Releases Saturday 17 May 2003
No 7398 Volume 326
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(1) HAS THE HEALTH EFFECT OF PASSIVE
SMOKING BEEN OVERSTATED?
(2) BIRTH
WEIGHT MAY BE LINKED TO ARTHRITIS
IN LATER LIFE
(3) 16%
OF ENGLISH SMOKERS CLASSED AS
HARDCORE
(4) ACTION
NEEDED TO TACKLE DEATH RATES
IN YOUNG OFFENDERS
(1) HAS THE HEALTH
EFFECT OF PASSIVE
SMOKING BEEN OVERSTATED?
(Environmental tobacco smoke and
tobacco related
mortality in a prospective study
of Californians,
1960-98)
http://bmj.com/cgi/content/full/326/7398/1057
(Editorial: Effect of passive smoking
on health)
http://bmj.com/cgi/content/full/326/7398/1048
The link between environmental tobacco
smoke and
coronary heart disease and lung cancer
may be
considerably weaker than generally believed,
conclude
James Enstrom of the University of California,
Los
Angeles and Geoffrey Kabat of New Rochelle,
New
York, in this week's BMJ.
This study will add to the already controversial
debate
on the health impact of passive smoking.
Their analysis involved 118,094 California
adults
enrolled in the American Cancer Society
cancer
prevention study in 1959, who were followed
until 1998.
Particular focus was on the 35,561 never
smokers who
had a spouse in the study with known smoking
habits.
The authors found that exposure to environmental
tobacco smoke, as estimated by smoking
in spouses,
was not significantly associated with
death from coronary
heart disease or lung cancer at any time
or at any level of
exposure. As expected, active cigarette
smoking was
confirmed as a strong, dose related risk
factor for
coronary heart disease, lung cancer, and
chronic
obstructive pulmonary disease.
These findings suggest that environmental
tobacco
smoke could not plausibly cause a 30%
increased risk of
coronary heart disease, as is generally
believed, although
a small effect cannot be ruled out, say
the authors.
Despite some limitations, this large study
has several
important strengths, add the authors.
As such, it seems
premature to conclude that environmental
tobacco
smoke causes death from coronary heart
disease and
lung cancer.
The impact of environmental tobacco smoke
on health
remains under dispute, writes Professor
George Davey
Smith in an accompanying editorial. He
points to several
difficulties in studies of passive smoking,
such as
problems with measurement imprecision,
misclassification, confounding factors,
and low statistical
power, that can lead to the risks being
distorted.
Despite suggesting that passive smoking
is associated
with an increased risk of respiratory
disease, the study
will be promoted as showing that the detrimental
effect
of passive smoking has been overstated,
he concludes.
Contacts:
Paper: James Enstrom, School of Public
Health,
University of California, Los Angeles,
USA
Email: jenstrom{at}ucla.edu
or
Geoffrey Kabat, Associate Professor, New
Rochelle,
New York, USA
Email: gck1{at}earthlink.net
Editorial: George Davey Smith, Professor
of Clinical
Epidemiology, Department of Social Medicine,
University of Bristol, UK
Email: zetkin{at}bristol.ac.uk
(2) BIRTH WEIGHT
MAY BE LINKED TO ARTHRITIS
IN LATER LIFE
(Perinatal characteristics and risk
of rheumatoid arthritis)
http://bmj.com/cgi/content/full/326/7398/1068
The cause of rheumatoid arthritis is unknown,
but
researchers in this week's BMJ suggest
that some factors
relating to the period shortly before
and after birth
(perinatal factors) may be implicated
in the development
of the disease in later life.
Researchers in Sweden identified 77 patients
with
rheumatoid arthritis and 308 matched controls.
Using
birth records, they collected information
such as birth
weight, mother's age, length of hospital
stay after
delivery, start of breast feeding during
the hospital stay,
and father's occupation (manual or non-manual
worker).
They found that high birth weight (4000g
or more) was
positively associated with rheumatoid
arthritis but low
birth weight was not. Initiation of breast
feeding during
the hospital stay and the father's occupation
were also
associated with rheumatoid arthritis.
They found no other
significant associations.
"Our findings indicate that characteristics
of the perinatal
period may be of aetiological importance
in the
pathogenesis of rheumatoid arthritis,"
they conclude.
Contact:
Lennart Jacobsson, Associate Professor,
Department of
Rheumatology, Malmö University Hospital,
Malmö,
Sweden
Email: lennart.jacobsson{at}orto.mas.lu.se
(3) 16% OF ENGLISH
SMOKERS CLASSED AS
HARDCORE
(Prevalence of hardcore smoking in
England, and
associated attitudes and beliefs:
cross sectional study)
http://bmj.com/cgi/content/full/326/7398/1061
As many as 16% of smokers in England are
classed as
hardcore, almost four times higher than
in California
where there has been an intensive campaign
against
smoking over the past decade, show researchers
in this
week's BMJ.
Their study was based on interviews with
7,766 adult
cigarette smokers in England. To be classified
as a
hardcore smoker, respondents had to satisfy
all the
following criteria: less than a day without
cigarettes in the
past five years; no attempt to quit in
the past year; no
desire and no intention to quit.
Sixteen per cent of all smokers were considered
to be
hardcore, almost four times higher than
in California.
Hardcore smokers tended to be older, more
dependent
on tobacco, and from more deprived backgrounds.
They
were also more likely to deny that smoking
affected their
health, and were less tolerant of social
pressure to quit
than other smokers.
Hardcore smoking presents a serious challenge
to public
health efforts to reduce the prevalence
of smoking, but
the proportion of hardcore smokers does
not necessarily
increase as overall prevalence in a population
declines,
say the authors.
More hardcore smokers could be persuaded
to quit, but
this will require interventions that are
targeted to the
particular needs and perceptions of both
socially
disadvantaged and older smokers, they
conclude.
Contact:
Martin Jarvis, Professor of Health Psychology,
Cancer
Research UK Health Behaviour Unit, Department
of
Epidemiology and Public Health, University
College
London, UK
Email: martin.jarvis{at}ucl.ac.uk
(4) ACTION NEEDED
TO TACKLE DEATH RATES
IN YOUNG OFFENDERS
(Mortality in young offenders: retrospective
cohort
study)
http://bmj.com/cgi/content/full/326/7398/1064
Young offenders are far more likely to
die than people of
the same age in the general population,
even those with
psychiatric and behavioural disorders,
claim researchers
in this week's BMJ. These findings have
important policy
implications for young offenders, they
say.
Their study involved 2,849 young offenders
who had
received their first custodial sentence
in the state of
Victoria, Australia between 1988 and 1999.
Participants
were followed for an average of three
years and deaths
were ascertained using national records.
Young male offenders were nine times more
likely and
female offenders were 40 times more likely
to die than
young people in the general population.
Drug related
causes, suicide, and non-intentional injury
were the
leading causes of death.
Death in young offenders was higher than
in equivalent
groups with schizophrenia or eating disorders,
and young
offenders accounted for a quarter of drug
related deaths
in 15-19 year old men.
These findings indicate that social disadvantage
and
marginalisation of this group may have
played an
additional part in many of the deaths,
suggest the
authors. Social policies for young offenders
should
address both drug and mental health problems
as well as
the high levels of social disadvantage.
Contact:
Professor George Patton, Centre for Adolescent
Health,
Murdoch Childrens Research Institute,
Royal Children's
Hospital, Victoria, Australia
Email: ncurtis{at}murdoch.rch.unimelb.edu.au
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