smoking

Heavy Smoking in Midlife Doubles the Risk for Alzheimer's Disease
November 1, 2010 — Heavy smoking in midlife more than doubles the risk of developing Alzheimer's disease (AD) and other forms of dementia 2 decades later, according to a new observational study reported online October 25 in the Archives of Internal Medicine.

The finding, from a large cohort of more than 20,000 people, suggests that the brain is not immune to long-term consequences of heavy smoking.

"This study shows that if you are an elderly person and you've been smoking and you are lucky enough that you didn't get respiratory disease or cancer or cardiovascular disease, you're still at risk for another disease that's pretty devastating that can occur in late life," senior study author Rachel Whitmer, PhD, an epidemiologist at Kaiser Permanente Division of Research, Oakland, California, told Medscape Medical News.

Some studies suggest that smokers have a reduced risk for Parkinson's disease and other neurodegenerative conditions, as well as cognitive impairment, but others have found an association between smoking in midlife and later development of AD and other dementias.


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Dietary Restrictions in Adolescents Linked to Smoking-Related Weight Concerns CME/CE


News Author: Laurie Barclay, MD
CME Author: Hien T. Nghiem, MDJune 14, 2010 — Dietary restrictions in adolescents are significantly associated with smoking-related weight concerns, according to the results of a large cross-sectional study published online June 14 in Pediatrics."There is a relationship between smoking, weight concerns and dietary behaviors in adolescents," write Dana A. Cavallo, PhD, from Yale University School of Medicine in New Haven, Connecticut, and colleagues. "This study is the first examination of the relationship among cigarette smoking, weight-related smoking expectancies, and dietary behaviors in a large, geographically diverse sample of adolescents. We also wanted to determine whether these relationships were altered by intensity of smoking."To evaluate the effects of sex, smoking intensity, and dietary-restrictive behavior on smoking-related weight concerns, the investigators analyzed data from a cross-sectional survey of 4523 adolescents attending high school in Connecticut.Smoking status was defined on the basis of past-month cigarette consumption and categorized into 3 groups of smokers: nonsmokers (no cigarettes in the past 30 days), light smokers (<1 cigarette per day and up to 7 cigarettes per day), and heavy smokers (>7 cigarettes per day). Boys were significantly more likely than girls to be heavy smokers.Compared with nonsmokers, heavy smokers were significantly less likely to follow healthy dietary restrictions, but light smokers did not differ from nonsmokers. Unhealthy dietary restriction was significantly more common in both light and heavy smokers than in nonsmokers.In a model used for analysis of data from smokers only, heavy smokers were significantly less likely to follow healthy dietary restriction than were light smokers. However, smoking level was not linked to unhealthy dietary restrictions."Dietary restrictions are significantly associated with smoking-related weight concerns; however, this seems to be related to type of dietary restrictive behavior, with greater weight concerns observed only in those smokers who engaged in unhealthy dietary restrictions and not in those who engaged in healthy dietary restrictions or no restrictions," the study authors write. "Although limited by its cross-sectional nature, the findings from this large, geographically diverse sample have clinical implications for smoking prevention and cessation interventions in adolescents."

From MedscapeCME Clinical Briefs

Smoking Cessation Linked to Higher Short-Term Risk for Type 2 Diabetes CME


News Author: Laurie Barclay, MD
CME Author: Laurie Barclay, MDAbstract

BACKGROUND: Cigarette smoking is an established predictor of incident type 2 diabetes mellitus, but the effects of smoking cessation on diabetes risk are unknown.OBJECTIVE: To test the hypothesis that smoking cessation increases diabetes risk in the short term, possibly owing to cessation-related weight gain.DESIGN: Prospective cohort study.SETTING: The ARIC (Atherosclerosis Risk in Communities) Study.PATIENTS: 10,892 middle-aged adults who initially did not have diabetes in 1987 to 1989.MEASUREMENTS: Smoking was assessed by interview at baseline and at subsequent follow-up. Incident diabetes was ascertained by fasting glucose assays through 1998 and self-report of physician diagnosis or use of diabetes medications through 2004.RESULTS: During 9 years of follow-up, 1254 adults developed type 2 diabetes. Compared with adults who never smoked, the adjusted hazard ratio of incident diabetes in the highest tertile of pack-years was 1.42 (95% CI, 1.20 to 1.67). In the first 3 years of follow-up, 380 adults quit smoking. After adjustment for age, race, sex, education, adiposity, physical activity, lipid levels, blood pressure, and ARIC Study center, compared with adults who never smoked, the hazard ratios of diabetes among former smokers, new quitters, and continuing smokers were 1.22 (CI, 0.99 to 1.50), 1.73 (CI, 1.19 to 2.53), and 1.31 (CI, 1.04 to 1.65), respectively. Further adjustment for weight change and leukocyte count attenuated these risks substantially. In an analysis of long-term risk after quitting, the highest risk occurred in the first 3 years (hazard ratio, 1.91 [CI, 1.19 to 3.05]), then gradually decreased to 0 at 12 years.LIMITATION: Residual confounding is possible even with meticulous adjustment for established diabetes risk factors.CONCLUSION: Cigarette smoking predicts incident type 2 diabetes, but smoking cessation leads to higher short-term risk. For smokers at risk for diabetes, smoking cessation should be coupled with strategies for diabetes prevention and early detection.

PMID: 20048267 [PubMed - indexed for MEDLINE]

ACOG Issues Recommendations for Providers to Support Perinatal Smoking Cessation CME/CE


News Author: Laurie Barclay, MD
CME Author: Désirée Lie, MD, MSEd


The 5A's

The 5A's of smoking cessation are as follows:

1. ASK the patient about smoking status at the first prenatal visit, and continue to ask at subsequent visits. If the patient stopped smoking before or after she learned she was pregnant, the clinician should reinforce her decision to quit, congratulate her on success in quitting, and encourage her to stay smoke-free. If she is still smoking, the clinician should document this in her medical record and proceed with the remaining A's.
2. ADVISE the patient who smokes to stop, while offering information about the risks of continued smoking to the woman and her baby.
3. ASSESS the patient's motivation to attempt smoking cessation. At subsequent prenatal care visits, the clinician should offer quitting advice, evaluation, and motivational assistance.
4. ASSIST the patient who wants to quit by offering pregnancy-specific, self-help smoking cessation materials, including a direct referral to the smoker's quit line (1-800-QUIT NOW).
5. ARRANGE follow-up visits to monitor the progress of the patient's attempt to quit smoking.
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