Active and passive smoking in married couples: results of 25 year follow up

Risk of all-cause mortality and cardiovascular disease associated with secondhand smoke exposure: a systematic review and meta-analysis

BACKGROUND

Emerging studies have assessed the association between secondhand smoke (SHS) exposure and cardiovascular disease (CVD) as well as all-cause mortality. However, findings were not consistent due to the heterogeneity of study characteristics.

METHODS

PubMed and Embase were searched through May 2014 for prospective cohort and case-control studies investigating the associations of SHS exposure in never smokers with all-cause mortality and the risk of CVD. The main analysis was performed in studies using self-reported SHS exposure and secondary analysis was performed in studies using objectively measured SHS exposure. Summary estimates were calculated using random-effects models.

RESULTS

Twenty-three prospective and 17 case-control studies were included. The pooled relative risks (RR) for never smokers exposed to SHS in comparison with those unexposed were 1.18 [95% confidence interval (CI): 1.10-1.27] for all-cause mortality (12 studies), and 1.23 (1.16-1.31) for CVD (38 studies). The association of SHS exposure with CVD was markedly stronger among studies conducted in China (RR=1.65, 95% CI 1.27-2.13) than that in the US (RR=1.09, 95% CI 1.03-1.16). Studies using objectively measured SHS exposure demonstrated a slightly higher risk for CVD compared with those using self-reported SHS exposure.

CONCLUSIONS

Exposure to SHS significantly increased the risk for all-cause mortality and CVD. The risk associated with SHS exposure was large in China while the risk was only modest in the US. Studies using objectively measured SHS exposure may yield a higher risk of CVD than those using self-reported SHS exposure.

Diet and nutrition in ulcer disease

In this era of H2-inhibitors, the available evidence does not support the need to place peptic ulcer disease patients on restrictive diets. The major goal of diet is to avoid extreme elevations of gastric acid secretion and the direct irritation of gastric mucosa. In view of this, only slight modifications in the patient's usual diet are recommended. Table 1 depicts a sample menu for chronic peptic ulcer disease. Frequent milk ingestion as previously prescribed is not encouraged. This is owing to the transient buffering effect and significant gastric acid secretion effect of milk. The fat content of milk has no influence on these effects. Spices, in particular black pepper, red pepper, and chili powder, may produce dyspepsia. One study shows red chili powder to have no detrimental effect on duodenal ulcer healing. It has also been proposed that daily pepper ingestion may have a beneficial adaptive cytoprotective response. While still controversial and under evaluation, peptic ulcer patients should avoid any spice that causes discomfort, especially during exacerbation of peptic disease. Currently, studies indicate that it is prudent to avoid alcohol. This is especially true for the concentrated forms, such as 40% (80 proof) alcohol. Coffee should be avoided on the basis of its strong acid secretagogue property. Coffee can induce dyspepsia. Whether noncoffee caffeine-containing beverages (tea, soft drinks) induce peptic ulcer is unknown, but they are acid secretion stimulators. Decaffeinated coffee has an acid stimulating effect as well. It is reasonable to have peptic ulcer patients restrict decaffeinated coffee and all caffeine-containing beverages. There appears to be no evidence to restrict dietary fiber. Some fiber-containing foods may possess factors that are protective against ulcer disease. According to the Mayo Clinic Diet Manual, previously recommended small frequent feedings have not been shown to be more effective than three meals per day in the treatment of chronic peptic ulcer disease. This reference cites authorities advising against extra feedings because of increased acid secretion and unnecessary complication of eating patterns. However, some patients claim to be relieved of symptoms with more frequent feedings, especially during acute phases. Citric acid juices may induce reflux and cause discomfort in selective patients. Stomach distention with large quantities of food should be discouraged. Although there is now little role for dietary therapy, one should note that bland and ulcer diets probably are not detrimental to most persons if they are used for a short time and may have some psychological benefit.(ABSTRACT TRUNCATED AT 400 WORDS)

Passive smoking and 20-year cardiovascular disease mortality among nonsmoking wives, Evans County, Georgia

The association of passive smoking and cardiovascular disease (CVD) mortality was assessed in a cohort of 513 rural, married Black and White women who were disease-free and self-described as never-smokers at baseline in 1960. Over a 20-year period, 76 of 147 total deaths were attributed to CVD. Relative risk estimates adjusted for age, cholesterol, blood pressure, and body mass from proportional hazards models were 1.59 for CVD (95% CI = 0.99, 2.57) and 1.39 (CI = 0.99, 1.94) for all cause mortality among women with husbands who smoked cigarettes.

Community impact of a localized smoking cessation contest

The present study assessed the effectiveness of a localized community contest timed to coincide with a statewide smoking cessation contest. Follow-up interviews were conducted with 218 local contest participants and 198 participants from the statewide contest. Overall cessation impact (participation rate x abstinence) was 0.39 percent for the local contest and 0.09 percent for the statewide contest. Localized community contests offered in conjunction with statewide or national campaigns may represent cost-effective methods of reaching large numbers of smokers.

Deaths from all causes in non-smokers who lived with smokers

Mortality associated with passive smoking was evaluated in a 12-year study of 27,891 White adult smokers and 19,035 never smokers identified in 1963. Death rates were calculated using an estimate of the person-years at risk. Adjusted for age, marital status, education, and quality of housing, the estimated relative risks of death from all causes were 1.17 (approximate 95% confidence interval 1.01, 1.36) for men and 1.15 (1.06, 1.24) for women with passive exposure. These relative risks were similar to those for ex-smokers and for pipe or cigar smokers. Risks increased slightly with level of exposure. The relative risk from passive smoking was greatest for men under age 50 (RR = 2.09, 1.31-3.34). Risks from passive smoking were slightly elevated for several causes among men and women, and may be broader than those previously reported. On the other hand, these small nonspecific increases in death rates may reflect other characteristics of passive smokers that increase mortality.

On the health effects of environmental tobacco smoke

Possible adverse health effects of breathing environmental tobacco smoke include lung cancer, respiratory illnesses in young children, decreased pulmonary function, decreased lung growth, allergy to tobacco, and exacerbation of angina. These effects are reviewed to aid informed discussion on this health issue. Some of the constituents of tobacco smoke are found in the home, the outdoor environment, and the workplace in permissible concentrations and are considered unlikely to cause ill health. A double standard, one in the workplace and another for the public, may be evolving for acceptable health risks.

Contribution of passive smoking to respiratory cancer

This article reviews data from experimental and epidemiologic studies on passive smoking and makes 12 recommendations for further study. The physicochemical nature of passive smoke, the smoke inhaled by nonsmokers, differs significantly from the mainstream smoke inhaled by the active smoker. At present, measurement of urinary cotinine appears to be the best method of assessing exposures to passive smoking. Data indicate that the greater number of lung cancers in nonsmoking women is probably related to environmental tobacco smoke. Exposures in utero and very early in life to passive smoking may be important in relationship to the subsequent development of cancer and need further consideration. The short-term effects of environmental tobacco smoke on the cardiovascular system, especially among high-risk individuals, may be of greater concern than that of cancer and requires further study. Further study of increased risks of lung cancers in relation to environmental tobacco smoke exposure requires larger collaborative studies to identify lung cancer cases among nonsmokers, better delineation of pathology, and more careful selection of controls. In addition, studies of epithelial cells or specific cytology should be undertaken to determine evidence of cellular changes in relation to environmental tobacco smoke exposure. Animal inhalation studies with passive smoke should be initiated with respect to transplacental carcinogenesis, the relationship of sidestream smoke exposure with lung cancer, the induction of tumors in the respiratory tract and other organs, and the differences in the physicochemical natures of sidestream and mainstream smoke.