Tobacco smoking- and alcohol drinking-attributable cancer mortality in Germany

Mortality attributable to tobacco in Tunisian adults, 2016Mortalité attribuable au tabac dans la population tunisienne adulte en 2016

OBJECTIVE

We aimed to estimate the mortality attributable to current cigarette smoking among Tunisian individuals aged 30 years and over in 2016.

METHODS

The number of deaths attributable to cigarette smoking was estimated using the population attributable fraction (PAF) method of calculation. Current cigarette smoking-related data and number of deaths by cause were obtained from a Tunisian national household survey conducted in 2016 (THES-2016) and the "Global Burden of Disease" study respectively. Relative risks for cause-specific mortality among current cigarette smokers compared to never-smokers were obtained mainly from the American cancer prevention study II (CPS II), including adjustments for a range of potential confounders.

RESULTS

In 2016, 6,039 deaths were attributed to current cigarette smoking (5,934 in men and 105 in women), accounting for 14.3 % of total deaths in persons aged 30 years and over (24.2 % in men and 0.6 % in women). Lung cancer, chronic obstructive pulmonary diseases and upper aerodigestive tract cancers represented the highest smoking-attributable risks (74.5 %, 49.1 % and 42.2 % respectively).

CONCLUSIONS

In the present study, high rates of smoking-attributable mortality were found, mainly among men. In addition to more rigorous application of existing laws, sensitization to the dangers of tobacco, educational anti-smoking campaigns and help in quitting are of prime importance.

[In vitro exposure of human nasal mucous membrane cells and lymphocytes to snuff]

BACKGROUND

While an abundant number of studies concerning tobacco smoke and chewing tobacco show carcinogenic potential, there is little data on the consequences of snuff, especially on the cellular level. Therefore, the mutagenic effect of snuff is difficult to estimate and the WHO assessment of snuff being not carcinogenic is based on very limited data.

OBJECTIVES

This paper investigates the potential cytotoxic and genotoxic effects of snuff on human lymphocytes and nasal mucosa cells.

MATERIALS AND METHODS

Two types of snuff were used: one without menthol and one with a high degree of menthol. The necessary nasal mucosa cells and lymphocytes were collected from 10 subjects undergoing nasal obstruction surgery and incubated for one hour with a snuff-DMSO mixture (range 0.01-2000 µg/ml). Methods included the trypan blue test, the comet assay, and the micronucleus test.

RESULTS

The trypan blue test showed no decrease in cell viability for either cell type. The comet assay revealed a significant increase in the Olive Tail Moment for lymphocytes starting at 100 µg/ml and at 1000 µg/ml for nasal mucosa cells. There was no significant increase in micronuclei according to the micronucleus test. No differences between these two types of tobacco were observed.

CONCLUSION

The present study demonstrated genotoxic damage, such as DNA strand breaks, which may be repaired, but no non-repairable elevated micronuclei. The present findings cast doubts on the WHO assessment that snuff is not carcinogenic. However, for a sound assessment of the risk potential of snuff, further research on various genotoxic endpoints in human cells is warranted.

Predictors of reduced smoking quantity among recovering alcohol dependent men in a smoking cessation trial

INTRODUCTION

Adults with alcohol dependence (AD) have exceptionally high smoking rates and poor smoking cessation outcomes. Discovery of factors that predict reduced smoking among AD smokers may help improve treatment. This study examined baseline predictors of smoking quantity among AD smokers in a pharmacotherapy trial for smoking cessation.

METHODS

The sample includes male, AD smokers (N = 129) with 1-32 months of alcohol abstinence who participated in a 12-week trial of medication (topiramate vs. placebo) and adjunct counseling with 6 months of follow-up. Baseline measures of nicotine dependence, AD severity, psychopathology, motivation to quit smoking, and smoking-related cognitions were used to predict smoking quantity (cigarettes per day) at post-treatment and follow-up.

RESULTS

Overall, the sample had statistically significant reductions in smoking quantity. Greater nicotine dependence (Incidence rate ratios (IRRs) = 0.82-0.90), motivation to quit (IRRs = 0.65-0.85), and intrinsic reasons for quitting (IRRs = 0.96-0.98) predicted fewer cigarettes/day. Conversely, greater lifetime AD severity (IRR = 1.02), depression severity (IRRs = 1.05-1.07), impulsivity (IRRs = 1.01-1.03), weight-control expectancies (IRRs = 1.10-1.15), and childhood sexual abuse (IRRs = 1.03-1.07) predicted more cigarettes/day.

CONCLUSIONS

Smokers with AD can achieve large reductions in smoking quantity during treatment, and factors that predict smoking outcomes in the general population also predict greater smoking reductions in AD smokers. Treatment providers can use severity of nicotine dependence and AD, motivation to quit, smoking-related cognitions, and severity of depression to guide treatment and improve outcomes among AD smokers.

Protective Role of Crocin Against Nicotine-induced Damages on Male Mice Liver

Background:

Nicotine is a major pharmacologically active substance in cigarette smoke. It is mainly metabolized in liver and causes devastating effects. Crocin is the chemical ingredient primarily responsible for the color of saffron. It has different pharmacological effects such as antioxidant and anticancer. This study was designed to evaluate the protective role of crocin against nicotine on the liver of mice.

Methods:

Forty-eight mice were equally divided into 8 groups; control (normal saline), nicotine (2.5 mg/kg), crocin (12.5, 25 and 50 mg/kg) and crocin plus nicotine treated groups. Saline, crocin, nicotine and crocin/nicotine (once a day) were intraperitoneally injected for 4 weeks. The liver weight and histology, aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and serum nitric oxide levels have been studied.

Results:

The results indicated that nicotine administration significantly decreased liver weight (48.37%) and increased the mean diameter of hepatocyte (239%), central hepatic vein (28.45%), liver enzymes level (ALP 29.43%, AST 21.81%, ALT 21.55%), and blood serum nitric oxide level (57.18%) compared to saline group (P < 0.05). However, crocin and crocin plus nicotine administration significantly boosted liver weight (49.54%) and decreased the mean diameter of hepatocyte (40.48%), central hepatic vein (15.44%), liver enzymes (ALP 22.02%, AST 19.05%, ALT 23.11%), and nitric oxide levels (35.80%) in all groups compared to nicotine group (percentages represent the maximum dose) (P < 0.05).

Conclusions:

Crocin showed its partly protective effect against nicotine-induced liver toxicity.

Risk of tobacco-related multiple primary cancers in Bavaria, Germany

BACKGROUND

With the prospect of increasing prevalence of cancer, the issue of multiple primary cancers becomes more relevant. The aim of this study was to estimate the risk of developing a tobacco-related subsequent primary cancer (TRSPC) in persons with a tobacco-related first primary cancer (TRFPC) compared with the general population in Bavaria, Germany.

METHODS

Using data from the Population-Based Cancer Registry Bavaria, we analyzed TRFPC and TRSPC diagnosed in Bavaria between 2002 and 2008 to estimate the relative and absolute risk of developing TRSPC using standardized incidence ratios (SIR) and excess absolute risks (EAR).

RESULTS

121,631 TRFPC in men and 75,886 respective cancers in women were registered, which in 2.5% of male and 1.2% of female cancer patients were followed by at least one TRSPC. In both males and females, the highest increased risks compared to the general population were found within the group of cancer in the mouth/pharynx, oesophagus, larynx, and lung/bronchus.

CONCLUSIONS

With respect to cancer in the mouth/pharynx, oesophagus, larynx, lung/bronchus, kidney, urinary bladder and urinary tract, smoking was confirmed as a shared risk factor based on our finding of mutually significantly increased risks of TRSPC. The results of this study illustrate the importance of smoking cessation and of continued follow-up care especially of smokers with the aforementioned TRFPC to detect TRSPC at an early stage.

Arbeitsweise und Wirksamkeit einer Telefonberatung für Tabakentwöhnung

Hintergrund: Wirksame und leicht zugängliche Ausstiegsangebote können dazu beitragen, die Rauchprävalenz und damit einhergehende tabakbedingte Morbidität und Mortalität zu senken. Telefonische Raucherberatung mit Rückrufen während der Ausstiegsphase gilt als dafür besonders geeignete Form der Tabakentwöhnung. Methode: Die Bundeszentrale für gesundheitliche Aufklärung (BZgA) bietet interessierten Anrufern eine proaktive Beratung mit fünf Folgeanrufen an. Einmalig beratene Anrufer ohne Folgeanrufe bilden die Kontrollgruppe. Untersucht wurde das Rauchverhalten beider Gruppen nach drei und 12 Monaten. Alle Daten wurden telefonisch erhoben. Ergebnisse: Die Anrufer sind überwiegend stark abhängige Raucher (M = 21,5 Zig./Tag; FTND = 5,33). Nach 3 Monaten unterscheidet sich die 30-Tage-Punktprävalenz der proaktiv beratenen Gruppe deutlich von der der Kontrollgruppe (22,3 % vs. 11,1 %, p = .010). Nach einem Jahr war proaktive Beratung mit mindestens drei zusätzlichen Beratungsgesprächen wirksamer als eine einmalige oder weniger intensive proaktive Beratung (Punktprävalenz: 34,4 % vs. 21,3 %, p = .024). Schlussfolgerungen: Proaktive Beratung ist eine wirksame Unterstützung und führt bei etwa jedem dritten Anrufer mit mindestens drei Folgeanrufen zu längerfristiger Abstinenz.

Treatment of tobacco dependence

BACKGROUND

110 000 to 140 000 people die in Germany each year of tobacco-related diseases. Thus, measures should be taken to lower the number of persons who start smoking, encourage smokers to stop, and keep those who have stopped from starting again, in order to achieve a sustained benefit in public health.

METHOD

We present recommendations for the diagnostic evaluation, counseling, psychotherapy, and pharmacotherapy of smokers, derived from the findings of current Cochrane meta-analyses and from the pertinent German-language and American guidelines.

RESULTS

Motivational interviewing by a physician, including a recommendation to stop smoking and counseling on how to do this, can reinforce a smoker's motivation to quit. Behavioral therapeutic approaches support changes in behavior, while medical aids such as nicotine replacement therapy, bupropion, and varenicline help former smokers overcome the initial withdrawal symptoms. Low-threshold measures such as self-help books, telephone counseling, and Internet-based cessation programs complement the evidence-based treatments. With a combination of medications and psychotherapeutic support, abstinence rates of up to approximately 40% can be achieved at the end of one year.

CONCLUSION

Smokers who decide to quit can benefit from their doctors' support. Physicians should be taught about tobacco dependency and how to treat it as part of their undergraduate medical education, residency training, and continuing medical education.

Attitudes towards brief interventions to reduce smoking and problem drinking behaviour in gynaecological practice

OBJECTIVE

To assess attitudes towards brief interventions, obstacles and assessment rates for smoking and problem drinking in gynaecological practice, and to evaluate the differences between smoking and problem drinking.

STUDY DESIGN

Cross-sectional survey.

METHOD

An anonymous mail survey was conducted with all 358 primary care gynaecologists in the state of Schleswig-Holstein, Germany.

RESULTS

Most gynaecologists considered brief interventions for problem drinking to be less important in gynaecological practice than in general (74% vs 64%). Brief interventions were believed to be ineffective, particularly for problem drinking (64% vs 53% for smoking). Gynaecologists felt better prepared to counsel their patients than to assess substance use. Only 35% stated that they assess the smoking status of every patient, and less than 12% stated that they assess the alcohol consumption of every patient. The counselling rate for smoking was high (79%), but problem drinkers were often referred to specialists (counselling rate 36%). The most important obstacles for the implementation of brief interventions were lack of time and poor patient compliance. In addition, for problem drinking, insufficient specialization was a further obstacle.

CONCLUSION

Although a link was found between primary gynaecological care and tobacco and alcohol use, brief interventions are not yet integrated into gynaecological practice. There are, however, some promising starting points for patients who smoke, as motivation among gynaecologists to conduct brief interventions and counselling is high. The findings underscore the need for increased medical education and information about brief interventions, as well as assessment programmes for gynaecologists.

Smoking during pregnancy and postpartum: smoking rates and intention to quit smoking or resume after pregnancy

BACKGROUND

A substantial number of women smoke while pregnant. The majority of those who quit return to smoking within 12 months. The aim of this study is to estimate smoking rates and to measure the urge to smoke and the motivation to change smoking behavior among women who recently delivered.

METHODS

Data presented stem from two studies. Study 1 is an epidemiological survey investigating the health of neonates. Study 2 presents screening data of an efficacy trial for a smoking cessation and relapse prevention intervention. Participants were recruited on maternity wards within 7 days after delivery.

RESULTS

Five hundred fifty-three (29.1%) women were never smokers, 145 (7.6%) were former smokers, 492 (25.9%) abstained during pregnancy, and 712 (37.4%) smoked throughout pregnancy. Of the smokers, 69% did not intend to quit smoking within the next 6 months. Of the women who quit during pregnancy, 80% did not want to resume smoking within the next 6 months or after weaning.

CONCLUSIONS

Smoking and relapse rates indicate a need for increased efforts to reduce smoking during pregnancy and postpartum. Reported intention to quit or resume does not reflect the high number of relapses. Indicators for relapse need to be found.

Timevarying predictors of smoking cessation among individuals in treatment for alcohol abuse and dependence: findings from Project MATCH

AIMS

Individuals in treatment for alcohol use disorders are more likely to die from cigarette use than from alcohol consumption. Advanced statistical methodologies that increase study power and clinical relevance have been advocated to examine the timevarying nature of substance use relapse and abstinence, including drinking and smoking. The purpose of this investigation was to examine timevarying factors that are associated with smoking cessation among smokers in the general population, including alcohol use, self-efficacy, and depression, to determine if they were also related to smoking cessation during and after treatment for alcohol use disorders.

METHODS

Data were garnered from Project MATCH, a longitudinal prospective study of the efficacy of three behavioural treatments for alcohol use disorders. Timevarying covariate analyses were conducted to examine future smoking cessation.

RESULTS

Results showed that greater self-efficacy regarding resisting temptations to drink and lower levels of depression were independently associated with increased likelihood of stopping smoking. In contrast, drinks per drinking day and confidence regarding not drinking did not demonstrate such associations.

CONCLUSIONS

Clinical implications of these findings suggest that interventions to help alcoholics in recovery avoid temptations to drink, as well as decrease depression, may be warranted. By using advanced statistical techniques, these results can help clinicians and organizations working with smokers in treatment for alcohol use disorders to make informed decisions regarding how best to use limited resources.

Population impact—Definition, calculation and its use in prevention science in the example of tobacco smoking reduction

INTRODUCTION

Population Impact is a criterion that can enhance prevention practices and provide a solid foundation for integrating policies and programs for prevention. However, to quantify the population impact of programs a statistical measure is needed. The objective of this article is to (a) deduct a formula to quantify population impact (PI), (b) define the formula for population impact of smoking prevention measures and (c) apply this formula on smoking prevention programs.

METHODS

Decision analytical approach.

RESULTS

The measurement of PI is defined with four parameters: recruitment, retention, efficacy and prevalence. A formula is mathematically deducted and the PI for different smoking prevention programs is calculated.

DISCUSSION

The formula supports decision makers in deciding what prevention measure shows a higher impact on the population, gives hints where to improve the measure to increase the impact, whether recruitment, retention or efficacy needs to be improved and makes it easy to do analyses of costs on the population level.

CONCLUSIONS

To enhance prevention practice prevention measures need to provide all parameters to calculate the PI, research needs to focus on all parameters influencing the PI and costs of prevention measures need to be provided.

[Effects of nicotine with special consideration given to tumorigenesis in the head and neck region]

BACKGROUND

Tumorigenesis is based on initiation, promotion, and progression, whereas tobacco smoke is a decisive predisposing factor for squamous cell carcinomas of the upper aerodigestive tract. A variety of tobacco smoke compounds is known to potentially initiate tumors, but the alkaloid nicotine is generally considered to induce addiction only. However, there is growing evidence that nicotine may also contribute to early stages of tumorigenesis. In the present study, a possible direct genotoxic potential of nicotine is investigated.

MATERIAL AND METHODS

Lymphatic tissue of the tonsilla palatina of eight donors was harvested during surgery and incubated with nicotine. DNA damage was measured with the comet assay.

RESULTS

Genotoxic effects of nicotine could be demonstrated.

DISCUSSION

The results suggest a direct contribution of nicotine to tumor initiation and carcinogenesis.

Midwives’ attitudes to counselling women about their smoking behaviour during pregnancy and postpartum

OBJECTIVE

to investigate the attitudes of midwives to counselling women about their smoking behaviour during pregnancy and postpartum.

DESIGN

survey using postal questionnaires.

SETTING

the entire federal state of Mecklenburg-West-Pomerania in Germany.

PARTICIPANTS

189 midwives constituting 77% of all midwives working in that State.

FINDINGS

midwives reported that they assessed smoking behaviour regularly (77%), addressed the consequences of smoking (70%) and advised women to quit. Among the midwives, 81% saw low chances of success and parents' expectations as the biggest barriers to counselling. Midwives reported that about 28% of women quit following their advice.

KEY CONCLUSIONS

smoking and exposure to environmental tobacco smoke are seen as prominent health threats that midwives reported they addressed routinely, including giving advice to stop smoking.

IMPLICATIONS FOR PRACTICE

midwives should be supported in learning effective intervention strategies to further strengthen their work. They are a target population to deliver brief smoking interventions.

Craving and other characteristics of the comorbidity of alcohol and nicotine dependence

PURPOSE

In this cross-sectional study we compared alcohol-dependent smokers and non-alcohol-dependent smokers with respect to intensity of nicotine dependence, craving conditions, sleep disturbances, comorbidity with major depression, reasons for smoking, accompanying somatic diseases and patients' prolonged abstinence from smoking during the 3 years preceding the study.

SUBJECTS AND METHODS

Fifty-one alcohol-dependent smokers and 327 non-alcohol-dependent smokers diagnosed as ICD-10 and DSM-IV-nicotine dependent, were investigated by means of the Fagerström Test for Nicotine Dependence, the Lübeck Craving-Recurrence Risk Questionnaire and the Lesch Alcohol Dependence Typology (both adapted to smoking).

RESULTS

The intensity of nicotine dependence was more enhanced in alcohol-dependent smokers compared to non-alcohol-dependent smokers. Several variables of all factors of craving ("depressive mood", "stimulation", "relaxation", "socially triggered tension") were significantly increased in alcohol-dependent patients (P<0.05). Alcohol-dependent smokers showed depressive symptoms and sleep disturbances, whilst non-alcohol-dependent individuals mainly smoked for stress release and weight control.

DISCUSSION

Our study demonstrates that the intensity of nicotine dependence, several conditions of craving for nicotine, sleep disturbances and symptoms of depression appear to be enhanced in alcohol-dependent smokers compared with non-alcohol-dependent smokers. Conclusions. - It is hoped that the factors of craving and reasons for smoking identified in this study will contribute to a better understanding of smoking temptation in alcohol-dependent smokers and non-alcohol-dependent smokers in future.

Genotoxicity of nicotine in mini-organ cultures of human upper aerodigestive tract epithelia

The direct role of nicotine in tobacco carcinogenesis is still controversial. Recently, DNA damage by nicotine has been demonstrated in isolated human tonsillar tissue cells. Presently, these effects were investigated using mini-organ cultures (MOC) of human nasal epithelia. Intact MOC were repeatedly exposed to 2 and 4 mM nicotine for 1 h on culture days 7, 9, and 11. N-Methyl-N'-nitro-N-nitrosoguanidine (MNNG) served as a positive control. DNA damage was examined by Comet assay either directly after exposure or following a 24-h recovery period. Cell viability was not reduced by any treatment. On day 7, 1 h exposure to 2 and 4 mM nicotine caused a significant dose-dependent 3.3- and 5.6-fold increase in DNA damage compared to solvent controls. Although there was no evidence of significant repair within 24 h recovery, DNA damage was not further increased by nicotine on days 9 and 11. After double and triple exposure to 4 mM nicotine a significant reduction in DNA damage following 24 h recovery was observed. In contrast, treatment with MNNG resulted in a highly significant and cumulative increase in DNA migration up to 110-fold compared to controls. During recovery periods, MNNG-induced DNA damage was significantly repaired, leading to a 1.5- to 1.8-fold reduction in DNA migration within 24 h. These results confirm genotoxic effects of nicotine on human nasal epithelia. Further studies are needed to explain the lack of cumulative DNA-damaging effects of nicotine and the absence of significant DNA repair. These studies should include a battery of assays with multiple end points.

Food and Nutrient Intake, Anthropometric Measurements and Smoking according to Alcohol Consumption in the EPIC Heidelberg Study

AIMS

The study was carried out to determine associations of reported alcohol intake with dietary habits, body mass index, waist-to-hip ratio (WHR) and smoking.

SUBJECTS AND METHODS

24,894 subjects who participated in the baseline examination of the German part of the European Prospective Investigation into Cancer and Nutrition (EPIC) in Heidelberg and were between 35 and 65 years of age at baseline were included in the present cross-sectional analysis (11,617 men, 13,277 women). Diet and alcohol consumption were assessed with a semiquantitative food frequency questionnaire. Analysis of covariance with age as a covariate was used to analyse the association between alcohol intake and dietary consumption patterns, BMI, WHR and smoking.

RESULTS

Alcohol did not replace other food items, but was an addition to the diet. Among alcohol consumers, fat and protein intake as a percentage of energy was slightly higher and carbohydrate intake was slightly lower than among abstainers. Alcohol consumers had a lower intake of fruits, dairy products, cereal products, and added vegetable fat and a higher intake of animal products such as meat, fish, eggs and added animal fat than abstainers. The prevalence of current smoking showed a U-shaped relation to alcohol intake in men and women. In men, a U-shaped association was also seen between the prevalence of former smoking and alcohol intake, while the prevalence of former smoking increased linearly with alcohol intake in women.

CONCLUSION

The results show that alcohol consumption is associated with dietary consumption patterns and smoking. Therefore, it will be important to consider dietary patterns and other lifestyle parameters when investigating the health effects of alcohol intake in the future.

Comparison of a population-based sample of "risky drinking" smokers and groups consuming just one substance

This population-based study compares a group of "risky drinking" smokers (n = 137) with groups of either smokers (n = 760) or "risky drinkers" (n = 173) regarding sociodemographic, behavioral and motivational variables. The study took place in a rural and urban region of Germany in 1997. No differences were found in sociodemographics, nicotine-related variables, frequency of alcohol consumption, and most alcohol-related diagnoses. People who drink and smoke show a higher proportion of alcohol dependence (ES: h = .20), drink more alcohol per occasion (ES: d = .39), and are more motivated to decrease alcohol consumption (ES: h = .45). The data suggest focusing research in more alcohol-related clinical settings and examining the relationship between smoking cessation and alcohol reduction.

Nicotine dependence, quit attempts, and quitting among smokers in a regional population sample from a country with a high prevalence of tobacco smoking

BACKGROUND

Nicotine dependence might function as a barrier to smoking cessation. Therefore, the goal was to determine whether single symptoms of nicotine dependence are related to the number of quit attempts and smoking status.

METHODS

In a random population sample of 4075 women and men aged 18-64, drawn from 47 German communities, data about nicotine dependence according to the US Diagnostic and Statistical Manual of Mental Disorders and according to the Fagerström Test for Nicotine Dependence (FTND), and data on quit attempts and quitting were collected at baseline with an interview and 30 months later with a questionnaire.

RESULTS

Nicotine dependence, in particular withdrawal, was related to a high number of quit attempts and to remaining a current smoker. The urgent need for tobacco, craving for nicotine, smoking to avoid withdrawal, and the expectation of increased appetite or weight gain correctly classified smoking status in 72.1% of individuals through logistic regression analysis.

CONCLUSIONS

Nicotine dependence is a strong factor that may partly explain the failure of a subpopulation of smokers to live abstinent. Population-based interventions should include measures of tobacco control and brief interventions carried out, for example, by experts in health care.

Probabilities of alcohol high-risk drinking, abuse or dependence estimated on grounds of tobacco smoking and nicotine dependence

AIMS

To estimate probabilities of alcohol high-risk drinking, alcohol abuse and alcohol dependence on grounds of smoking-behaviour related variables and single nicotine dependence criteria.

DESIGN

Cross-sectional population-based study.

SETTING

Adult population of a region in north Germany.

PARTICIPANTS

Cigarette smokers (n = 2437) among a random sample of 4075 females and males aged 18-64, drawn in 1996.

MEASUREMENT

Smoking, nicotine dependence according to the Diagnostic and Statistical Manual of Psychiatric Disorders (DSM-IV) and the Fagerström Test for Nicotine Dependence (FTND); increasing alcohol-related harm (ARH): high-risk drinking, DSM-IV alcohol abuse, remitted and current alcohol dependence diagnosed by the Composite International Diagnostic Interview (CIDI).

FINDINGS

Having smoked 30 cigarettes or more per day, onset of smoking at the age of 17 or younger, nicotine dependence and single nicotine dependence criteria revealed odds ratios higher than 4.0 for alcohol dependence. For alcohol dependence, a logistic regression model showed an increased odds ratios for male gender, smoking for 25 years or more, no attempt to quit or cut down, continuation of smoking despite problems, craving for nicotine, withdrawal experience 1 day or longer, smoking first cigarette in the morning 5 minutes or less after waking. The probability of increasing ARH was more likely in males, smokers for 25 years or more, no attempt to quit or cut down, continuation of smoking despite problems and smoking first cigarette in the morning 5 minutes or less after waking.

CONCLUSIONS

Gender and single nicotine dependence criteria show particularly high probabilities of alcohol dependence and increasing ARH. Interventions need to take these connections into account.

The approach of comprehensive tobacco control in cancer prevention: elements and evidence

The aim of this overview is to present measures of comprehensive tobacco control (CTC) and recent evidence according to their efficacy. CTC includes eight measures: raising taxes, consumer regulations, information about tobacco products, advertisement and sponsoring, economic alternatives to the production of tobacco, programmes for the support of the motivation to stop smoking and maintain tobacco abstinence, including the change of attitudes and norms in the population to support non-smoking, financial and human resources of CTC, and quality assurance of CTC. These measures include single elements such as activities against smuggling, to be considered in conjunction with tax increases. Evidence, particularly from single US states, reveals the efficacy of CTC. As discussed, the literature shows that programmes have not yet included all single elements. This is due to individual, programme-related and external limiting factors. It is concluded that in spite of these, CTC programmes are effective in adults as well as minors. A dose-response relationship between CTC and reduction of smoker rates, the amount of tobacco consumption and tobacco-attributable mortality is probable.