M. Kunze

Nicotine dependence versus smoking prevalence: comparisons among countries and categories of smokers.

OBJECTIVES: To collect available international data on nicotine dependence as defined by the Fagerström Test of Nicotine Dependence, and to compare levels of dependence among countries and categories of smokers. DATA SOURCES: Published and unpublished studies known to the authors and a search of EMBASE from 1985-1995. STUDY SELECTION: Studies included were those based on a nationally representative sample of a countrys population, or a sample of smokers seeking cessation assistance. DATA SYNTHESIS: Smokers who seek help in stopping smoking are much more dependent than the average smoker. Men consistently score higher on dependence than women. Ex-smokers appear to have lower dependence than current smokers. A country with low smoking prevalence, the United States, seems to have smokers with higher dependence scores than countries where smoking is more prevalent (such as Austria and Poland). CONCLUSIONS: Successful tobacco control may result in a higher dependence among the remaining smokers (due to selective quitting by low-dependent smokers). The remaining highly dependent smokers may need more intensive treatment.

European Union policy on smokeless tobacco: a statement in favour of evidence based regulation for public health.

Rationale: This statement is an updated version of one released by the same authors in February 2003. The statement was produced to follow up the Royal College of Physicians (RCP) Tobacco Advisory Group report “Protecting smokers, saving lives: the case for a tobacco and nicotine regulatory authority”,1 which argued for an evidence based regulatory approach to smokeless tobacco and harm reduction and posed a series of questions that regulators must address in relation to smokeless tobacco. The purpose of this statement is to provide arguments of fact and principle to follow the RCP’s report and to outline the public health case for changing existing European Union (EU) regulation in this area. A review of regulation in relation to harm reduction and regulation of tobacco products other than cigarettes is required in Article 11 of EU directive 2001/37/EC,2 and this is a contribution towards forming a consensus in the European public health community about what policy the EU should adopt in the light of this review, or following ongoing legal action that may potentially strike out the existing regulation altogether. Public health case: We believe that the partial ban applied to some forms of smokeless tobacco in the EU should be replaced by regulation of the toxicity of all smokeless tobacco. We hold this view for public health reasons: smokeless tobacco is substantially less harmful than smoking and evidence from Sweden suggests it is used as a substitute for smoking and for smoking cessation. To the extent there is a “gateway” it appears not to lead to smoking, but away from it and is an important reason why Sweden has the lowest rates of tobacco related disease in Europe. We think it is wrong to deny other Europeans this option for risk reduction and that the current ban violates rights of smokers to control their own risks. For smokers that are addicted to nicotine and cannot or will not stop, it is important that they can take advantage of much less hazardous forms of nicotine and tobacco—the alternative being to “quit or die”… and many die. While nicotine replacement therapies (NRT) may have a role in harm reduction, tobacco based harm reduction options may reach more smokers and in a different, market based, way. Chewing tobacco is not banned or regulated in the EU but is often highly toxic, and our proposal could remove more products from the market than it permitted. Regulatory options: We believe that the EU policy on smokeless tobacco should adapt to new scientific knowledge and that the European Commission should bring forward proposals to amend or replace Article 8 of directive 2001/37/EC with a new regulatory framework. Canada has developed testing regimens for tobacco constituents and these could be readily adapted to the European situation. A review of EU policy in this area is required no later than December 2004, and we believe the Commission should expedite the part of its review that deals with harm reduction and regulation of tobacco products other than cigarettes so as to reconsider its policy on smokeless tobacco. We held this view before Swedish Match brought its legal proceedings to challenge EU legislation and we will continue to hold these views if its action fails.

Nicotine replacement: a new approach to reducing tobacco-related harm

Primary prevention is usually regarded as the most desirable goal in efforts to control tobacco-related diseases. However, this has not been very effective so far; moreover, it would take 30-40 yrs for primary prevention to translate into major health benefits. Modification of tobacco products and/or reduction of tobacco use may also have some impact on tobacco-related diseases. A tobacco dose-dependent risk has been observed in these diseases, including cancer, cardiovascular diseases, chronic nonspecific respiratory disorders, and problems during pregnancy. Reduced smoking (smoking fewer cigarettes, leading to a reduced intake of toxic substances) may be indicated in individuals who: 1) are failing in cessation attempts; 2) want to quit but are unable to do so; and 3) do not want to quit but want to reduce smoking. Studies have shown that nicotine replacement medications may be an untapped source in efforts to reduce smoking. Based on Austrian data, it is estimated that, approximately 10 yrs after implementation, a 1% reduction in smoking could save 14 male lung cancer deaths each year, and a 50% reduction would save 700 male lives. Inclusion of females and other tobacco-related diseases suggest that thousands of lives could be saved if smoking could be reduced by 50%. In the European Union, such a reduction in smoking could save > or = 100,000 lives annually. Even a 1% reduction would save 1,000 lives. In conclusion, reduced smoking should be explored as a valid method of reducing tobacco-related harm in those unwilling or unable to quit smoking.

Supplementation with Mixed Fruit and Vegetable Juice Concentrates Increased Serum Antioxidants and Folate in Healthy Adults

Objective: Epidemiological studies have shown that low plasma levels of antioxidant micronutrients, which are commonly found in fruit and vegetables, are associated with increased risk for diseases such as heart disease, cancer, metabolic disorders and the like. The aim of this study was to monitor the dietary habits of a group of healthy, middle-aged, men and women and to assess the effect of supplementation with a natural phytonutrient preparation from fruits and vegetables, on plasma levels of various antioxidant micronutrients and oxidative stress assessed by measuring 8-oxodGuo (8-oxo-7,8-dihydro-2′-deoxyguanosine) in urine. Methods: The study followed a double-blind randomized cross-over design involving 59 healthy men and women (40–60 years of age). The supplement or a placebo was given to two groups for a total period of 14 weeks (crossover week 7). Blood levels of β-carotene, vitamin C, vitamin E, selenium and folate were measured at 0, 7 and 14 weeks. Fruit and vegetable consumption was monitored by means of a retrospective food frequency questionnaire at week 0, 7 and 14. Urinary 8-oxodGuo was also determined at these time points. Results: Significant increases in blood nutrient levels after active supplementation were observed for β-carotene, vitamin C, vitamin E, selenium and folate. Ranges measured, after supplementation, often fell into those associated with a reduced risk for disease. Our data suggests that, although generally health conscious, participants still fell short of the recommended five portions of fruit and vegetables per day. No significant group changes were noted for 8-oxodGuo concentration in urine. Conclusion: Supplementation with mixed fruit and vegetable juice concentrates effectively increased plasma levels of important antioxidant nutrients and folate.

Impact of nasal continuous positive airway pressure treatment on quality of life in patients with obstructive sleep apnoea

Quality-of-life (QoL) issues have become increasingly important in health care practice and research. Obstructive sleep apnoea syndrome (OSAS) results in an especially serious reduction in QoL. The purpose of this study was to measure the QoL (life satisfaction) of OSAS patients treated with nasal continuous positive airway pressure (nCPAP). We aimed to determine whether and to what extent the QoL of OSAS patients using nCPAP differs from that of randomly selected subjects without this disorder. The QoL of 67 patients treated for at least 3 months with nCPAP, 21 OSAS patients at the time of OSAS diagnosis, and 113 randomly selected persons visiting the hospital (controls) was investigated with the help of the Munich life-quality dimension list (MLDL), an instrument for cognitive assessment of elementary components (physical condition, psyche, social life, everyday life) of QoL. It was found that QoL of OSAS patients treated with nCPAP did not significantly differ from that of control subjects with regard to elementary components. The 21 untreated OSAS patients showed significantly lower scores in all four subcategories: physical condition (p<0.0005), psyche (p<0.01), social life (p<0.0005) and everyday life (p<0.007). Thus, it may be concluded that nasal continuous positive airway pressure therapy has an important impact on the quality of life of obstructive sleep apnoea syndrome patients, and signifies a further advantage in addition to clinical aspects. Treated patients are as satisfied or dissatisfied with their life as persons without this illness.

The anti-smoking climate in EU countries and Poland.

BACKGROUND In the fall of 1998, 9095 smokers above 18 years, were interviewed about their smoking behaviour and knowledge and attitudes relating to the smoking. The survey (S) was conducted for the Cancer Commission of the EU and sponsored by SmithKline Beecham. An anti-smoking thermometer that is intended to assess the anti-smoking climate (ASC) in each EU country plus Poland was created. In doing so country owners of the S were asked to choose and rank the five questions in the S they thought best reflected the ASC. The five questions chosen were--smoking is a major cause of death and disease, want to stop smoking, governments should do more, ever made a serious quit attempt and smoke free areas should be provided. METHOD The smokers comprised a representative sample of smoking cigarette per day, vis-a-vis age, sex and rural or urban area. Face to face interviews were conducted using a semi-structured questionnaire. RESULTS Poland had the most developed ASC, 368 points, followed closely by Sweden 358. In the bottom were Germany 266 and Austria 258. Large differences were noted on willingness to quit; from the 85% in Sweden to Italy 37%. CONCLUSION The ASC varies considerably within EU and measures to reduce the death and disease from smoking should be tailored to the situation in each country.

Sleeping habits in the Austrian population

OBJECTIVES To gain reliable data on sleeping habits and sleep disturbances of the Austrian population. BACKGROUND Exact data on sleeping habits are of interest in relation to assessment of sleep disturbance-related illnesses and general social processes. METHODS A prospective, cross-sectional study was performed with recruitment of a representative sample of 1049 Austrians (aged 15-82 years), according to the Federal Statistics population characteristics. Interviews were conducted in the households of the participants by specially trained interviewers of an institute for empirical research. RESULTS Men consider their quality of sleep to be significantly better than women (P=0.00234), and younger persons consider their quality of sleep to be significantly better than older persons (P=0.00001). In comparison, women and people over the age of 50 report worse subjective sleep quality, worse sleep efficiency, more difficulty in falling asleep and sleep maintenance, more apneic events, more pathologic limb movements, more daytime dysfunction, and more intake of sleeping medication. Other sociodemographic factors influence sleep reports to a lesser extent. CONCLUSIONS Subjectively disturbed sleep (prevalence in the total population 24.9%), excessive hypnotic drug intake (prevalence 13.0%), and daytime dysfunction (prevalence 17.4%) are a widespread problem, especially in women and older people. With increasing life expectancy in Western societies, the prevalence of sleep disturbances will increase.

Lung cancer risk in women in relation to tar yields of cigarettes

Abstract Of 297 female lung cancer patients studied, 188 or 63% were cigarette smokers, significantly ( P R = 1.5, for group II-type cigarettes (15–24 mg tar/cig.) R = 2.7 ( P 24 mg tar/cig.) R = 6.3. The risks for smokers who had smoked primarily cigarettes belonging to groups I, II, and III were R = 2.6, R = 4.4 ( P R = 8.9 ( P

Prevalence of overweight and obesity in Austrian male and female farmers

SummaryObjectives:Risk factors for chronic and degenerative diseases, especially overweight and obesity are rarely examined among farmers. Objective of the study was to determine subjective health and health-related lifestyle among Austrian farmers.Methods:The study was performed in 1999/2000 as a nationwide survey by mail among all Austrian farmers, men and women, all insured by the Health Insurance Agency of Farmers.Results:15.2% of the farmers were obese. 42.9% were overweight. The prevalence of overweight and obesity was high amongst 15-19 year olds, and reached a second peak among the age groups 50-59 and 60-69 years old. Geographically, the highest concentration of overweight and obese farmers was found in the eastern, flat regions of Austria and the lowest concentration in the western, mountainous areas of Austria.Conclusions:Prevalence of overweight and obesity is very high among Austrian farmers, especially when compared to the general population. The results of this study emphasize the need for further work, with respect to the development of prevention strategies to reduce the prevalence of overweight and obesity among Austrian farmers.

Epidemiologie der Adipositas

SummaryToday, obesity has already reached endemic proportions in the industrialised nations and will be the major health problem of the century. Worldwide, almost half a billion people are overweight or obese. In Austria, the prevalence of obesity amongst adults is 9.1%, irrespective of gender, but dependent on age, social status, level of education and geographical location. In children and juveniles, the proportion of obesity lies between 4.5% and 7.5% and the trend is increasing. In light of the epidemiological situation and the risks of accompanying and consequential illnesses, it is particularly important that in the future, awareness of the problem is increased, public health strategies are developed, prevention measures targeting specific groups are accelerated and professional therapy is offered to those affected.ZusammenfassungAdipositas hat heute in Industriestaaten bereits endemische Ausmaße und wird das Hauptgesundheitsproblem des Jahrhunderts sein. Weltweit sind bereits nahezu eine halbe Milliarde Menschen übergewichtig oder adipös. In Österreich liegt die Prävalenz der Adipositas der erwachsenen Bevölkerung bei 9,1 %, unabhängig vom Geschlecht, aber abhängig vom Alter, sozialen Status, Schulbildung und geografischer Lage. Bei Kindern und Jugendlichen liegt der Anteil der Adipositas zwischen 4,5 % und 7,5 %, mit steigender Tendenz. Angesichts der epidemiologischen Situation und des Risikos für Begleit- und Folgeerkrankungen ist es künftig besonders wichtig, das Problembewusstsein zu stärken, Public-Health-Strategien zur Gesundheitsförderung zu entwickeln, Präventionsmaßnahmen zielgruppenspezifisch zu forcieren und für die Betroffenen eine professionelle Therapie anzubieten.