Benign symmetrical lipomatosis: Madelung''s disease

The relationship between smoking and bladder cancer risk was investigated using data from a case-control study conducted between January 1994 and July 1996 in Alexandria, Egypt. Cases were 151 males with incident, histologically confirmed invasive cancer of the bladder, and controls were 157 males admitted to hospital for acute, non-neoplastic, non-urinary tract, non-smoking-related conditions. With reference to never smokers, ex-smokers had a multivariate odds ratio (OR) of 4.4 [95% confidence interval (CI) 1.7-11.7] and current smokers of 6.6 (95% CI 3.1-13.9). The ORs were 5.4 for < 20 and 7.6 for > or = 20 cigarettes per day. After adjustment for cigarette smoking, the ORs were 0.8 for waterpipe and 0.4 for hashish smokers. The risk was significantly related to duration of smoking (OR of 16.5 for > 40 years), and inversely related to age at starting (OR of 8.8 for starting < 20 years), and inversely related to time since quitting smoking. Compared with never smokers who did not report a clinical history of schistosomiasis, the OR was 9.4 for smokers with a history of schistosomiasis, and 10.7 for smokers ever employed in high-risk occupations compared with non-smokers not reporting such a history. Thus, our results, while not giving indications of an increased bladder cancer risk with habits other than cigarette smoking, found a remarkably strong association with various measures of cigarette smoking that could explain 75% of bladder cancer cases among males from Alexandria. The prevalence of smoking was very low among women, and consequently tobacco was not a relevant risk factor for female bladder cancer.     

Toxicity of 2,3,7,8-tetrachlorodibenzo-p-dioxin to several ecological receptor groups: a short review

The objective of this study was to examine the risks for lung cancer associated with lifestyle characteristics of smoking in a developing country where lung cancer is the first cause of mortality by cancer in men, tobacco propaganda is freely allowed, and there are no restrictions operating for smoking. The design was a case-control and hospital-based study. Two hundred men with lung cancer and 397 hospital controls were interviewed. Odds ratio (OR) for current smokers was 8.5, whereas former smokers displayed an OR of 5.3. The risk increased with duration of smoking and with the number of cigarettes smoked per day. The attributable risk for smoking was 85%. Smokers of black tobacco and more than 24 cigarettes/day showed a risk of 12.9 regarding non-smokers, and of 15.5 for 40 or more years duration of smoking. The proportion of cases diagnosed as adenocarcinoma was higher than the proportion of squamous cell carcinoma.     

Alcohol, smoking, and cataracts: the Blue Mountains Eye Study

OBJECTIVE: To investigate the associations between alcohol consumption, tobacco smoking, and cataract. DESIGN: A population-based, cross-sectional study. SETTING: An urban community in the Blue Mountains, close to Sydney, Australia. PARTICIPANTS: Three thousand six hundred fifty-four people aged 49 to 97 years. The participation rate was 82%. MAIN OUTCOME MEASURES: Smoking history and details of current alcohol consumption were assessed by questionnaire. Lens photographs were taken and graded for presence and severity of cortical, nuclear, and posterior subcapsular cataracts. RESULTS: After adjusting for multiple potential confounders, people who had ever smoked cigarettes had a higher prevalence than nonsmokers of more severe nuclear (adjusted odds ratio [OR], 1.3; 95% confidence interval [CI], 1.1-1.6) and posterior subcapsular (adjusted OR, 1.5; 95% CI, 1.1-2.1) cataracts. The association between pipe smoking and nuclear cataract (adjusted OR, 3.1; 95% CI, 1.5-8.2) was stronger than the association with cigarette smoking. Alcohol consumption was associated with a reduced prevalence of cortical cataract: compared with people who did not drink, the adjusted OR for cortical cataract among people who drank at least 1 drink a day was 0.7 (95% CI, 0.6-0.9). Heavy alcohol consumption (> or =4 drinks a day) was associated with nuclear cataract in current smokers (adjusted OR compared with nondrinkers, 3.9; 95% CI, 0.9-16.6) but not in never smokers. CONCLUSIONS: Consistent with other studies, smoking was associated with a higher prevalence of nuclear and posterior subcapsular cataracts. The only adverse effect of alcohol was among smokers: people who smoked and drank heavily had an increased prevalence of nuclear cataract.     

Confocal laser scanning microscopy of chondrocytes in vitro: cytoskeletal changes after quinolone treatment

CONTEXT: Whether tobacco advertising and promotion increases the likelihood that youths will begin smoking has important public policy implications. OBJECTIVE: To evaluate the association between receptivity to tobacco advertising and promotional activities and progress in the smoking uptake process, defined sequentially as never smokers who would not consider experimenting with smoking, never smokers who would consider experimenting, experimenters (smoked at least once but fewer than 100 cigarettes), or established smokers (smoked at least 100 cigarettes). DESIGN: Prospective cohort study with a 3-year follow-up through November 1996. SETTING AND PARTICIPANTS: A total of 1752 adolescent never smokers who were not susceptible to smoking when first interviewed in 1993 in a population-based random-digit dial telephone survey in California were reinterviewed in 1996. MAIN OUTCOME MEASURE: Becoming susceptible to smoking or experimenting by 1996. RESULTS: More than half the sample (n=979) named a favorite cigarette advertisement in 1993 and Joe Camel advertisements were the most popular. Less than 5% (n=92) at baseline possessed a promotional item but a further 10%(n=172) were willing to use an item. While having a favorite advertisement in 1993 predicted which adolescents would progress by 1996 (odds ratio [OR] = 1.82; 95% confidence interval [CI], 1.04-3.20), possession or willingness to use a promotional item was even more strongly associated with future progression (OR=2.89; 95% CI, 1.47-5.68). From these data, we estimate that 34% of all experimentation in California between 1993 and 1996 can be attributed to tobacco promotional activities. Nationally, this would be over 700000 adolescents each year. CONCLUSION: These findings provide the first longitudinal evidence to our knowledge that tobacco promotional activities are causally related to the onset of smoking.     

Prospective study of effect of switching from cigarettes to pipes or cigars on mortality from three smoking related diseases

OBJECTIVE: To estimate the extent to which cigarette smokers who switch to cigars or pipes alter their risk of dying of three-smoking related diseases-lung cancer, ischaemic heart disease, and chronic obstructive lung disease. DESIGN: A prospective study of 21520 men aged 35-64 years when recruited in 1975-82 with detailed history of smoking and measurement of carboxyhaemoglobin. MAIN OUTCOME MEASURES: Notification of deaths (to 1993) classified by cause. RESULTS: Pipe and cigar smokers who had switched from cigarettes over 20 years before entry to the study smoked less tobacco than cigarette smokers (8.1 g/day v 20 g/day), but they had the same consumption as pipe and cigar smokers who had never smoked cigarettes (8.1 g) and had higher carboxyhaemoglobin saturations (1.2% v 1.0%, P < 0.001), indicating that they inhaled tobacco smoke to a greater extent. They had a 51% higher risk of dying of the three smoking related diseases than pipe or cigar smokers who had never smoked cigarettes (relative risk 1.51; 95% confidence interval 0.96 to 2.38), a 68% higher risk than lifelong non-smokers (1.68; 1.16 to 2.45), a 57% higher risk than former cigarette smokers who gave up smoking over 20 years before entry (1.57; 1.04 to 2.38), and a 46% lower risk than continuing cigarette smokers (0.54; 0.38 to 0.77). CONCLUSION: Cigarette smokers who have difficulty in giving up smoking altogether are better off changing to cigars or pipes than continuing to smoke cigarettes. Much of the effect is due to the reduction in the quantity of tobacco smoked, and some is due to inhaling less. Men who switch do not, however, achieve the lower risk of pipe and cigar smokers who have never smoked cigarettes. All pipe and cigar smokers have a greater risk of lung cancer than lifelong non-smokers or former smokers.     

Tobacco consumption among the student population. Related factors

OBJECTIVE: To know smoking prevalence among schoolchildren and factors related with this habit. METHODS: A cross-sectional study. 548 school-children in their 6th and 8th years of primary studies at schools from an area of Córdoba (Spain) were interviewed. INTERVENTIONS: Autoadministered questionnaire. RESULTS: Tobacco was tried in 22% (CI 95%: 18.7-25.8) school-children. The average age for starting with this habit was 11.6 (SD)(CI 95%: 11.4-11.8). 12.1% smoked regularly and 1.3% smokers every day. The tobacco consumption in children was related with age (OR = 2.96; CI 95%: 1.12-7.82), cough medicines consumption (OR = 3.15; CI 95%: 1.32-7.48), to have a smokers sister (OR = 2.53; CI 95%: 1.06-6.00) and best friend (OR = 4.42; CI 95%: 1.85-10.60) and drinking beer (OR = 3.68; CI 95%: 1.15-11.7). CONCLUSIONS: The prevalence of smoking in our school-children is very close to that reported by others. Among the factors accounted with the tobacco consumption in schoolchildren, highlight the presence of this habit in the eldest sister and the best friend.     

The association between cigarette smoking and selected HIV-related medical conditions

OBJECTIVE: To clarify the effect of cigarette smoking on the development of conditions associated with HIV infection. DESIGN: Prospective and retrospective cohort study, with interview and examination twice a year since 1988. METHODS: Data on 516 HIV-infected men from cohorts of homosexual and bisexual men in San Francisco, Denver and Chicago, who were repeatedly interviewed and examined between 1988 and 1992, were analysed. After excluding men who did not have well-defined dates of seroconversion and those who were classified as ex- or intermittent smokers, 232 men remained for analysis: 106 were smokers and 126 were non-smokers. Univariate and Kaplan-Meier survival analyses were performed to assess the relationship between cigarette smoking and loss of CD4+ T-lymphocytes, diagnosis of any AIDS-defining illness, and specific diagnosis of Kaposi's sarcoma, Pneumocystis carinii pneumonia (PCP), oral candidiasis, hairy leukoplakia, and community-acquired pneumonia. RESULTS: By univariate analyses, cigarette smoking was not associated with clinical AIDS, loss of CD4+ cells, Kaposi's sarcoma or PCP, but was significantly associated with oral candidiasis [relative risk (RR), 1.32; 95% confidence interval (CI), 1.02-1.70], hairy leukoplakia (RR, 1.51; 95% CI, 1.15-1.99), and community-acquired pneumonia (RR, 2.62; 95% CI, 1.30-5.27). Dose-response effect was also evident for these three conditions (all P < 0.01). Kaplan-Meier survival analysis indicated no association between cigarette smoking and time of progression to clinical AIDS, Kaposi's sarcoma (KS), or PCP (P = 0.62, 0.54 and 0.11, respectively) but showed that cigarette smokers developed oral candidiasis, hairy leukoplakia, and pneumonia more quickly than non-smokers (P = 0.031, 0.006 and 0.009, respectively). CONCLUSIONS: Cigarette smoking was not associated with an increased likelihood or rate of developing KS, PCP or AIDS, but was associated with developing community-acquired pneumonia, oral candidiasis, and hairy leukoplakia in these HIV-infected men.     

Effect of growth factors on matrix synthesis by human nasal chondrocytes cultured in monolayer and in agar

OBJECTIVES: In this paper we describe the proportion of US adults who report receiving oral cancer screening and tobacco cessation counseling and assistance from dentists and other health professionals. METHODS: Data from the 1992 National Health Interview Survey (NHIS) Cancer Control Supplement, a nationally representative sample of 12,035 adults 18 years of age and older, are analyzed. RESULTS: In 1992, less than 10 percent of adults reported oral cancer screening by a dentist or hygienist within the past three years. White adults (10.1%, 95% CI = 9.3, 10.9) reported an oral cancer screening three times more frequently than black (3.2%, 95% CI = 1.9, 4.5) or Hispanic (3.4%, 95% CI = 2.1, 4.7) adults. About half of adult current smokers had seen a dentist within 12 months, and of those only 24.1 percent (95% CI = 21.7, 26.5) had been advised to quit smoking. Heavy smokers (two or more packs a day) were more likely to have been advised to quit than light (pack or less per day) or occasional smokers. A similar proportion (24.3%, 95% CI = 17.6, 31.0) of white adult men who reported using smokeless tobacco products had been told by a dentist to quit using tobacco. CONCLUSIONS: Results from this population-based survey indicate that cancer screening and tobacco cessation advice are underutilized in the dental practice. Increased patient awareness and implementation of screening and tobacco cessation interventions could improve oral cancer incidence and mortality and have a public health benefit for other tobacco-related morbidity and mortality as well.     

Cigarette smoking and periodontal destruction in young adults

The relationship between cigarette smoking and periodontal destruction was assessed in young adults. Eighty-two regular dental attenders (21 current cigarette smokers, 61 non-smokers) aged between 20 and 33 years were examined. The smokers consumed on average 15.4 (+/- 7.3) cigarettes per day and had smoked for an average of 11.8 (+/- 7) years. Cigarette smokers had almost the same levels of plaque as non-smokers but had more proximal surfaces with subgingival calculus (P < 0.01) and which bled on probing (P < 0.05). Smokers had significantly more pockets > or = 4 mm (14.6 +/- 19.9) than non-smokers (5.8 +/- 7.9), P < 0.01. Only 2 (10%) of the smokers and 1 (2%) of the non-smokers had deep pocketing (> or = 6 mm). Smokers had significantly more sites (21.8 +/- 24.9) with periodontal attachment loss of > or = 2 mm than non-smokers (9.3 +/- 12.2), P < 0.01. Severe loss of periodontal attachment (> or = 6 mm) was present in 4 (19%) of smokers compared with 2 (3%) of non smokers. In total 4 (19%) of the smokers had "established periodontitis" compared with 1 (2%) of the non-smokers. The odds ratio for the presence of "established periodontitis" and smoking was 14.1 (confidence interval 1.5 to 132.9). It is concluded that cigarette smoking was a major environmental factor associated with accelerated periodontal destruction in this selected group of young adult regular dental attenders.     

Parental smoking and respiratory illnesses in Australian children aged 0-4 years: ABS 1989-90 National Health Survey results

OBJECTIVE: This study investigated the associations between parental smoking and respiratory infections in Australian children aged 0-4 years. METHODS: Data from the ABS 1989-90 National Health Survey were used. The exposure variables examined were maternal, paternal and combined family smoking. Outcome variables were parent-reported chronic or recent asthma, asthma wheeze, bronchitis, influenza, common cold, cough, otitis media and other respiratory conditions. Logistic regression techniques were used to control for confounding by socio-economic status, child's sex, maternal education, place of residence, ethnicity and family size. RESULTS: Of the 4,281 children in the sample, 45% lived in households with one or more current smokers and 29% had a mother who smoked. Maternal (but not paternal) smoking was significantly associated with asthma (OR 1.52, 95% CI 1.19-1.94) and asthma wheeze (OR 1.51, 95% CI 1.26-1.80). No other significant associations were observed. Positive and significant dose response relationships were found between the amount of maternal smoking and both asthma variables. Population attributable risks were calculated and almost 13% of asthma and asthma wheeze in 0-4 year old Australian children in 1989-90 was estimated to be due to maternal smoking. CONCLUSION: Large numbers of Australian children live in households with smokers. This study, like others, has shown an association between maternal smoking and respiratory illnesses in young children. Further strategies are needed to prevent or reduce young children's exposure to environmental tobacco smoke in their homes.     

Cancers related to tobacco smoking

Tobacco smoking is the major cause of lung cancer. Cigarette smokers have a risk of lung cancer 10 to 15 times greater than nonsmokers. Tobacco and alcohol are the main risk factors for cancers of oral cavity, larynx, pharynx and oesophagus (cancers of the upper respiratory and upper digestive tract) and the effects of tobacco and alcohol are multiplicative. For these cancers, the risk associated with tobacco was about 2 to 4 among people who drink little or no alcohol. Risks of lung cancer and of cancers of the upper respiratory and upper digestive tract increase with an increasing number of cigarettes smoked per day and duration of smoking. Tobacco is also a risk factor for bladder cancer. Cigarette smoking is a possible contributory factor in the development of kidney, pancreatic and cervical cancers. Among males, lung cancer mortality increased regularly over time and today, lung cancer is the leading cause of death and illness from cancer. Substantial reductions in the number of deaths from tobacco-related cancers could be achieved if a large proportion of smokers stopped smoking.     

Use of transition probabilities to estimate the effect of smoking on the duration of episodes of respiratory symptoms in diary data: the Swiss Study on Air Pollution and Lung Diseases in Adults (SAPALDIA)

Incompletely documented symptom episodes pose methodological problems in the analysis of diary data. The aim of this study was to develop a method of estimating the average durations of symptomatic and nonsymptomatic episodes, respectively, coping with the problem of bias due to undocumented days and censored episodes that is found in most diary studies. The authors derived their outcome variables from a Markov model using transition probabilities. To evaluate this method, the authors assessed the impact of active smoking on the duration of episodes of bronchitis symptoms and the corresponding nonsymptomatic periods, respectively, using diary data (1992-1993) obtained from 801 participants in the Swiss Study on Air Pollution and Lung Diseases in Adults. Covariate-adjusted distribution curves for the mean durations of individual episodes were estimated by Cox regression. Median values for light smokers (<10 cigarettes/day) were 60.0 symptom-free days (95% confidence interval (CI) 42.0-78.5) and 4.0 symptomatic days (95% CI 3.0-6.0), respectively, compared with medians of only 21.0 days (95% CI 16.2-29.8) for periods without bronchitis symptoms and 6.0 days (95% CI 4.9-9.0) for episodes of bronchitis symptoms in heavy smokers (> or =30 cigarettes/day). The authors suggest that the Markov method is a feasible approach to the assessment of long term effects of smoking and environmental risk factors on the average duration of symptomatic and nonsymptomatic respiratory episodes.     

Efficacy of a tailored tobacco control program on long-term use in a population of U.S. Military troops.

The authors evaluated the effect of a brief tailored smoking control intervention delivered during basic military training on tobacco use in a population of military personnel (N = 33,215). Participants were randomized to either a tobacco use intervention (smoking cessation, smokeless tobacco use cessation, or prevention depending on tobacco use history) or a health education control condition. Results indicated that smokers who received intervention were 1.16 (95% confidence interval [CI] = 1.04, 1.30) times (7-day point prevalence) and 1.23 (95% CI = 1.07, 1.41) times (continuous abstinence) more likely to be abstinent than controls from smoking cigarettes at the 1-year follow-up (p p     

Alcohol and smoking. The risk factors for the oral cavity

A higher risk for the development of oral cancer was associated with heavy smoking and heavy drinking, but alcohol drinking and tobacco smoking are also correlated with other oral cavity disease. Tobacco is the most important factor of leukoplakia, but other diseases like ANUG, periodontitis, median rhomboid glossitis, chronic hyperplastic candidiasis and others are also correlated to cigarette smoking. It was observed that smokers have more plaque than non-smokers, even if no difference in the bacteria composition was found between smokers and non-smokers samples, and the vascular reaction associated with plaque induced gingivitis is suppressed in smokers. Periodontitis are generally considered to be a consequence of an unfavourable host-parasite interaction, but personal factors that diminish the efficiency of the host defence, like tobacco smoking and alcohol drinking, can play an important role in the development of periodontal diseases. Cigarette smoking may be considered a major risk factor for periodontitis and it can also increase its severity; therefore, alveolar bone loss increases with tobacco smoking. Recent investigations show that smokers respond less favourably than no smokers to the different modalities of periodontal therapy, as surgical and non surgical, or guided tissue regeneration. Moving from these observations the authors critically analyze the literature concerning these important risk factors which appear to be strongly correlated with periodontal diseases.     

Cellular ingrowth and thickness changes in poly-L-lactide and polyglycolide matrices implanted subcutaneously in the rat

BACKGROUND: The purpose of this study was, to identify predictors of quitting following general practitioners' (GP) anti-smoking counseling. METHODS: We studied determinants (characterized following the Precede framework) of successful quitting (1 year sustained abstinence, biochemically confirmed at 6- and 12-month follow-up) among 861 smokers randomized to the intervention groups based on repeated counseling (RC), RC + spirometric testing, and RC + nicotine gum, in a smoking cessation trial carried out in Turin, Italy. RESULTS: GPs' intervention worked best for male (OR = 2.30; 95% CI, 1.13-4.52) and married (OR = 3.63; 95% CI, 1.37-9.59) smokers, for smokers who had maintained abstinence for at least 1 month in the past (OR = 6.78; 95% CI, 1.56-29.52) or at their first quit attempt (OR = 10.91; 95% CI, 2.37-50.13), and for those who spontaneously reduced their coffee consumption (OR = 3.30; 95% CI, 1.59-6.82); heavy smokers (> = 20 cig/day OR = 0.48; 95% CI, 0.24-0.93) and those living with other smokers (> = 1 smokers in the household: OR = 0.44; 95% CI, 0.22-0.90) were less likely to give up. Previous antismoking advice by the GP represented a strong barrier to success for healthy smokers (OR = 0.19; 95% CI, 0.07-0.52), but not for those reporting symptoms of shortness of breath (OR = 0.63; 95% CI, 0.39-9.20). There were no interactions between predictors and treatment conditions. CONCLUSIONS: Assessment of factors influencing quitting would allow GPs to tailor their message to address existing barriers and to help patients utilize their resources for change.     

Notes on the intermediary form of incontinentia pigmenti

In a survey of a representative sample of 900 persons in Switzerland (excluding the Italian speaking parts comprising some 4-5 percent of the population), the smoking habits of the adult population were studied. Smokers were defined as persons smoking at least one cigarette or an equivalent weight of pipe tobacco or cigars per day. 51.8% of men and 29.0% of women over age 15 are smokers. Among male smokers of cigarettes only (42% of all men), over three quarters (77.6%) smoke ten cigarettes or more per day, i.e., a quantity found harmful to health; over one half (55.8%) smoke twenty or more cigarettes per day. Half of all female smokers smoke ten or more cigarettes, more than one in every four female smokers (28.8%) smoke twenty or more cigarettes per day. It is calculated that almost two thirds of all cigarettes sold in Switzerland are smoked by smokers of twenty or more cigarettes per day, and that almost three quarters are smoked by smokers of ten or more cigarettes. Among men, smoking habits are independent of social status, whereas among women, those with higher family incomes show more frequent smoking, but also more widespread cessation of smoking than with lower incomes. Thirty percent of adults having been smokers have given up the habit, so that among men and women above age 15, theree are now some 20% and 14% respectively, of ex-smokers. This corresponds to at least 700,000 former smokers in all of Switzerland. The trend to give up starts already in the group aged 15-24 (over 20% of men and women having ever smoked have given up) and becomes more marked with increasing age. A large part of male and female smokers would like to free themselves of the habit. 30% of male and 34% of female smokers indicate that they had tried seriously to stop smoking during the twelve months preceding the interview. Trying to give up was not significantly associated with intensity of smoking or social status. According to this survey, a majority of the population (57.6%) is in favor of reserving certain parts of restaurants to non-smokers, following the example of non-smokers-compartments in railway trains. In a situation where a non-smoker asks a co-worker in a closed room not to smoke, 78.3% take sides with the non-smoker, either by conceding to him a right to smoke-free air, or by demanding from the smoker to show consideration for the non-smoker. Only 10.9% demand from the non-smoker understanding for the smoker, or concede to the smoker a right to smoke at work. Women show more understanding for cause of the non-smoker than men. This difference is more marked among smokers and former smokers than among non-smokers. Inasmuch as the results of this study are comparable to those of earlier surveys conducted in Switzerland, ther is good agreement. The only exception is a significant increase of the proportion of former smokers in the past years.     

Unemployment and change of tobacco habits: a study of young people from 16 to 21 years of age

In a cohort study of 1080 pupils who were followed for 5 years from when they left compulsory school (from age 16 to age 21 years), smoking habits were found to correlate with unemployment among both boys and girls. Pupils who were smokers in school had a higher risk of becoming unemployed than non-smokers. Irrespective of early smoking, smoking habits developed more unfavourably among unemployed young people than among those with no unemployment during the period studied. The odds ratio of being a smoker at the age of 21 years when unemployed more than 20 weeks during the observation period, compared with those without or with short unemployment, was 2.44 for men and 3.45 for women. When adjusted for the influence of socio-economic background, education, economy and smoking habits at the start of the period, the odds ratio was 1.7 (95% CI 1.01-2.86) for men and 2.0 (1.13-3.53) for women. The adjusted odds ratio for increasing or starting smoking during the period was 1.5 (95% CI 0.89-2.56) for men and 2.0 (1.18-3.35) for women. No significant correlation was found between snuffing and unemployment. Thus, it seems that unemployment is a risk factor for development of tobacco smoking in young people, especially among women.     

Adverse influence of cigarette smoking on the endothelium

The effect of smoking on the blood vessel intima was examined by comparing indices of endothelial activity in serum from smokers with that from non-smokers. Serum from smokers contained higher levels of von Willebrand factor (p < 0.01), the smoking markers cotinine (p < 0.02) and thiocyanate (p < 0.01), and was more cytotoxic to endothelial cells in vitro (p < 0.02) than serum from non-smokers. The acute effects of smoking two unfiltered medium tar cigarettes was to briefly increase von Willebrand factor (p < 0.001) and cytotoxicity of serum to endothelial cells in vitro (p < 0.005), but lipid peroxides or thiocyanate were not increased by this short exposure to tobacco smoke. Although there were correlations between von Willebrand factor and smokers consumption of cigarettes (r = 0.28, p < 0.02), number of years smoking (r = 0.41, p < 0.001) and cotinine (r = 0.45, p < 0.01), the tissue culture of endothelial cells with physiological levels of thiocyanate or nicotine suggested that these two smoking markers were not cytotoxic. They are therefore unlikely to be directly responsible for increased von Willebrand factor in the serum of smokers. We suggest that smoking exerts a deleterious influence on the endothelium and that the mechanism is complex.     

Reliability of the Agitated Behavior Scale

Polycyclic aromatic hydrocarbon-DNA adducts were evaluated in oral cells from 98 healthy volunteers by an immunohistochemical method using a specific antiserum against benzo(a)pyrene-DNA adducts revealed by the immunoperoxidase reaction. Mean adduct content, determined as relative staining intensity by absorbance image analyzer, was significantly higher in the cells from tobacco smokers compared with nonsmokers (330 +/- 98, n = 33 versus 286 +/- 83, n = 64, respectively) with a P = 0.013 obtained by two-sample t test with equal variances. We found that in the smoker group, the PAH-DNA adduct content increases with the number of cigarettes. Thus, the relative staining intensity was 305 +/- 105 in the group smoking 1-10 cigarettes/day (n = 16), 347 +/- 77 in the 11-20 group (n = 14), and 386 +/- 112 in the group smoking more than 20 cigarettes/day (n = 3; P = 0.03 by nonparametric test for trend). No significant association was detected between PAH-DNA adducts in oral cells and variables such as residential area, oral infections, alcohol or vitamin intake, grilled food consumption, and professional activity. This work confirms and extends previous data suggesting that this immunohistochemical method might be used as a valuable dosimeter of genotoxic damage in a carcinogen-exposed population, although further studies are needed to verify the applicability of the test in high-risk populations other than smokers.     

Genetic polymorphism of CYP2D6 and lung cancer risk in African-Americans and Caucasians in Los Angeles County

The well described genetic polymorphism of the CYP2D6 gene influences response to a wide variety of therapeutic agents metabolized by the CYP2D6 enzyme product. CYP2D6 also appears to play a role, along with other cytochrome P450 enzymes, in the metabolic activation of the tobacco specific nitrosamine, NNK, as well as metabolism of nicotine to cotinine. While impaired activity of CYP2D6 was strongly protective against lung cancer in some studies, primarily based on phenotyping, the literature is conflicting. The molecular basis of CYP2D6 deficiency is now well understood, enabling the use of genotyping to classify individuals. We therefore examined whether lung cancer risk is reduced by the presence of four CYP2D6 alleles associated with impaired activity due to an inactivating mutation--CYP2D6*4, CYP2D6*3, CYP2D6*5 and CYP2D6*16--among 341 incident cases of lung cancer and 710 population controls of Caucasian or African-American ethnicity in Los Angeles County, California. We did not confirm a strong association between the presence of these inactivating alleles and lung cancer risk [odds ratio (OR) = 0.90, 95% confidence interval (CI) 0.60-1.35 for Caucasians], although there was a small decreased risk among the African-Americans (OR = 0.66, 95% CI 0.38-1.14). Among smokers, when the data are stratified according to lifetime smoking history, there is a suggestion of an association limited to Caucasian smokers of <35 pack-years, the median for all smokers in these data (OR = 0.49, 95% CI 0.23-1.04). However, among African-American smokers, who smoke less than Caucasians, the association did not differ between smoking categories. We also examined the possible role of additional copies of the CYP2D6 gene, which lead to enhanced CYP2D6 activity, in increasing lung cancer risk. Among controls the prevalence of having more than two copies of the CYP2D6 gene and no inactivating alleles was 4.3% for Caucasians and 4.9% for African-Americans. Relative to subjects with an inactivating allele, those with an additional copy of the CYP2D6 gene and no inactivating alleles may be at increased risk of lung cancer, particularly for adenocarcinoma (OR = 3.61, 95% CI 1.08-11.7 for African-Americans and OR = 2.20, 95% CI 0.69-6.0 for Caucasians). Our data suggest that the CYP2D6 genetic polymorphism is not the strong risk factor for lung cancer suggested by some studies of phenotype, but may play a minor role.