Tobacco.org

Intensive in-hospital support doubles likelihood of smoking cessation in heart patients 

Patients admitted to hospital with coronary artery disease are twice as likely to quit smoking after receiving intensive smoking cessation support compared to minimal support, found a new study in CMAJ (Canadian Medical Association Journal) http://www.cmaj.ca/press/pg1297.pdf.

The study, a randomized clinical trial, compared intensive intervention with minimal intervention and found that patients admitted for open heart surgery (coronary artery bypass grafts) had significantly higher long-term abstinence rates at 1 year compared with those admitted for heart attacks (acute myocardial infarctions.)

Jump to full article »

Secondhand Smoke in Pennsylvania Casinos: A Study of Nonsmokers’ Exposure, Dose, and Risk (PDF) 

Mining is described as the most dangerous industry.34 Sixteen Pennsylvania miners died in 15 disasters from 1995 to 2002, a rate of 1.2 deaths per10000 mine workers per year.34 The estimated rate of worker deaths per year from SHS is about 5 times the average annual death rate for Pennsylvania miners in coal mine disasters.

By the workplace standards of the US ½Q22 Occupational Safety and Health Administration ½Q20 (OSHA), which employs a 45-year average time period, casino workers’ risk from SHS-induced lung cancer and heart disease combined is 26 times the level indicating significant risk of material impairment.30

Pennsylvania’s new clean indoor air law permits smoking in 25% to 50% of casino floors. Confining smokers to a smaller area will increase the local smoker density in the smoking area and not protect nonsmoking areas from drifting or recirculated tobacco smoke. . . .

Conclusions

Despite ventilation rates per occupant 50% higher on average than those formerly recommended by ventilation engineers for smoking-permissible casinos, the average RSP concentration measured inside 3 Pennsylvania casinos in which smoking was permitted averaged 6 times that of outdoor levels; PPAH concentrations averaged 4 times outdoor levels, exposing both workers and patrons to harmful levels of air pollution. In the only casino with a separate nonsmoking floor, considerable amounts of RSPs and PPAHs infiltrated the nonsmoking salon. Based on measured RSP levels, SHS odor and irritation thresholds were massively exceeded in smoking areas and considerably exceeded in 1 nonsmoking salon. Using default values, the Active Smoker Model predicted combined RSP observations to within 14%.

Based on cotinine-derived RSP levels, SHS in Pennsylvania casinos produces an estimated excess mortality of approximately 6 deaths per year per 10000 workers at risk, 5 times the rate at which Pennsylvania coal miners have died in mining disasters and 26 times OSHA’s significant risk level. Nonsmoking workers or patrons exposed to casino SHS at the observed level of occupancy for 8 hours would experience ‘‘unhealthy air’’ according to the US Air Quality Index and, at maximum occupancy or exposure duration, ‘‘very unhealthy’’ air. Cotinine- derived PPAHs from SHS increases workers’ 24-hour exposure to PPAHs by an estimated 6-fold over measured outdoor background levels.

Further research is needed to generalize exposures observed in this study to the casino industry as a whole. It is clear, however, that Pennsylvania casino workers and patrons are put at significant excess risk of heart disease and lung cancer from SHS through a failure to include casinos in the state’s smoke-free-workplace law.

Jump to full article »

• Secondhand Smoke Threatens Casino Workers’ Health  

New research suggests that casino workers face a higher risk of heart disease and lung cancer because they work in buildings filled with tobacco smoke.

By one scientist’s calculation, six of every 10,000 nonsmoking casino employees in Pennsylvania will die each year because of exposure to secondhand smoke.

The estimate does not rely on the tracking of individual casino workers over time, nor does it compare them to workers who have not had smoke exposure. Still, the findings suggest a significant risk to the health of the workers, said study author James Repace, a Washington D.C.-area consultant who studies the effects of secondhand smoke.

Casino workers “are really the most exposed group in society now,” Repace said. “The only other group that’s exposed so much is bartenders,” but many states have banned smoking in bars and restaurants.

The Flight Attendant Medical Research Institute — which has studied the risk of secondhand smoke to flight attendants when airlines allowed smoking — funded the study. The casino findings appear online and in the August issue of the American Journal of Public Health.

Jump to full article »

• Health research agencies form global alliance to curb humanity's most fatal diseases 

Six of the world's foremost health agencies, collectively managing an estimated 80% of all public health research funding, today announced formation of a landmark alliance to collaborate in the critical battle against chronic, non-communicable diseases: cardiovascular diseases (mainly heart disease and stroke), several cancers, chronic respiratory conditions, and type 2 diabetes.

The health impact and socio-economic cost of these largely-preventable diseases is enormous and rising, potentially derailing efforts at poverty reduction.

The Global Alliance for Chronic Diseases (Alliance) is being created to support clear priorities for a coordinated research effort . . .

The Alliance's charter members are:

* Australia National Health and Medical Research Council;

* Canadian Institutes of Health Research;

* Chinese Academy of Medical Sciences;

* The U.K. Medical Research Council; and

* The U.S. National Institutes of Health, specifically its National Heart, Lung, and Blood Institute (NHLBI), and the Fogarty International Center. . . .

The following research priorities have been proposed by some founding Alliance members, for discussion at their inaugural scientific meetings in November:

* Test ways to prevent cardiovascular diseases and complications of diabetes;

* Identify and promote public health measures for controlling obesity;

* Characterize and quantify the major risk factors for chronic obstructive airways disease (both tobacco and environmental pollution) and the development of control measures; and

* Advance research into the problem of tobacco consumption and its relationship to cancer, cardiovascular disease and other disorders;

* Develop interventions to address the above priorities.

Jump to full article »

Heart Patients Are Twice As Likely To Quit Smoking With Intensive In-Hospital Support 

A new study in CMAJ (Canadian Medical Association Journal) shows that patients admitted to a hospital with coronary artery disease are twice as likely to quit smoking after receiving intensive smoking cessation support than those receiving minimal support.

The researchers, through a randomized clinical trial, compared intensive intervention with minimal intervention. They found that patients admitted for open heart surgery, such as coronary artery bypass grafts, had considerably higher long-term abstinence rates after one year, compared with those admitted for heart attacks, such as acute myocardial infarctions.

Other elements were instrumental in reaching successful long-term smoking cessation, including absence of a previous heart attack, postsecondary education and some type of smoking restrictions at home.

The study used an intervention that turned out to be in the highest rates of one-year confirmed smoking termination in prior tests in the US.

Jump to full article »

Intensive In-Hospital Support Doubles Likelihood Of Smoking Cessation In Heart Patients 

Patients admitted to hospital with coronary artery disease are twice as likely to quit smoking after receiving intensive smoking cessation support compared to minimal support, found a new study in CMAJ (Canadian Medical Association Journal).

The study, a randomized clinical trial, compared intensive intervention with minimal intervention and found that patients admitted for open heart surgery (coronary artery bypass grafts) had significantly higher long-term abstinence rates at 1 year compared with those admitted for heart attacks (acute myocardial infarctions.)

Other factors that contributed to successful long-term smoking cessation included absence of a previous heart attack, postsecondary education and at least some smoking restrictions at home.

The intervention used in the study resulted in the highest rates of 1-year confirmed smoking cessation in previous tests in the US.

Jump to full article »

Why Smoking Increases The Risk Of Heart Disease And Strokes 

Researchers at Charles Drew University of Medicine and Science in Los Angeles and Western University of Health Sciences in Pomona have discovered a reason why smoking increases the risk of heart disease and strokes.

The study, which was presented at The Endocrine Society's 91st annual meeting in Washington, D.C., found that nicotine in cigarettes promotes insulin resistance, a pre-diabetic condition that raises blood sugar levels higher than normal. People with pre-diabetes are at greater risk of developing cardiovascular disease.

Theodore Friedman, MD, Ph.D., chief of the endocrinology division at Charles Drew University, said the findings help explain a "paradox" that links smoking to heart disease.

Smokers experience a high degree of cardiovascular deaths, Friedman said. "This is surprising considering both smoking and nicotine may cause weight loss and weight loss should protect against cardiovascular disease."

The researchers studied the effects of twice-daily injections of nicotine on 24 adult mice over two weeks. The nicotine-injected mice ate less food, lost weight and had less fat than control mice that received injections without nicotine.

"Our results in mice show that nicotine administration leads to both weight loss and decreased food intake," Friedman said. "Mice exposed to nicotine have less fat. In spite of this, mice have abnormal glucose tolerance and are insulin resistant (pre-diabetes)."

Jump to full article »

Smoking cessation initiated during hospital stay for patients with coronary artery disease: a randomized controlled trial 

Interpretation

More patients in the intensive intervention than in the minimal intervention were abstinent at 1 year (absolute increase of 19%). The odds of quitting smoking were 2 times greater for those in the intensive intervention. The unique contributions of this study include significantly higher rates of continuous abstinence for patients admitted to hospital for CABG than for acute MI, significantly lower rates of abstinence among patients who used pharmacotherapy regardless of the intervention group (which is a finding consistent with general hospital patients) 28 and real-time tracking of the prevalence of tobacco use among patients admitted for acute MI or CABG. The prevalence of tobacco use was higher for patients with acute MI (34%) than the provincial average of smoking prevalence (22%-24%), 29 which is an important consideration for case-load estimation. In addition to receiving the intensive intervention, the absence of a previous acute MI and having a postsecondary education and at least some restrictions on smoking at home contributed to successful long-term cessation of tobacco use.

The rates of confirmed long-term abstinence observed in this trial are among the highest rates reported in cardiac populations and are among the highest reported absolute differences between minimal and intensive interventions. 8 Our results suggest that intensive counselling provided during the hospital stay is more effective than a stepped-care approach that provides intensive counselling only after a patient has relapsed. 30 By significantly increasing abstinence among cardiac patients, inpatient programs for smoking cessation have the potential to produce sizeable reductions in cardiac events 1,3,4,6,7 and hospital costs. . . .

Fifteen years ago, routine smoking-cessation interventions for cardiac patients in hospital were deemed an "idea whose time has come," 40 but the interventions have not been widely adopted. The current trial contributes to the international evidence base and provides support to suggest that future research and practice should focus on dissemination of intensive interventions for smoking cessation into standard hospital practice for cardiac patients. The potential contributions to health and health care costs are substantial.

Jump to full article »

RIGOTTI: Helping smokers with cardiac disease to abstain from tobacco after a stay in hospital 

Key points

* Smoking cessation is a critical but often neglected component of the secondary prevention of cardiovascular disease.

* Smokers who are admitted to hospital for cardiovascular disease benefit from smoking-cessation counselling that begins in hospital and continues for more than 1 month after discharge.

* Interventions for smoking cessation initiated in hospital need to be translated from research into routine clinical practice.

Jump to full article »

• Intensive smoking-cessation program can double quit rate in cardiac patients 

Cardiac patients were twice as likely to successfully quit smoking if they received intensive in-hospital counseling plus follow-up support vs only minimal in-hospital counseling, in a recent study [1].

Among patients hospitalized for CABG or MI who were smokers, 54% who received the intensive counseling protocol vs only 35% of patients who received minimal support were confirmed nonsmokers one year after discharge.

Unfortunately, counseling patients about quitting smoking--which research has shown can greatly reduce the risk of a subsequent cardiovascular event--is often neglected by cardiologists, author Dr Ellen Burgess (University of Calgary, Calgary, ON) told heartwire. . . .

The study is published in the June 23, 2009 issue of the Canadian Medical Association Journal.

Jump to full article »

Iranians smoke 60b cigarettes a year 

Secretary of the 11th National Congress on Cardiovascular Update here on Thursday said that Iranians smoke about 60 billion cigarettes each year, lamenting the increasing rate of smoking among the Iranian youth and women.

Speaking at the congress closed today, Mohammad-Reza Mohammad-Hassani said that a total of 80% of heart and vascular diseases can be preventable by planning and informing the society of the major risk factors for the spread of diseases.

Jump to full article »

• Effects of Timing and Extent of Smoking, Type of Cigarettes, and Concomitant Risk Factors on the Association Between Smoking and Subclinical Atherosclerosis  

The purpose of this study was to evaluate the effects of timing and extent of smoking, type of cigarettes, and concomitant vascular risk factors (VRFs) on the association between smoking and carotid intima-media thickness (C-IMT) in a lipid clinic population. . . .

Conclusions-- In the present cross-sectional observational investigation, carried out in a cohort of patients attending a lipid clinic, consumption of light cigarettes does not reduce the atherogenic effect of smoking on C-IMT. The number of pack-years, cigarettes/d, and years of smoking are relevant covariates in evaluating the effects of smoking on vascular health. The presence of diabetes or hypertension strengthens the association between smoking and cardiovascular risk.

Jump to full article »

Minerva 

Smoking light cigarettes (with low nicotine, tar, or carbon monoxide content) did not seem to reduce the atherogenic effect of smoking on carotid intima-medial thickness in patients attending a lipid monitoring clinic. Thickness was highest in current smokers and lowest in never smokers, and it was positively related to the number of pack years in both former and current smokers. Diabetes and hypertension strengthened the association between smoking and cardiovascular risk (Stroke 2009;40:1991-8, doi:10.1161/strokeaha.108.543413).

Jump to full article »

Social- and Behavioral-Specific Genetic Effects on Blood Pressure Traits: The Strong Heart Family Study  

Conclusions--Our findings suggest that behavioral and socioeconomic factors can modify the genetic effects on blood pressure phenotypes. Accounting for context dependent factors may help us to better understand the complexities of the gene effects on blood pressure and other complex phenotypes with high levels of genetic heterogeneity.

Jump to full article »

Lifestyle May Counter Blood Pressure Genes  

Being born with genes that predispose you to high blood pressure doesn't mean you're doomed to have it, a long-term study shows.

"It's been known for many years that blood pressure is affected by genes," said Dr. Nora Franceschini, an assistant professor of epidemiology at the University of North Carolina and lead author of a report on the study. "It's also known that lifestyle affects blood pressure. Now we are showing that they interact, and that the effect of those genes varies among individuals who have different behaviors."

It's an important finding because high blood pressure is a major risk factor for heart attack, stroke and other cardiovascular diseases. The study, reported online Tuesday in Circulation: Cardiovascular Genetics, "reinforces the message that lifestyle changes can alter the effect of genetics," Franceschini said.

That message comes from the Strong Heart Family Study, which has been looking at diabetes and high blood pressure among American Indians in Arizona, North and South Dakota and Oklahoma, an ethnic group in which the incidence of both is high. The study now includes more than 3,600 people aged 14 to 93.

Jump to full article »