % of Lithuanian adult men and 14,9 % of women.ResultsDaily smoking was least common in the oldest age group in both sexes. Indirect educational gradient was found among men. Among women, no association was observed between smoking and educational level.ConclusionsAssessment of inequalities in smoking habits helps to identify subgroups of society that should have a priority of tobacco control policies.

Objective To assess the behaviour, knowledge, and attitudes towards smok ing of medical students in Africa and to stimulate interest in the problem among both students and their teachers. Design As part of a global survey, first and final year medical students in one centre in each of five sub-Sahar?n Afri can (southern Africa) and five North African and Middle Eastern countries (northern Africa) replied anonymously to a multiple choice questionnaire in French or English according to country. Subjects 87 % of first year students and 84% of final year students participated in the survey. A total of 1564 replies were analysed, 875 from first year students and 689 from final year students. Women comprised 37 % of the overall sample, but with considerable differences between countries. Results In northern Africa the preva lence of daily smoking (both sexes com bined) was 8 % among first year students and 19% among final year students; in southern Africa the corresponding figures were 9% and 20%, respectively. For men the figures were 13% and 22%; for women, 2 % and 6 %. Combining daily with occasional smoking, overall figures for both sexes combined were 19% for the first year and 27 % for the final year. 9 % of male students were ex-smokers in northern Africa and 20% in southern Africa; for women the corresponding figures were 5 % and 12 %, respectively. A serious attempt to quit had been made by 53% of smokers; 49% thought that they would no longer smoke in five years' time. Over 80% of students thought smoking was harmful to health, but there was considerable underestimation of its causal role in a number of diseases notably, oral, laryngeal, and bladder cancer; emphysema; coronary and peri pheral arterial disease; and neonatal mortality. There were important defects both in knowledge and motivation re garding counselling patients to stop smoking. Only a minority appreciated the value of tobacco taxation in de creasing consumption. Conclusions The proportion of daily smokers in male medical students was similar in Africa to that in Europe, previously reported, but in females the rate was much lower. As in Europe, overall there was much ignorance of smoking as a cause of specific diseases; lack of knowledge and motivation re garding counselling patients; and only a partial grasp of preventive measures. We hope that the survey will stimulate rel evant improvements in medical educa tion.

Studies have shown that the rate at which children take up smoking is still very high, particularly for female adolescents. While some progress has been made in determining the factors related to the initiation of smoking, an issue that still requires investigation is the relationship between early smoking patterns and later smoking behaviour. This paper reports the results of a longitudinal study which examined the continuity between smoking at an early age and later smoking behaviour. The smoking behaviour of a cohort of New Zealand children was followed from age 9 to age 15 years. Results showed that children's smoking pattern at age 9 years was not highly related to their smoking behaviour at age 15. The children most likely to become daily smokers by age 15 were those who had smoked within the last year at ages 11 and 13. It was concluded that the formative period for children's daily smoking at age 15 was from 10 to 13 years of age.

The present study was designed to explore the relationship between cigarette smoking and headache activity in a sample of patients presenting for treatment. Subjects completed various self-report measures and monitored headache activity four times per day over a 4-week period. Analyses revealed that smokers experienced greater weekly peak headache intensity, and reported higher levels of depression and general physical symptoms. Among smokers, nicotine content of the preferred brand was associated with mean headache index and weekly headache-free days, as well as depression and anxiety scores. Daily smoking rate and pack-year history were related to level of general physical symptoms only. Thus, both smoking status and the nicotine content of the preferred cigarette appear to adversely impact headache activity. Further, smokers who are more anxious or depressed may increase their headache activity via their preference for higher nicotine-content cigarettes. These results are discussed in the context of possible mechanisms underlying these effects, and implications for the clinical management of headache suffers who smoke.

One hundred twenty-nine chronic smokers successfully completed a smoking cessation program composed of behavioral counseling and aversive smoking. During the two-year follow-up period, 92 of these subjects reported smoking. The progression from subjects' first cigarette to full relapse was examined via standardized telephone interviews. The latency between subjects' initial postcessation smoking episode and subsequent return to daily smoking was related to pretreatment confidence level, affective state at the time of the first cigarette, and origin of the first cigarette. Neither affective reaction nor coping response execution after the initial cigarette was related to the rate of relapse. Results are discussed in terms of current theory and treatment implications.

Objective To investigate the association between smoking behavior among secondary school students and school smoking policies. Design Cross-sectional provincially representative study. Setting Quebec secondary schools. Participants Complete data were available for 763 of 1058 students aged 13 years in 50 schools and for 768 of 1160 students aged 16 years in 57 schools. School principals provided data on school smoking policies. Main Exposure School smoking policies. Outcome Measure Student tobacco use. Results Of students aged 13 years, 3.8% of boys and 7.1% of girls smoked daily; 21.0% of boys and 25.2% of girls aged 16 years smoked daily. Of schools, 28.0% permitted staff to smoke indoors, 84.1% permitted staff to smoke outdoors on school grounds, and 83.2% permitted students to smoke outdoors on school grounds. Daily smoking was not associated with policies targeting student smoking or those targeting indoor smoking by staff. In multilevel analyses, girls aged 13 years were almost 5 times more likely to be daily smokers if they attended schools at which staff were permitted to smoke outdoors. Conclusions Younger girls may be more susceptible to social influences at school related to tobacco use. School policies banning smoking by teachers and other school personnel within and outside the school should be an important component of comprehensive adolescent smoking prevention programs.

29 Ss were assigned to one of 3 treatment conditions and treated for their cigarette smoking over a 2-week period. These conditions were: group rapid smoking, group hypnosis, and an attention-placebo control group. All treatments produced significant reductions in average daily smoking rates during the treatment phase but all Ss returned to near baseline levels of smoking by the 6-week follow-up. The rapid smoking and hypnosis groups did not differ from the control group in smoking rates at treatment termination or at the 6-week follow-up. They also did not differ from the control group in the number of Ss abstaining from smoking by treatment termination but did differ at follow-up. Eventually, at the 9-month follow-up, only Ss from the group rapid smoking condition had significantly more abstainers than the control group. The results suggested that rapid smoking can work as effectively in group procedures as previous individualized approaches had demonstrated. Group hypnosis, while less effectiv...

In a randomised controlled trial, 151 pregnant smokers were randomised into a control group and a test group; the latter receiving individual counselling and health education leaflets. The trial ran concurrently with a television series on stopping smoking. There was a significant improvement in the test group with respect to the numbers trying to stop smoking and in the mean daily number of cigarettes smoked but not in the number of mothers actually ceasing to smoke. In the test group, those who also watched the television health education programmes reduced their daily smoking significantly more than those who did not.

A 2×2×2 factorial design with 64 clients compared the effects of Taste Satiation (TS) and Focused Smoking (FS) treatments, breath CO and spirograph testing feedback, and booster sessions available for 6 months posttreatment. TS tended to be more effective overall than FS, but the physiological testing and feedback combined with FS was as effective as TS alone. Booster sessions appeared to have a negative influence on maintenance of abstinence, but a positive influence on minimizing the daily smoking rate of recidivists through 3 months. Initial success in achieving abstinence was useful in predicting abstinence at 6 months.

The cross-sectional study of 1980 for atherosclerosis precursors in Finnish children and adolescents aimed at a wide coverage of the relevant relationships of the smoking behaviour to Socioeconomic and psychoSocial factors. The initiation and establishment of the smoking habits were primarily viewed as a function of the youngsters’main Socializing agents: the peer group and the family. A subpopulation comprising 1,790 children and adolescents aged 12, 15 and 18 years of the total sample was included in the study on smoking behaviour. The information on smoking habits was collected in connection with the medical examination in a solitary room where the youngsters could respond undisturbed. Data on the children's families were obtained by means of a general questionnaire filled out by the parents. The prevalence of daily smoking was 1 % in the 12-year-old, 10 % in the 15-year-old, and 30 % in the 18-year-old subjects. The best friend's behaviour was the best predictor of an adolescent's smoking behaviour, although the family had retained its role as an important model as regards the learning of smoking behaviour. Quitting school turned out to be a major event leading to an increased risk of becoming a habitual smoker. No clear associations between Socioeconomic status of the family and daily smoking were found, except that farmers’children had generally lower rates of daily smoking than children from other Socio-economic groups. First contacts with tobacco formed part of a normal behaviour pattern at a certain age, and this experimentation was unrelated to a later regular habit. Smoking seemed to become part of a more general health behavioural pattern after the age of 15 in a young person's life.

Using expired CO analysis by 20-second breath holding method, various population groups were investigated to evaluate their body burden of carbon monoxide. For urban children mean expired CO level was 2.2 ppm in autumn and 3.8 ppm in winter, and for rural children 2.8 and 6.6 ppm in the same sea-sons. For urban adult people, 10.1 ppm for male and 8.5 ppm for female, and for male smoker, ranged from 16.9 to 29.3 ppm in ascending order according to daily smoking habit. For rural inhabtants, very high CO level was found in both sexes, 16.4 and 19.0 ppm. This is due to traditional heating facilities in rural area. For urban public bus drivers and street policemen, the higher CO level was estimated, which was attributed to occupational and pollution sources.

54 smokers were treated under one of three conditions. The longer the subject had been smoking prior to treatment and higher daily smoking rates at the time of therapy were the best predictors of whether the subject was able to quit smoking. Subjects were treated with several self-control procedures over varying number of daily sessions. It was concluded that an immediate punishment technique was not effective and that 5, 7, or 9 days of therapy were not of sufficient duration for a high rate of success to be attained.

The presence of risk factors for cardiovascular disease in adolescents aged 10–15 years was investigated in 15 countries participating in a research program coordinated by the American Health Foundation. The agency responsible for this program in Greece was the Institute of Child Health in Athens. A total of 1,113 Greek boys and girls aged 10–15 years who attended public schools in the area of Athens were examined. Schools were selected to represent all socioeconomic categories. Information about health knowledge and health habits was collected by a self-administered questionnaire and demographic data were recorded by an interviewer. For all children, blood pressure, pulse rate, postexercise pulse rate, and anthropometric measurements were taken, and plasma cholesterol was estimated. One or more risk factors [hypertension, hypercholesterolemia, smoking, and obesity (weight above the 90th percentile)] were present in 34% of the Greek adolescents. Nine percent of the children admitted to occasional smoking and 1% to daily smoking; both percentages are considered to be underreported. The scores achieved by the Health Knowledge Questionnaire varied from 36% for the question on blood pressure to 60% in the area of general health knowledge. The high incidence of risk factors in the adolescents found in the present study may increase morbidity and mortality in future generations.

Blood nicotine and cotinine concentrations were measured in 27 volunteers before and after taking snuff. Within 10 minutes after snuffing blood nicotine concentrations were comparable to those obtained after the 10 minutes or so that it takes to smoke a cigarette. Nicotine intake from snuffing was related to the experience of the snuffer. In daily and occasional snuffers increases in plasma nicotine concentrations averaged 77.7 and 12.3 nmol/l (12.6 and 2.0 ng/ml) respectively, while the novices showed no appreciable increase. The increase shown by thea daily snuffers was comparable to the average increase of 62.3 nmol/l (10.1 ng/ml) obtained from a single cigarette by a group of heavy smokers. The peak nicotine concentrations in the daily snuffers were also similar to the peak values in 136 heavy smokers--222.6 and 226-3 nmol/l (36.1 and 36.7 ng/ml), respectively. Unusual multiple-dose snuffing produced massive increases in plasma nicotine to concentrations that have never been recorded in smokers. The similarity of the concentrations produced by regular daily snuffing and regular daily smoking suggests that the plasma nicotine concentration has some controlling influence over the self-regulation of these two quite different forms of tobacco use. The rapid absorption of nicotine from snuff confirms its potential as an acceptable and relatively harmless substitute for smoking.

Biochemical determinations of plasma and salivary cotinine and thiocyanate were used to differentiate smokers from non-smokers and to follow daily smoking patterns in smokers. Results indicate that cotinine is better suited than thiocyanate to determine smoking status in large scale epidemiologic studies and to follow alterations in smoking behavior over periods of time. Salivary cotinine is a reliable alternative to plasma for validation of smoking status and for following changes in daily smoking patterns.

Instructions were used to modify topographical characteristics of smoking behavior in a single-case multiple-baseline design experiment. Topographical components of puff frequency and puff duration were modified. Generalization to natural environment situations was unobtrusively assessed. Carbon monoxide levels, subjective enjoyment, and daily smoking rate also were observed. Results showed that instructions modified topographical components of smoking behavior in clinically significant directions and that these changes generalized.

Two methods of gradual reduction in smoking over a 12-week period were compared. The first required subjects to smoke at pre-set random times using a signalling device. The second allowed subjects to smoke at times of their choice using a mechanical counter to self-regulate their daily smoking quota. Each method was tested with and without group meetings. More subjects in the counter groups finished the program; however, groups using the signalling device were more successful in eliminating smoking at the time of a 3-month follow-up. The use of the signalling device was associated with a tendency to reduce the effects of situational cues on smoking, and group meetings seemed to raise morale among participants. The greatest difficulty in further smoking reduction occurred at the 12–14 cigarettes per day level for all groups. It was hypothesized that, despite the decrease in learned cues, further reduction is inhibited by the manifestation of withdrawal symptoms caused by some physiological addiction. These results suggest that a successful smoking elimination program should combine psychological and physiological approaches.

It is well established that poor academic performance is related to smoking, but the association between academic well-being and smoking is less known. We measured academic well-being by school burnout and schoolwork engagement and studied their associations with smoking among 14- to 17-year-old schoolchildren in Belgium, Germany, Finland, Italy, the Netherlands, and Portugal. A classroom survey (2013 SILNE survey, N = 11,015) was conducted using the Short School Burnout Inventory and the Schoolwork Engagement Inventory. Logistic regression, generalized linear mixed models, and ANOVA were used. Low schoolwork engagement and high school burnout increased the odds for daily smoking in all countries. Academic performance was correlated with school burnout and schoolwork engagement, and adjusting for it slightly decreased the odds for smoking. Adjusting for socioeconomic factors and school level had little effect. Although high school burnout and low schoolwork engagement correlate with low academic performance, they are mutually independent risk factors for smoking. (C) 2016 The Authors. Published by Elsevier Ltd on behalf of The Foundation for Professionals in Services for Adolescents.

The role of psychic risk factors in the early history of atherosclerosis was studied in 3,596 Finnish children and adolescents, aged 3, 6, 9, 12, 15, and 18 years. The family atmosphere, behavioural pattern and self-esteem were tested. The results showed that the abuse of alcohol by the parents and daily smoking by the child were the factors most clearly indicating the existence of psychic problems. The results showed that boys manifested in every age group behaviour most disposed to coronary heart disease (CHD). Furthermore, low serum HDL-cholesterol, high serum triglycerides, thick triceps skinfold and self-esteem problems coexisted and they can be supposed to independently contribute to the aetiology of CHD.

Pancreatic cancer has been on the sharp increase in Japan in recent years, the rate of increase being as high as for lung and liver cancers. A large scale cohort study on pancreatic cancer in Japan revealed close associations with cigarette smoking and daily meat consumption among the many life-style associated risk factors studied. The risk was observed to be highest when both habits were combined. Their effect was practically multiplicative. A five year accelerated aging was observed in daily cigarette smokers and, when daily meat consumption was combined with daily smoking, the accelerated aging had extended to approximately 10 years. This somewhat non-specific background was considered relevant when evaluating the reasons for such an elevated risk of developing pancreatic cancer from smoking and meat consumption when looked at together with more specific biological mechanisms. The sharp increase in the consumption of animal fats in Japan in recent years was considered the most probable reasons for the recent increase in mortality from pancreatic cancer, in addition to an increase in other identified risk factors such as cigarette consumption. Further, possible exposure to hitherto unidentified chemicals must also be considered, as suggested by the elevated risk of developing pancreatic cancer in certain occupations such as chemical production.

This study examined relapse following treatment in a smoking reduction program. Twenty-two smokers with an average daily smoking rate of 25.7 cigarettes were provided a reduction-oriented smoking self-manegement program. Subjects were then classified on the basis of their reduction at posttreatment. A 50% or greater reduction from pretreatment qualified subjects as successful reducers. To provide further understanding of controlled smoking, subjects who successfully maintained at least a 50% reduction (at three month follow-up) were compared to those subjects who were unable to maintain that level of reduced smoking. A set of cognitive, smoking history, and reduction motivation variables were used to compare the two groups in a stepwise discriminant function analysis. Two variables, internal locus of control and self-label as a nonsmoker, produced an overall correct classification rate of 88.9%. Multiple regression analyses further demonstrated the importance of these two cognitive variables; self-label and internal locus of control accounted for 50.4% of the variance in smoking at three months follow-up. The implications of these findings for future study of controlled smoking are discussed.

This study reports daily smoking rates among older adolescents obtained by a unique follow-up of a cohort originally identified in the seventh grade. Those no longer in their original school districts were located and interviewed by telephone. Smoking rates among dropouts exceeded 70 per cent in all age-sex groups. Smoking rates among transfers were as high as those among absentees. Including these subgroups raised smoking prevalence rates among older adolescents substantially.

As part of the international Know Your Body program 1,016 Dutch schoolchildren (response rate, 85%) were examined for CHD risk indicators. In both boys and girls, the plasma cholesterol level was lower at age 14 than at age 10. However, the decrease was larger in boys than in girls. A comparison with the results of other studies showed that the mean plasma cholesterol level in Dutch schoolchildren was lower in 1979 than in the period 1973–1976. The mean systolic blood pressure level increased 2–3 mm Hg per year in boys from age 10 to 14. In girls there was a 5 mm Hg increase from age 10 to 11. After a small increase from age 11 to 12 the mean blood pressure level in girls remained constant. Among all boys the prevalence of occasional and daily cigarette smokers was approximately 12 and 4%, respectively. For girls, these percentages were 8 and 3, respectively. Frankly high levels of plasma cholesterol (>5.7 mmol/liter or 220 mg/dl), systolic blood pressure (> 140 mm Hg), and daily smoking were found to be present in 7%, 2% and 4% of all boys and 8%, 2% and 3% of all girls, respectively. Combined frankly high risk indicator levels were observed in three children. It was concluded that frankly high levels of risk indicators did not aggregate in schoolchildren aged 10–14 years.

Serum high-density lipoprotein (HDL) cholesterol levels were assessed in a random sample of 939 men and 853 women ages 14–65 years in eastern Finland. Amount of daily smoking measured by serum thiocyanate concentration was negatively and independently associated with serum HDL cholesterol level and HDL/total cholesterol ratio in men. This negative association seemed largely to be due to low HDL cholesterol levels in heavy smokers. Both male and female current smokers had lower HDL cholesterol levels and HDL/total cholesterol ratios than those who had never smoked. This difference was found even after adjustment for age, body mass index, and beer drinking. The reduction of HDL cholesterol level seemed to be reversible, because those who had recently stopped smoking had higher HDL cholesterol levels and higher HDL/total cholesterol ratios than current smokers.

To evaluate possible differences between patients with refractory duodenal ulcers and those with duodenal ulcers that respond to standard doses of antisecretory medications, we determined basal acid outputs by nasogastric suction and daily smoking histories in 75 patients with endoscopically documented active duodenal ulcers. Patients were treated for at least eight weeks with standard doses of antisecretory medications and endoscopic healing or nonhealing was documented. Fifty-five patients that had complete healing of their duodenal ulcers had a mean basal acid output of 6.6 +/- 5.3 meq/hr, and 18/55 had daily cigarette smoking histories, whereas 20 patients that had nonhealing duodenal ulcers had a mean basal acid output of 20.0 +/- 9.6 meq/hr, and 8/20 had daily cigarette smoking histories. There were no significant differences between the two groups with regard to age, duodenal ulcer size, or cigarette smoking history. However, there were significant differences in male-female ratio (P less than 0.02) and in mean basal acid output (P less than 0.001), and all patients with nonhealing duodenal ulcers had basal acid outputs of greater than 10.0 meq/hr. Patients with nonhealing duodenal ulcers were treated with increased doses of ranitidine, mean 675 mg/day (range 600-1200 mg/day), and all had complete healing endoscopically documented. These results indicate that patients treated with standard doses of antisecretory medications with nonhealing duodenal ulcers have increased basal acid outputs of greater than 10.0 meq/hr, and the duodenal ulcers heal with increased doses of antisecretory medication.

Background In developed countries, smoking spreads through society like an epidemic in which adults from higher socioeconomic groups are the first to adopt and earlier to quit smoking, and in which exists a lag in adoption of smoking between men and women. The objective of this study was to describe trends in daily and occasional smoking, to investigate association between smoking status and education, and to examine if the associations in 1990–2010 in Estonia fit the pattern predicted by the model of tobacco epidemic. Methods The study was based on a 20–64-year-old subsample (n = 18740) of nationally representative postal cross-sectional surveys conducted every second year in Estonia during 1990–2010. Cigarette smoking and education were examined. χ2 test for trend was used to determine daily and occasional smoking trends over study years. Multinomial logistic regression model was used to test educational differences in daily and occasional smoking for every study year. Adjusted relative risk ratios (RRRs) with 95% confidence intervals were calculated. Results In 1990–2010, daily smoking varied largely between genders showing decreasing trend among men, but not among women. In 2010, one third of men and one fifth of women were daily smokers. Daily smoking was not clearly associated with education among men in 1990–1994 and among women in 1990–2000. Men revealed inverse relationship between daily smoking and education since 1996, but women since 2002. In 2010, compared to men and women with higher education, relative risk ratio of daily smoking was 2.92 (95% CI = 2.01–4.25) among men and 2.29 (95% CI = 1.65–3.17) among women with secondary education, but 4.98 (95% CI 3.12–7.94) among men and 6.62 (95% CI = 4.07–10.76) among women with basic education. In 1990–2010, occasional smoking was stable and similar (varying between 7–10%) among men and women, no association with education was found. Conclusions Daily smoking patterns in Estonia fit the model of tobacco epidemic in developed countries. Educational differences in daily smoking highlight the importance of addressing smoking behaviour in the general population by educational subgroups in Estonia.

Objective: The article analyses changes in tobacco use in medical students in Slovakia in 1995, 1999 and 2004.Methods: Questionnaire survey in 448 students of the Jessenius Faculty of Medicine, Comenius University in Martin, Slovakia, was carried out in October and November 2004. Data were compared with similar surveys carried out in 1995 and 1999.Results: Prevalence of daily smoking in men increased from 11.1 in 1995 to 21.8% in 2004. In women, within 1995-2004, daily smoking increased from 5.2% to 12.3%, occasional smoking from 11.6% to 19.8%. Also proportion of women initiating smoking during their university study increased. In both genders the proportion of never smokers dramatically dropped between 1995 and 1999 (in men from 43.2% to 23.2%; in women from 61.9 to 18.2).Conclusion: Upward trend in tobacco use, particularly in women, is a reason for concern. In medical faculties, principles of prevention should be more emphasized and the students motivated for healthy life-style and to fulfill their future role in public health. The situation noted among medical students indicates that a community in Slovakia is still not satisfactory inclined towards non-smoking and a dramatic decrease of tobacco use can hardly be expected either in the near future.

This study intended to see if there is an association between personality traits and daily smoking in adults from Bucaramanga. A transveral population study with a probabilistic sample of adults between 18 and 65 years of age. Personality traits were assesed with the self-report questionnaire of the Structured Clinical Interview for DSM-IV, Axis II (SCID-II), and logistic regression was used in order to control confounding factors. Participants were 2.496 adults, 38 years old on average (SD=13.5); mean schooling was 9.2 years (SD=4.1), 69.7% were women, 58.1% married, 49.1% employed and 67.8% had a middle socioeconomic status. Current smokers (10% of the population) were defined as those who reported daily smoking during the last month. Marked antisocial and borderline traits were found to be independently and modestly associated to current smoking. Nevertheless, it is suggested that personality traits be taken into consideration in prevention programs. Esta investigación tuvo como objetivo determinar la asociación entre rasgos de personalidad y consumo diario de cigarrillo en adultos de la población general de Bucaramanga (Colombia). Para ello se realizó un estudio transversal poblacional con una muestra probabilística de adultos entre dieciocho y sesenta y cinco años. Las características de personalidad se establecieron con el cuestionario de autoinforme de la Entrevista Clínica Estructurada para Diagnósticos DSM-IV del Eje II (SCID-II) y se utilizó regresión logística para controlar factores de confusión. En el estudio participaron 2.496 adultos con una edad promedio de treinta y ocho años (DE = 13,5), la escolaridad promedio fue 9,2 años (DE = 4,1), 69,7% eran mujeres, 58,1% estaban casados, 49,1% tenían un empleo y 67,8% vivían estrato socioeconómico medio. Quienes reportaron consumo diario de cigarrillo durante el último mes fueron considerados como fumadores actuales y ellos representaron el 10% de la población. Se encontró que las características marcadas antisociales y límites de personalidad están independiente y modestamente asociadas al consumo actual de cigarrillo. Sin embargo, se considera que las características de personalidad se deben tener en cuenta en los programas de prevención.

The modification of smoking behavior usually involves the target goal of total abstinence. However, many smokers are unable or unwilling to quit completely. An alternative is to teach people to smoke in ways that minimize the associated health risks. Such an approach would involve decreasing smoking rate, switching to “safer” tobacco products, and modifying the topography of consumption. Previous research has shown that topographical components of smoking behavior such as puff frequency, puff duration, cigarette duration, and amount smoked can be reliably measured and experimentally manipulated (Frederiksen, Miller, and Peterson, Addictive Behaviors, 1977, 2, 55–61). Further, there is preliminary evidence from a single-subject experiment that topography can be changed in clinically relevant directions and that such changes can generalize to the smoker's natural environment (Frederiksen and Simon, Behavior Therapy, in press). To replicate and extend these findings, three single-subject experiments were conducted. In each experiment, verbal instructions to modify individual components of smoking topography were sequentially introduced using a multiple-baseline design across components. The components of puff frequency and puff duration were modified in three experiments. Cigarette duration was also modified in two experiments. Following the topography change phase, daily smoking rate was stabilized, using a behavioral contracting procedure (Frederiksen, Peterson, and Murphy, Addictive Behaviors, 1976, 1, 193–196). Generalization was assessed during sessions in which no instructions were given (Subjects 1 and 3) and at six monthly followups (Subjects 2 and 3). For Subjects 2 and 3, data were also available on the amount of carbon monoxide (CO) uptake associated with the consumption of a cigarette (postcigarette CO-precigarette CO). This physiological measure is important because CO and its byproducts constitute a major health risk (Russell, Lancet, 1974, 1, 254–258). Results showed that instructions were effective in modifying components of smoking topography. These changes generalized to sessions in which no instructions were given and across six months of followup. Daily smoking rate did not increase during topography change nor did smoking topography deteriorate when smoking rate was subsequently stabilized on a behavioral contract. Subjective ratings of smoking enjoyment decreased during topography change for two of three subjects but subsequently returned to baseline levels during followup. The observed topography changes were associated with a decrease in the amount of each cigarette smoked. Mean CO uptake was also reduced from baseline levels of 6.0 ppm and 8.0 ppm (Subjects 2 and 3, respectively) to followup levels of 3.3 ppm and 2.1 ppm. These results replicate and extend previous work and suggest that moderate or “controlled” smoking is an approach that deserves continued attention. The importance of assessing smoking topography and physiological variables, as well as directions for subsequent investigation, are discussed.

Background There is elevated prevalence of marijuana use among young adults who use tobacco, but little is known about the extent of co-use generated from surveys conducted online. The purpose of the present study was to examine past-month marijuana use and the co-use of marijuana and tobacco in a convenience sample of young adult smokers with national US coverage. Methods Young adults age 18 to 25 who had smoked at least one cigarette in the past 30 days were recruited online between 4/1/09 and 12/31/10 to participate in an online survey on tobacco use. We examined past 30 day marijuana use, frequency of marijuana use, and proportion of days co-using tobacco and marijuana by demographic characteristics and daily smoking status. Results Of 3512 eligible and valid survey responses, 1808 (51.5%) smokers completed the survey. More than half (53%, n = 960) of the sample reported past-month marijuana use and reported a median use of 18 out of the past 30 days (interquartile range [IR] = 4, 30). Co-use of tobacco and marijuana occurred on nearly half (median = 45.5%; IR = 13.1, 90.3) of the days on which either substance was used and was more frequent among Caucasians, respondents living in the Northeast or in rural areas, in nonstudents versus students, and in daily versus nondaily smokers. Residence in a state with legalized medical marijuana was unrelated to co-use or even the prevalence of marijuana use in this sample. Age and household income also were unrelated to co-use of tobacco and marijuana. Conclusion These results indicate a higher prevalence of marijuana use and co-use of tobacco in young adult smokers than is reported in nationally representative surveys. Cessation treatments for young adult smokers should consider broadening intervention targets to include marijuana.