Tobacco, Nicotine and Health.

Recent studies have explored improvements in smoking prevention and cessation to reduce smoking prevalence, however, in Europe, only Finland has already set a date to become nicotine free. Studies reporting on central, eastern and southern Europe have mostly focused on combustible cigarettes up to now. In young people, correlations were found between traditional smoking, the "vaping" of e-cigarettes, experimentation with alcohol intoxication, and the use of illicit drugs. Prevention and cessation should include strategies against active and passive exposures to new nicotine products. This is a prerequisite for a successful public health policy and a future end-game against the business interests of the tobacco industry and its allies.

PM10, and children's respiratory symptoms and lung function in the PATY study.

Studies of the impact of long-term exposure to outdoor air pollution on the prevalence of respiratory symptoms and lung function in children have yielded mixed results, partly related to differences in study design, exposure assessment, confounder selection and data analysis. We assembled respiratory health and exposure data for >45,000 children from comparable cross-sectional studies in 12 countries. 11 respiratory symptoms were selected, for which comparable questions were asked. Spirometry was performed in about half of the children. Exposure to air pollution was mainly characterised by annual average concentrations of particulate matter with a 50% cut-off aerodynamic diameter of 10 µm (PM(10)) measured at fixed sites within the study areas. Positive associations were found between the average PM(10) concentration and the prevalence of phlegm (OR per 10 µg · m(-3) 1.15, 95% CI 1.02-1.30), hay fever (OR 1.20, 95% CI 0.99-1.46), bronchitis (OR 1.08, 95% CI 0.98-1.19), morning cough (OR 1.15, 95% CI 1.02-1.29) and nocturnal cough (OR 1.13, 95% CI 0.98-1.29). There were no associations with diagnosed asthma or asthma symptoms. PM(10) was not associated with lung function across all studies combined. Our study adds to the evidence that long-term exposure to outdoor air pollution, characterised by the concentration of PM(10), is associated with increased respiratory symptoms.

Lung function predicts survival in a cohort of asbestos cement workers.

PURPOSE: To study the predictive power of respiratory screening examinations a cohort of asbestos workers was followed from active work in an asbestos cement plant until death. METHODS: From a cohort with data on individual exposure since first employment 309 workers who had a preventive medical examination in 1989/1990 were observed until death or the end of 2006. The impact of asbestos exposure (fibre years) and of smoking history on lung function was examined by linear regression, on specific causes of death and total mortality by Cox regression. The prognostic value of lung function, chest X-ray, and various clinical findings regarding total mortality was also examined by Cox regression. RESULTS: Lung function proved to be the best predictor of survival apart from current smoking. Depending on the lung function variable an impairment by the interquartile range resulted in a hazard ratio of 1.5-1.6 while for current smokers it was 2.3. An increase of 70 fibre years (interquartile range) led to a hazard ratio of only 1.1. Lung function was influenced by asbestos exposure, current (but not former) smoking, and by pathological X-ray findings. The risk for pleural mesothelioma was dominated by time since first exposure to crocydolite in the pipe factory while the risk for bronchial cancer increased with smoking and total fibre years. An unexpected finding was an increase of gastric cancer in asbestos cement workers. CONCLUSION: Lung function decrease predicts risk of premature death better than exposure history and regular spirometry should therefore be offered as primary screening to all former asbestos workers. In workers with a history of high cumulative exposure or rapid lung function decrease or radiological signs (diffuse pleural thickening or small irregular opacities) more sensitive techniques (high resolution computer tomography) need to be applied. All smokers with a history of asbestos exposure should be given free smoking cessation therapy to prevent premature death and lung cancer in particular.

Fine and ultrafine particle exposure during commuting by subway in Vienna.

Mass concentrations of particulate matter (PM10, PM2.5, PM1), lung deposited surface area and particle number concentrations were measured for the first time in all Viennese subway lines inside cabins and in two subway stations, one aboveground and the other underground. The observed data were examined for significant differences between the exposure to fine particulate matter and ultrafine particles. Analysis of the trip averages in the five lines U1, U2, U3, U4 and U6 showed significant differences for PM10, PM2.5 and PM1 (all three mass concentrations: p < 0.001). Medians for PM10, PM2.5 and PM1 were highest in the U1 (73.6, 38.9, 27.1 µg/m3, respectively) and U3 (113.3, 47.1, 26.7 µg/m3, respectively) and significantly higher in the underground subway station than in the subway station on ground level. Regarding ultrafine particles no significant differences were found between the subway lines and no significant differences between the underground subway station and the subway station on ground level; however, new air-conditioned cabins had lower particle number concentrations and both particle number concentrations and lung deposited surface area were higher in cabins with open windows.

Commuter exposure to fine and ultrafine particulate matter in Vienna.

Mass concentrations PM10, PM2.5, PM1, particle number concentrations of ultrafine particles and lung deposited surface area were measured during commutes with a subway, tram, bus, car and bicycle in Vienna for the first time. Obtained data were examined for significant differences in personal exposure when using various transport modalities along similar routes. Mean PM2.5 and PM1 mass concentrations were significantly higher in the subway when compared to buses. Mean PM10, PM2.5 and PM1 mass concentrations were significantly higher in the subway when compared to cars using low ventilation settings. Particle number concentrations of ultrafine particles were significantly higher in trams when compared to the subway and lung deposited surface area was significantly greater on bicycles when compared to the subway. After adjusting for different vehicle speeds, exposure to PM10, PM2.5 and PM1 along the same route length was significantly higher in the subway when compared to cars while exposure to ultrafine particles and partly also lung deposited surface area was significantly higher in bus, tram and on bicycle when compared to the subway. Car and bus passengers could be better isolated from ambient fine particulate matter than passengers in the subway, where a lot of ventilation occurs through open windows and larger doors. Tram passengers and cyclists might be exposed to increased amounts of ultrafine particles and larger lung deposited surface area due to a closer proximity to road traffic. Comparing cumulative exposure along the same route length leads to different results and favors faster traffic modes, such as the subway.

Critical review: nicotine for the fetus, the infant and the adolescent?

The recent expansion of Nicotine Replacement Therapy to pregnant women and children ignores the fact that nicotine impairs, disrupts, duplicates and/or interacts with essential physiological functions and is involved in tobacco-related carcinogenesis. The main concerns in the present context are its fetotoxicity and neuroteratogenicity that can cause cognitive, affective and behavioral disorders in children born to mothers exposed to nicotine during pregnancy, and the detrimental effects of nicotine on the growing organism. Hence, the use of nicotine, whose efficacy in treating nicotine addiction is controversial even in adults, must be strictly avoided in pregnancy, breastfeeding, childhood and adolescence.

Parental smoking and children's respiratory health: independent effects of prenatal and postnatal exposure.

OBJECTIVES: Adverse effects have been reported of prenatal and/or postnatal passive exposure to smoking on children's health. Uncertainties remain about the relative importance of smoking at different periods in the child's life. We investigate this in a pooled analysis, on 53,879 children from 12 cross-sectional studies--components of the PATY study (Pollution And The Young). METHODS: Effects were estimated, within each study, of three exposures: mother smoked during pregnancy, parental smoking in the first two years, current parental smoking. Outcomes were: wheeze, asthma, "woken by wheeze", bronchitis, nocturnal cough, morning cough, "sensitivity to inhaled allergens" and hay fever. Logistic regressions were used, controlling for individual risk factors and study area. Heterogeneity between study-specific results, and mean effects (allowing for heterogeneity) were estimated using meta-analytical tools. RESULTS: There was strong evidence linking parental smoking to wheeze, asthma, bronchitis and nocturnal cough, with mean odds ratios all around 1.15, with independent effects of prenatal and postnatal exposures for most associations. CONCLUSIONS: Adverse effects of both pre- and postnatal parental smoking on children's respiratory health were confirmed. Asthma was most strongly associated with maternal smoking during pregnancy, but postnatal exposure showed independent associations with a range of other respiratory symptoms. All tobacco smoke exposure has serious consequences for children's respiratory health and needs to be reduced urgently.

The electronic cigarette: a wolf in sheep's clothing.

The American Heart Association warned from the potential of electronic cigarettes to renormalize smoking in public and the International Respiratory Societies demanded regulation of all nicotine products as medicines or tobacco products. This review summarizes the results of studies on hazards of e-cigarette use, which has increased dramatically and may be the real threat for the achievements in tobacco control of the past 20 years.

Nicotine and surface of particulates as indicators of exposure to environmental tobacco smoke in public places in Austria.

As part of a Europe-wide project the amount of exposure to environmental tobacco smoke (ETS) in public places like schools, restaurants, and public transport facilities was investigated. Three methods were applied: nicotine passive samplers (with a filter treated with sodium bisulphate), the same filters with an active sampling device, and the measurement of fine particles' active surface by unipolar diffusion charging. Settings were selected where either high or low ETS concentrations were expected and where non-smokers would have to stay or at least to pass by. Highest ETS concentrations were found in discos (mean nicotine concentration 154.4 maximum 487.1 microg/m3) and intermediate concentrations in restaurants with no significant difference between smoking (21.3 +/- 6.1 microg/m3) and non-smoking areas (23.3 +/- 15.9 microg/m3) but on average higher values in restaurants with no separation between smoking and non-smoking areas (38.0 +/- 60.6 microg/m3). Concentrations usually below 10 microg/m3 were found in transport facilities (8.9 +/- 8.0 microg/m3, maximum 20.6 in the restaurant section of a railway station's waiting room) and in schools (3.0 +/- 4.6 microg/m3). In hospitals "problem spots" were sought and so concentrations from very low to as high as 45.1 microg/m3 next to a smoking area with no physical barrier or separation and 47.7 microg/m3 inside a smoking room could be documented (21.4 +/- 39.3 microg/m3). The fine particle's surface correlated well with the nicotine concentration (r = 0.8; p < 0.001). Only in one instance (in a pizza restaurant on a busy road with heavy duty diesel traffic and the sampling spot next to the pizza stove) high concentration of fine particles was detected without high nicotine. Tobacco smoke is a key source of indoor fine particles. Health policy must intervene to change the situation found at present in many public places in Austria.

[Suspended particulates and lung health]. / Schwebstaub und Lungengesundheit.

Based on several severe air pollution episodes, a temporal correlation between high concentrations of particulate matter (PM) and SO2 pollution and acute increases in respiratory and cardiopulmonary mortality had been established in Vienna for the 1970's. After air pollution had decreased in Austria in the 1980's--as documented by data on SO2, and total suspended particles (TSP)--no such associations between day-to-day changes of SO2 and TSP and mortality have been documented any more, however, traffic related pollutants like fine particles and NO2 remained a problem. Therefore, short term effects of PM on lung function, morbidity and mortality were investigated in Vienna, Linz, Graz and a rural control area. Long-term exposure and chronic disease--even more important for public health--were studied in repeated cross-sectional, a mixed longitudinal and a birth cohort study on school children in the city of Linz. Lung function growth was found impaired from long-term exposure to air pollutants and improved in districts where ambient air pollution had decreased. Where only TSP and SO2 had decreased, no continuous improvement of small airway function was found and end-expiratory flow rates stayed impaired where NO2-reduction from technical improvements of cars and industry was counterbalanced by increase of motorized (diesel) traffic. Remaining acute effects of ambient air pollution in 2001 from PM, NO2 and co-pollutants found in a time series study also show that continuing efforts are necessary. Active surface of particles inhaled several hours to days before spirometry was found related to short-term reductions in forced vital capacity-FVC (p<0.01), forced expiratory volume in one second-FEV1 (p<0.01) and maximal expiratory flow rate at 50% of vital capacity-MEF50 (p<0.05). In pupils with asthma or previous airway obstruction 4-week-diaries proved that the following symptoms increased with acute exposure to higher active surface of particles: wheezing (p<0.01), dyspnea, cough when going to sleep, cough at night (p<0.05). Efforts to reduce exposure to fine particles from motor traffic and passive smoking have to be increased if we want to achieve full recovery of children from air pollution effects and best respiratory performance in adulthood. Surveillance seems to be necessary not only for particle mass but also for particle number and surface. Little is known on the mechanisms of irreversible long-term effects of PM such as myocardial infarction and cancer. In a prospective cohort study on 1630 dust-exposed and 1630 non dust-exposed workers matched for smoking we found an increase of lung cancer related to nonfibrous insoluble PM. Other studies were able to relate lung cancer to specific particles like those from diesel engines, and a large prospective study of the American Cancer Society was able to link lung cancer in the general population with long-term exposure to fine particles from combustion processes. All these recent epidemiological findings will have consequences for occupational and ambient air PM standards.

Cross-sectional association between cigarette smoking and abdominal obesity among Austrian bank employees.

OBJECTIVES: There is increasing evidence that smoking is associated with abdominal obesity and other risk factors for the metabolic syndrome. The aim of this study is to investigate these associations in a sample of healthy Austrian adults. SETTING AND PARTICIPANTS: Data of 986 employees of an Austrian company (405 men and 581 women; participation rate approximately 80%) obtained during their annual medical check-up at the workplace were analysed. PRIMARY AND SECONDARY OUTCOME MEASURES: Information on smoking status, education level, physical activity, diet, body weight, height, body mass index (BMI), waist circumference and biochemical parameters was obtained. The influence of smoking on health and anthropometric measures was investigated. RESULTS: No differences in total body fat and/or body fat distribution were found between non-smokers, smokers and former smokers; however, among daily smokers, the number of cigarettes smoked per day was significantly associated with higher body weight (p=0.001) and BMI (p=0.009). Male and female smokers had significantly higher white cell count than non-smokers and former smokers. Heavy smokers also had an unhealthier lipid profile (lower high-density lipoprotein cholesterol) and higher fasting glucose levels even after controlling for physical activity and calorie intake. CONCLUSIONS: Contrary to the beliefs of many smokers, heavy smoking is associated with higher body weight and unfavourable metabolic changes.

Exposure to ultrafine particles in hospitality venues with partial smoking bans.

Fine particles in hospitality venues with insufficient smoking bans indicate health risks from passive smoking. In a random sample of Viennese inns (restaurants, cafes, bars, pubs and discotheques) effects of partial smoking bans on indoor air quality were examined by measurement of count, size and chargeable surface of ultrafine particles (UFPs) sized 10-300 nm, simultaneously with mass of particles sized 300-2500 nm (PM2.5). Air samples were taken in 134 rooms unannounced during busy hours and analyzed by a diffusion size classifier and an optical particle counter. Highest number concentrations of particles were found in smoking venues and smoking rooms (median 66,011 pt/cm(3)). Even non-smoking rooms adjacent to smoking rooms were highly contaminated (median 25,973 pt/cm(3)), compared with non-smoking venues (median 7408 pt/cm(3)). The particle number concentration was significantly correlated with the fine particle mass (P<0.001). We conclude that the existing tobacco law in Austria is ineffective to protect customers in non-smoking rooms of hospitality premises. Health protection of non-smoking guests and employees from risky UFP concentration is insufficient, even in rooms labeled "non-smoking". Partial smoking bans with separation of smoking rooms failed.

Acute and subacute effects of urban air pollution on cardiopulmonary emergencies and mortality: time series studies in Austrian cities.

Daily pollution data (collected in Graz over 16 years and in the Linz over 18 years) were used for time series studies (GAM and case-crossover) on the relationship with daily mortality (overall and specific causes of death). Diagnoses of patients who had been transported to hospitals in Linz were also available on a daily basis from eight years for time series analyses of cardiopulmonary emergencies. Increases in air pollutant levels over several days were followed by increases in mortality and the observed effects increased with the length of the exposure window considered, up to a maximum of 15 days. These mortality changes in Graz and Linz showed similar patterns like the ones found before in Vienna. A significant association of mortality could be demonstrated with NO2, PM2.5 and PM10 even in summer, when concentrations are lower and mainly related to motor traffic. Cardiorespiratory ambulance transports increased with NO2/PM2.5/PM10 by 2.0/6.1/1.7% per 10 µg/m³ on the same day. Monitoring of NO2 (related to motor traffic) and fine particulates at urban background stations predicts acute effects on cardiopulmonary emergencies and extended effects on cardiopulmonary mortality. Both components of urban air pollution are indicators of acute cardiopulmonary health risks, which need to be monitored and reduced, even below current standards.

Woodsmoke marker levoglucosan: kinetics in a self-experiment.

OBJECTIVES: Concerns on climate change are leading to the renaissance of wood burning and particulate exposures. Levoglucosan is used as a marker of woodsmoke in air and urine. OBJECTIVES: Contribution of data on urinary excretion of levoglucosan, to improve biomonitoring and source apportionment of woodsmoke. MATERIALS AND METHODS: 1, 3, 5, and 7 hours after 5 mg of levoglucosan had been administered orally, urinary excretion was measured by HPLC and mass spectrometry. RESULTS: After oral intake, urine concentrations increased rapidly, reached highest values after 3 hours, and after 7 hours approximately 70% of the administered dose was excreted. CONCLUSIONS: Urinary levoglucosan may be used for biomonitoring of woodsmoke exposure on the same day.

Estimated health impact of a shift from light fuel to residential wood-burning in Upper Austria.

The dependency on carbon-based fossil energy and growing awareness of climate change issues has induced ambitious policy initiatives to promote renewable energy sources for indoor heating. Combustion of regionally available material such as wood is considered a carbon-neutral alternative for oil and gas, but unregulated revival of wood stoves may cause detrimental health effects. For the prognosis of the health impact of air pollution due to the use of wood stoves, Upper Austria served for a case study. On the basis of recent measurements of particulate matter <10 µm in aerodynamic diameter (PM10) and nitrous gases (NO(x)), we compared the air pollution attributable to present energy mix (termed scenario 1) with two alternatives: For scenario 2, we assumed replacement of light fuel oil by either fossil gas or biomass, and for scenario 3, replacement of light fuel oil by biomass only. Compared with the current exposure from scenario 1, the increased annual mean PM10 levels are estimated to lead to 101 (95% CI 56;146) and 174 (95% CI 92;257) additional deaths among 1.4 million inhabitants per year for scenarios 2 and 3, respectively. Without adequate strategies for reducing the emissions of domestic heating facilities, replacement of fossil energy sources could lead to an increased health risk.

[The Fetal Tobacco Syndrome - A statement of the Austrian Societies for General- and Family Medicine (ÖGAM), Gynecology and Obstetrics (ÖGGG), Hygiene, Microbiology and Preventive Medicine (ÖGHMP), Pediatrics and Adolescence Medicine (ÖGKJ) as well as Pneumology (ÖGP)]. / Das Fetale Tabaksyndrom - Ein Statement der Österreichischen Gesellschaften für Allgemein- und Familienmedizin (ÖGAM), Gynäkologie und Geburtshilfe (ÖGGG), Hygiene, Mikrobiologie und Präventivmedizin (ÖGHMP), Kinder- und Jugendheilkunde (ÖGKJ) sowie Pneumologie (ÖGP).

Over more than 50 years, the nocuous effects of smoking in pregnancy on the fetus are well known. In the first years of science the focus was primarily on restricted fetal growth while in more recent years over 10.000 studies investigated the incomparably big sum of detrimental effects for the unborn's health. In this statement we want to present the recent scientific findings on this topic. The statement is aimed to show all doctors who treat pregnant women the present situation and evidence. In the beginning we give a short overview about the epidemiological situation in Europe. Then we present step by step the health effects with regards to pathophysiology and clinics. Furthermore the reader will learn about possibilities for smoking cessation in pregnancy. The problem of passive-smoking in pregnancy will be dealt with in a separate chapter. At present there is strong evidence that pregnant smoking has a detrimental effect on birth-weight, placenta-associated disease, stillbirth, sudden infant death syndrome (SIDS), childhood overweight, clefts, lung function, asthma, cardiovascular diseases and mental developmental disorders. These factors can be summarized by the term Fetal Tobacco Syndrome. There is supply for more studies for less investigated health effects. Pregnancy is a chance to stop smoking as most women show a high motivation in this period. Hence doctors of all disciplines should inform pregnant women about the detrimental effects of smoking on their unborn child and show them possibilities for smoking cessation.

Tobacco smoke load and non-lung cancer mortality associations in Austrian and German males.

The millstone around the neck of tobacco control in Europe has been the influence of the tobacco industry on the governments of German speaking countries. This study attempts to estimate non-lung cancer mortality attributable to smoking in Austria during 1967-2006 and in Germany during 1973-2006. National estimates of the annual smoking-attributable fractions (SAF) were calculated for all ages in males, using lung cancer mortality rates as indicators of "tobacco smoke load" associated with cancer from active and passive smoking. In both countries non-lung cancer rates showed a nearly perfect linear correlation with lung cancer rates (R (2) = 0.95 in Austria and 0.94 in Germany) with a slope of 1.86 (95% confidence intervals [CI]: 1.71-1.99) in Austria and 1.77 (95% CI: 1.60-1.93) in Germany. In 2006 SAF of male cancer mortality for all ages were 61% in Austria (sensitivity range [SR]: 45%-70%) without autocorrelation and 61% in Germany (SR: 41-75%), if adjusted for possible autocorrelation. The similarity of the results is in line with the poor tobacco control measures in both countries until recently. Cancer prevention programs in Austria and Germany should focus on tobacco control, because 61% of male cancer mortality was associated with tobacco smoke load.