[Systematic review of the effect of pictorial warnings on cigarette packages in smoking behavior]. / Revisión sistemática del efecto de las advertencias gráficas impresas en los paquetes de cigarrillos sobre el comportamiento de los fumadores.

We used a structured approach to assess whether active smokers presented with pictorial warnings on cigarette packages (PWCP) had a higher probability of quitting, reducing, and attempting to quit smoking than did unexposed smokers. We identified 21 articles from among nearly 2500 published between 1993 and 2013, prioritizing coverage over relevance or quality because we expected to find only a few studies with behavioral outcomes. We found very large heterogeneity across studies, poor or very poor methodological quality, and generally null or conflicting findings for any explored outcome. The evidence for or against the use of PWCP is insufficient, suggesting that any effect of PWCP on behavior would be modest. Determining the single impact of PWCP on behavior requires studies with strong methodological designs and longer follow-up periods.

Use of Scandinavian moist smokeless tobacco (snus) and the risk of atrial fibrillation.

BACKGROUND: Snus is a smokeless tobacco product, widely used among Swedish men and increasingly so elsewhere. There is debate as to whether snus is an acceptable "harm-reduction" tobacco product. Since snus use delivers a dose of nicotine equivalent to cigarettes, and has been implicated in cardiac arrhythmia because of associations with sudden cardiovascular death, a relation with atrial fibrillation is plausible and important to investigate. METHODS: To assess the relation between use of snus and risk of atrial fibrillation, we carried out a pooled analysis of 7 prospective Swedish cohort studies. In total, 274,882 men, recruited between 1978 and 2004, were followed via the National Patient Register for atrial fibrillation. Primary analyses were restricted to 127,907 never-smokers. Relative risks were estimated using Cox proportional hazard regression. RESULTS: The prevalence of snus use was 25% among never-smokers. During follow-up, 3,069 cases of atrial fibrillation were identified. The pooled relative risk of atrial fibrillation was 1.07 (95% confidence interval = 0.97-1.19) in current snus users, compared with nonusers. CONCLUSION: Findings from this large national pooling project indicate that snus use is unlikely to confer any important increase in risk of atrial fibrillation.

Systematic review of the effect of pictorial warnings on cigarette packages in smoking behavior.

We used a structured approach to assess whether active smokers presented with pictorial warnings on cigarette packages (PWCP) had a higher probability of quitting, reducing, and attempting to quit smoking than did unexposed smokers. We identified 21 articles from among nearly 2500 published between 1993 and 2013, prioritizing coverage over relevance or quality because we expected to find only a few studies with behavioral outcomes. We found very large heterogeneity across studies, poor or very poor methodological quality, and generally null or conflicting findings for any explored outcome. The evidence for or against the use of PWCP is insufficient, suggesting that any effect of PWCP on behavior would be modest. Determining the single impact of PWCP on behavior requires studies with strong methodological designs and longer follow-up periods.

Revisión sistemática del efecto de las advertencias gráficas impresas en los paquetes de cigarrillos sobre el comportamiento de los fumadores / Systematic review of the effect of pictorial warnings on cigarette packages in smoking behavior

Aplicamos un método estructurado para evaluar si los fumadores activos a los que se les mostraban advertencias gráficas en los paquetes de cigarrillos tenían una probabilidad mayor de abandonar el hábito, reducir el consumo de cigarrillos o intentar dejar de fumar por comparación con fumadores no expuestos. Seleccionamos 21 artículos de entre casi 2500 publicados entre 1993 y 2013, dando prioridad a la cobertura sobre la pertinencia o la calidad porque preveíamos encontrar muy pocos estudios con resultados comportamentales. Observamos una heterogeneidad muy grande entre los estudios, una calidad metodológica deficiente o muy deficiente y resultados por lo general nulos o contradictorios con respecto a cualquier desenlace explorado. Los datos científicos a favor o en contra del uso de las advertencias gráficas son insuficientes, lo cual hace sospechar que cualquier efecto de estas sobre el comportamiento sería moderado. La determinación del efecto individual de las advertencias gráficas sobre el comportamiento requiere de estudios con diseños metodológicos sólidos y períodos de seguimiento más largos.

We used a structured approach to assess whether active smokers presented with pictorial warnings on cigarette packages (PWCP) had a higher probability of quitting, reducing, and attempting to quit smoking than did unexposed smokers. We identified 21 articles from among nearly 2500 published between 1993 and 2013, prioritizing coverage over relevance or quality because we expected to find only a few studies with behavioral outcomes. We found very large heterogeneity across studies, poor or very poor methodological quality, and generally null or conflicting findings for any explored outcome. The evidence for or against the use of PWCP is insufficient, suggesting that any effect of PWCP on behavior would be modest. Determining the single impact of PWCP on behavior requires studies with strong methodological designs and longer follow-up periods.

On the measurement of nicotine dependence in adolescence: comparisons of the mFTQ and a DSM-IV-based scale.

OBJECTIVE: To compare nicotine-dependent smokers identified by the modified Fagerström Tolerance Questionnaire (mFTQ) and a scale based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), in a multiethnic adolescent sample. METHODS: A school survey was conducted on 6th- to 10th-grade students (N=15,007) in a large urban public school system. RESULTS: The two scales formed two distinct factors. The concordance between the two classifications of nicotine dependence was low. The DSM identified a much larger number of nicotine-dependent smokers than the mFTQ, mostly because smokers met dependence criteria at much lower levels of cigarettes consumed, especially when they were depressed. Rates of dependence were higher among whites than minority-group members, especially African Americans. Control for level of cigarette consumption attenuated or eliminated ethnic differences. CONCLUSIONS: This investigation provides some understanding of youths defined as dependent by each scale but cannot by itself indicate which scale better measures dependence. Differences in dependence rates among ethnic groups are accounted for mostly by quantity of cigarettes smoked.

Risk of thyroid cancer after exposure to 131I in childhood.

BACKGROUND: After the Chernobyl nuclear power plant accident in April 1986, a large increase in the incidence of childhood thyroid cancer was reported in contaminated areas. Most of the radiation exposure to the thyroid was from iodine isotopes, especially 131I. We carried out a population-based case-control study of thyroid cancer in Belarus and the Russian Federation to evaluate the risk of thyroid cancer after exposure to radioactive iodine in childhood and to investigate environmental and host factors that may modify this risk. METHODS: We studied 276 case patients with thyroid cancer through 1998 and 1300 matched control subjects, all aged younger than 15 years at the time of the accident. Individual doses were estimated for each subject based on their whereabouts and dietary habits at the time of the accident and in following days, weeks, and years; their likely stable iodine status at the time of the accident was also evaluated. Data were analyzed by conditional logistic regression using several different models. All statistical tests were two-sided. RESULTS: A strong dose-response relationship was observed between radiation dose to the thyroid received in childhood and thyroid cancer risk (P<.001). For a dose of 1 Gy, the estimated odds ratio of thyroid cancer varied from 5.5 (95% confidence interval [CI] = 3.1 to 9.5) to 8.4 (95% CI = 4.1 to 17.3), depending on the risk model. A linear dose-response relationship was observed up to 1.5-2 Gy. The risk of radiation-related thyroid cancer was three times higher in iodine-deficient areas (relative risk [RR]= 3.2, 95% CI = 1.9 to 5.5) than elsewhere. Administration of potassium iodide as a dietary supplement reduced this risk of radiation-related thyroid cancer by a factor of 3 (RR = 0.34, 95% CI = 0.1 to 0.9, for consumption of potassium iodide versus no consumption). CONCLUSION: Exposure to (131)I in childhood is associated with an increased risk of thyroid cancer. Both iodine deficiency and iodine supplementation appear to modify this risk. These results have important public health implications: stable iodine supplementation in iodine-deficient populations may substantially reduce the risk of thyroid cancer related to radioactive iodines in case of exposure to radioactive iodines in childhood that may occur after radiation accidents or during medical diagnostic and therapeutic procedures.

Factors related to abstinence in a telephone helpline for smoking cessation.

BACKGROUND: Studies indicate that shortage of cessation counsellors may be a major barrier for tobacco prevention among physicians. Telephone helplines (quitlines) may be an option. The effectiveness of the Swedish quitline and factors related to abstinence from smoking 12 months after the first contact were assessed. METHOD: Subjects included 694 smokers calling a reactive (no contact initiated by the counsellors) and 900 smokers calling a proactive (four or five contacts initiated by the counsellors after the first call) quitline for smoking cessation. The subjects were followed up 12 months after the first call using a mailed questionnaire assessing current abstinence, stages of change and factors potentially related to abstinence rates. RESULTS: The questionnaire was returned by 70% of the subjects. Women receiving the proactive treatment reported 34% abstinence rates compared with 27% for those receiving the reactive treatment (p=0.03). For men the abstinence rates were 27% and 28%, respectively (p=0.80). Factors significantly related to abstinence in the adjusted analysis included no nicotine use at base-line, the adjusted odds ratio with 95% confidence interval being 6.4 (2.1-19.4), additional support from a health care professional 3.5 (1.0-12.3), additional social support 3.1 (1.6-6.1), stress or depressive mood 2.7 (1.6-4.7), nicotine replacement therapy for five weeks or more 2.1 (1.1-4.0), and exposure to second-hand smoke 1.9 (1.1-3.3). The use of oral tobacco did not significantly increase current abstinence. CONCLUSION: Quitlines are effective as an adjunct to the health care system. For women a proactive treatment may be more effective than a reactive treatment.

A pooled analysis of case-control studies of thyroid cancer: cigarette smoking and consumption of alcohol, coffee, and tea.

OBJECTIVE: To analyze the role of smoking, alcohol, coffee and tea in relation to thyroid cancer, we conducted a pooled analysis of 14 case-control studies conducted in the United States, Europe, and Asia. METHODS: The sample consisted of 2725 thyroid cancer cases (2247 females, 478 males) and 4776 controls (3699 females, 1077 males). Conditional logistic regression with stratification on study, age at diagnosis, and gender was used to compute odds ratios and 95% confidence intervals. RESULTS: Thyroid cancer risk was reduced in persons who had ever smoked. The relationship was more pronounced in current smokers (OR = 0.6, 95% CI = 0.6-0.7) than former smokers (OR = 0.9, 95% CI = 0.8-1.1). There were significant trends of reduced risk with greater duration and frequency of smoking. For consumption of wine and beer, there was a significant trend of decreasing thyroid cancer risk (p = 0.02) that was not maintained after adjustment for current smoking (p = 0.12). Thyroid cancer risk was not associated with consumption of coffee or tea. These findings were consistent in both gender-specific and histology-specific (papillary and follicular) analyses. CONCLUSIONS: Pooled analyses of these geographically diverse case-control data indicate a reduced thyroid cancer risk associated with current smoking. A reduced risk associated with alcohol was eliminated after adjustment for smoking, and caffeinated beverages did not alter thyroid cancer risk.