Mary Sexton

Cigarette Smoking and Asthma Symptom Severity Among Adult Asthmatics

Contrary to what would be expected, smoking habits of asthmatics do not differ from those of the general population: approximately 30% of asthmatic patients smoke cigarettes. Although the relationship between smoking and the incidence of asthma has been well explored, little attention has been paid to documenting the relationship between smoking and asthma symptoms among adults with asthma. The objective of this study was to assess the association of cigarette smoking with asthma symptom severity. The present report is of a cross-sectional study of 225 asthmatics, aged 20-54 years, from six general practice clinics in East Anglia, U.K. The outcome measures are overall asthma symptom score (range 6.3-28) and three asthma symptom domains: respiratory (range 1.3-8), daily activity interference (range 2-8), and physical activity interference (range 3-12), generated from the sum of ordinal responses to questions on asthma symptom severity. Of the sample, 27.0% were current and 22.1% were former smokers. Current smokers more frequently had bothersome asthma symptoms than nonsmokers in both unadjusted analyses and analyses controlling for age, gender, recent visits to the general practitioner for asthma, and asthma medication use (p = 0.06). Respiratory symptoms (p = 0.03) and symptoms that affect daily activities (p = 0.03) were more strongly associated with smoking than symptoms that affect physical activities (p = 0.62). Our data suggest that smoking hastens asthma progression or affects disease control. Increased frequency of symptoms may be an indicator for potential morbidity among asthmatics, especially those who smoke cigarettes. The hazards associated with smoking among asthmatics need to be more clearly emphasized by physicians and public health officials in order to convince people with asthma who smoke to stop.

Sexual Abuse of Young Children

For an 18-month period, all sexual abuse cases were referred to a project social worker. From her initial interview and the medical records, data were analyzed for 113 children who were 12 years of age or younger. It was found that half were five years or younger and three-fourths of the cases were female children. Reasons were discussed as to why females are more likely to be identified as sexually abused cases. A higher than average rate of gonorrhea was found among the pediatric group studied. While only 44 per cent of abusers were relatives of the abused, almost all (93%) were known to the family. If a relative were the alleged abuser, there was a high probability that it was a father, stepfather, or uncle.

Dose-response of birth weight to various measures of maternal smoking during pregnancy

Thus far little is known about the dose-response relationship between birth weight and the amount of maternal smoking during pregnancy. The purpose of this report is to describe the effects of smoking intensity, duration, and timing on birth weight with the use of three measures of exposure: self-reported daily consumption, self-reported cumulative consumption, and salivary thiocyanate. Data were obtained on 867 single live-born infants and their mothers who participated in a randomized anti-smoking intervention trial. Smoking was measured for the women at about 15 weeks gestation and again during the eighth month. Although all indicators of dose, as derived from early or late pregnancy smoking measures, were significantly associated with birth weight, whether or not the mother had quit smoking by the time of the 8th month follow-up was almost as predictive as any dose variable. For women who quit smoking before 30 weeks gestation, neither the duration nor the amount of smoking earlier in pregnancy was an important determinant of birth weight.

Baseline factors associated with smoking cessation and relapse. MRFIT Research Group

Background. Data on smoking cessation and relapse for 6 years of the Multiple Risk Factor Intervention Trial were evaluated in univariate and multivariate analyses to determine the relationship between variables measured at the beginning of the trial and smoking cessation and relapse for special intervention and usual care participants. Results. The variables positively associated with smoking cessation in both the SI and the UC groups included age, education, and past success in quitting; there was a negative association with the number of cigarettes smoked per day. The expectation of quitting was positively associated with cessation in the special intervention group only, while life events, alcohol, and the presence of a wife who smokes were significant predictors of reduced cessation for the usual care group. The special intervention program may have overcome obstacles which interfered with cessation among the usual care participants. Associations with relapse were generally stronger in the usual care group than in the special intervention group. For usual care participants, multivariate analyses showed that education, past success in quitting smoking, alcohol, and life events were associated with relapse rates. For special intervention participants, only alcohol emerged as a significant predictor. Conclusion. The data are relevant in terms of factors that govern smoking cessation and relapse for adult smokers who take part in formal intervention programs and for those who are left to modify their behavior on their own.BACKGROUND Data on smoking cessation and relapse for 6 yers of the Multiple Risk Factor Intervention Trial were evaluated in univariate and multivariate analyses to determine the relationship between variables measured at the beginning of the trial and smoking cessation and relapse for special intervention and usual care participants. RESULTS The variables positively associated with smoking cessation in both the SI and the UC groups included age, education, and past success in quitting; there was a negative association with the number of cigarettes smoked per day. The expectation of quitting was positively associated with cessation in the special intervention group only, while life events, alcohol, and the presence of a wife who smokes were significant predictors of reduced cessation for the usual care group. The special intervention program may have overcome obstacles which interfered with cessation among the usual care participants. Associations with relapse were generally stronger in the usual care group than in the special intervention group. For usual care participants, multivariate analyses showed that education, past success in quitting smoking, alcohol, and life events were associated with relapse rates. For special intervention participants, only alcohol emerged as a significant predictor. Conclusion. The data are relevant in terms of factors that govern smoking cessation and relapse for adult smokers who take part in formal intervention programs and for those who are left to modify their behavior on their own.

Relationship between blood lead and dietary iron intake in preschool children: A cross-sectional study☆

The relationship between dietary iron intake and blood lead levels in urban preschool children was investigated in a cross-sectional study of 299 children from 9 months to 5 years old. Mothers of children attending the University of Maryland Pediatric Ambulatory Clinic volunteered for the children and themselves to join the study. The data collected included nutritional status, socioeconomic status, medical history, and potential sources of lead exposure. Blood samples from all participants were evaluated for levels of blood lead, serum iron (ferritin), free erythrocyte protoporphyrin, calcium, and hematocrit. The average blood lead level (standard deviation) in the studied population was 11.4 (7.3) micrograms/dL. With multiple linear and logistic regression analyses to adjust for covariates, a negative association (P = 0.03) between blood lead and dietary iron intake was found. This finding is consistent with similar results from experimental studies. It is concluded that there is evidence that higher dietary iron intake is associated with lower blood lead among urban preschool children in the studied population.

Adherence to Asthma Guidelines in General Practices

Adherence to asthma practice guidelines is low. Improved compliance could potentially improve care of patients with asthma. The purpose of this study was to determine if patients managed in a general practice with an associated asthma clinic are more likely to use asthma medications according to clinical practice guidelines than patients managed in the general surgery of the practice. A cross-sectional study of adult asthmatics, aged 18-55 years, was conducted in six British general practices. Prescription data on all asthma medication was collected for a 6-month period. Information on asthma clinic attendance, age, sex, employment status, other medical illness, and how patients used their inhaled beta2-agonist was collected through questionnaire. The prescription data for asthma medication and patient use of inhaled beta2-agonist were compared to the British Thoracic Societys (BTS) Guidelines for Management of Asthma in Adults to determine if the patients asthma medication regimen was appropriate. There was no significant association found between appropriate asthma medication and asthma clinic attendance or other patient characteristics. Adherence to the BTS guidelines was low. Fifty-eight percent of the asthma patients used asthma medication regimens that were not consistent with the BTS guidelines published 1 year earlier. Adherence to the BTS guidelines was low regardless of patient characteristics, including asthma clinic attendance, age, sex, employment status, other medical illness, or individual practice. These findings underscore the need to document the utility of clinical practice guidelines which may improve physician compliance.

Lead and δ-Aminolevulinic Acid Dehydratase Polymorphism: Where Does It Lead? A Meta-Analysis

Background Lead poisoning affects many organs in the body. Lead inhibits δ-aminolevulinic acid dehydratase (ALAD), an enzyme with two co-dominantly expressed alleles, ALAD1 and ALAD2. Objective Our meta-analysis studied the effects of the ALAD polymorphism on a) blood and bone lead levels and b) indicators of target organ toxicity. Data source We included studies reporting one or more of the following by individuals with genotypes ALAD1-1 and ALAD1-2/2-2: blood lead level (BLL), tibia or trabecular lead level, zinc protoporphyrin (ZPP), hemoglobin, serum creatinine, blood urea nitrogen (BUN), dimercaptosuccinic acid–chelatable lead, or blood pressure. Data extraction Sample sizes, means, and standard deviations were extracted for the genotype groups. Data synthesis There was a statistically significant association between ALAD2 carriers and higher BLL in lead-exposed workers (weighted mean differences of 1.93 μg/dL). There was no association with ALAD carrier status among environmentally exposed adults with BLLs < 10 μg/dL. ALAD2 carriers were potentially protected against adverse hemapoietic effects (ZPP and hemoglobin levels), perhaps because of decreased lead bioavailability to heme pathway enzymes. Conclusion Carriers of the ALAD2 allele had higher BLLs than those who were ALAD1 homozygous and higher hemoglobin and lower ZPP, and the latter seems to be inversely related to BLL. Effects on other organs were not well delineated, partly because of the small number of subjects studied and potential modifications caused by other proteins in target tissues or by other polymorphic genes.

Comparison of patterns of smoking behavior change among smokers in the Multiple Risk Factor Intervention Trial (MRFIT)

Abstract The Multiple Risk Factor Intervention Trial (MRFIT) is a 6-year clinical trial for the study of the prevention of heart disease. Twelve thousand eight hundred and sixty-six men in the upper 10–15% of heart attack risk were randomly assigned to Special Intervention (SI) or Usual Care (UC). The SI participants received “risk factor” (hypertension, hypercholesterolemia, and cigarette smoking) intervention at the clinical centers; the UC participants were referred to their usual source of medical care for treatment. Forty percent of SI and 21% of UC smokers at entry reported not smoking at year 4, with lighter smokers in both treatment groups reporting significantly more cessation than heavier smokers. The greatest SI-UC difference in cessation rate was achieved during the first year of the program. The use of serum thiocyanate, an objective indicator of cigarette smoking, avoided problems inherent in self-reported data. Misreporting of smoking status was found in both groups with more occurring among the SI smokers. Cohort analysis revealed that of the smokers who stopped during the first year of the trial, 68% of SI and 57% of UC remained abstinent through the 4-year follow-up. Of the smokers who stopped later in the program the UC had better maintenance rates than the SI.

Can Obesity Explain the Racial Difference in Stage of Breast Cancer at Diagnosis between Black and White Women

OBJECTIVE Black women are more likely to be diagnosed at a more advanced stage of breast cancer than are white women. Traditionally, this has been attributed in part to social or cultural factors. Given that black women are more likely to be obese than white women and that being obese is associated with a more advanced stage at diagnosis, this study aims to assess to what extent the racial difference in stage at diagnosis can be explained by racial differences in obesity. METHODS Incident cases of breast cancer between 1991 and 1997 (white, n = 585; black, n = 381) were identified from hospitals in the Baltimore metropolitan area. Information, including age, race, weight, height, and pathology reports, was obtained from hospital medical records. RESULTS Black women were more likely than white women to be diagnosed with breast cancer at tumor-node-metastasis (TNM) stage II or greater (age-adjusted odds ratio [OR] = 1.51, 95% confidence interval [CI] 1.15-1.99). Further, black women were more likely than white women to be overweight or obese. A high body mass index (BMI) was significantly associated with an advanced stage of breast cancer at diagnosis. Adjustment for the higher prevalence of obesity in black women attenuated the risk estimate of more advanced stage of breast cancer at diagnosis in black women compared with white women by approximately 30%. CONCLUSIONS Our results suggest that the higher prevalence of obesity among black women plays an important role in explaining their relative disadvantage in stage at diagnosis of breast cancer. Nonetheless, a racial difference in stage of breast cancer at diagnosis persists after adjustment for obesity.

The reliability of self-reports of smoking and alcohol consumption by pregnant women

The reliability of self-reports of prepregnancy smoking and drinking habits was assessed in over 700 pregnant smokers who participated in a randomized clinical trial of smoking cessation intervention. The participants provided self-reports of their prepregnancy smoking and drinking habits prior to the 18th week (test) and again in the eighth month of gestation (retest). About half the subjects gave identical reports of prepregnancy smoking habits at test and retest. Among those who changed their estimates, the changes were usually small. The reliability of reports of prepregnancy alcohol intake was also high. The reliability of reports by the treatment group - which experienced an anti-smoking intervention and extensive contact with study personnel - was very similar to that of the control group.