Tobacco smoking increases the risk of high-grade dysplasia and cancer among patients with Barrett's esophagus

Background & Aims: Esophageal adenocarcinoma arises from Barrett's esophagus (BE); patients with this cancer have a poor prognosis. Identification of modifiable lifestyle factors that affect the risk of progression from BE to esophageal adenocarcinoma might prevent its development. We investigated associations among body size, smoking, and alcohol use with progression of BE to neoplasia. Methods: We analyzed data from patients with BE identified from the population-based Northern Ireland BE register, diagnosed between 1993 and 2005 with specialized intestinal metaplasia (n = 3167). Data on clinical, demographic, and lifestyle factors related to diagnosis of BE were collected from hospital case notes. We used the Northern Ireland Cancer Registry to identify which of these patients later developed esophageal adenocarcinoma, adenocarcinomas of the gastric cardia, or esophageal high-grade dysplasia. Cox proportional hazards models were used to associate lifestyle factors with risk of progression.
Results: By December 31, 2008, 117 of the patients with BE developed esophageal high-grade dysplasia or adenocarcinomas of the esophagus or gastric cardia. Current tobacco smoking was significantly associated with an increased risk of progression (hazard ratio = 2.03; 95% confidence interval, 1.29-3.17) compared with never smoking, and across all strata of smoking intensity. Alcohol consumption was not related to risk of progression. Measures of body size were infrequently reported in endoscopy reports, and body size was not associated with risk of progression.
Conclusions: Smoking tobacco increases the risk of progression to cancer or high-grade dysplasia 2-fold among patients with BE, compared with patients with BE that have never smoked. Smoking cessation strategies should be considered for patients with BE.

Relationship between job strain and smoking cessation: the Finnish Public Sector Study

Aims: To examine whether job strain (ie, excessive demands combined with low control) is related to smoking cessation.

Methods: Prospective cohort study of 4928 Finnish employees who were baseline smokers. In addition to individual scores, coworker-assessed work unit level scores were calculated. A multilevel logistic regression analysis, with work units at the second level, was performed.

Results: At follow-up, 21% of baseline smokers had quit smoking. After adjustment for sex, age, employer and marital status, elevated odds ratios (ORs) for smoking cessation were found for the lowest vs the highest quartile of work unit level job strain (OR 1.43, 95% CI 1.17 to 1.75) and for the highest vs the lowest quartile of work unit level job control (OR 1.61, 95% CI 1.31 to 1.96). After additional adjustment for health behaviours and trait anxiety, similar results were observed. Further adjustment for socioeconomic position slightly attenuated these associations, but an additional adjustment for individual strain/control had little effect on the results. The association between job strain and smoking cessation was slightly stronger in light than in moderate/heavy smokers. The results for individual job strain and job control were in the same direction as the work unit models, although these relationships became insignificant after adjustment for socioeconomic position. Job demands were not associated with smoking cessation.

Conclusions: Smoking cessation may be less likely in workplaces with high strain and low control. Policies and programs addressing employee job strain and control might also contribute to the effectiveness of smoking cessation interventions.

Work-place social capital and smoking cessation: The Finnish Public Sector Study

AIMS:
To examine whether high social capital at work is associated with an increased likelihood of smoking cessation in baseline smokers.
DESIGN:
Prospective cohort study.
SETTING:
Finland.
PARTICIPANTS:
A total of 4853 employees who reported to be smokers in the baseline survey in 2000-2002 (response rate 68%) and responded to a follow-up survey on smoking status in 2004-2005 (response rate 77%).
MEASUREMENTS:
Work-place social capital was assessed using a validated and psychometrically tested eight-item measure. Control variables included sex, age, socio-economic position, marital status, place of work, heavy drinking, physical activity, body mass index and physician-diagnosed depression.
FINDINGS:
In multi-level logistic regression models adjusted for all the covariates, the odds for being a non-smoker at follow-up were 1.26 [95% confidence interval (CI)=1.03-1.55] times higher for baseline smokers who reported high individual-level social capital than for their counterparts with low social capital. In an analysis stratified by socio-economic position, a significant association between individual-level social capital and smoking cessation was observed in the high socio-economic group [odds ratio (OR) (95% CI)=1.63 (1.01-2.63)], but not in intermediate [(OR=1.10 (0.83-1.47)] or low socio-economic groups [(OR=1.28 (0.86-1.91)]. Work unit-level social capital was not associated with smoking cessation.
CONCLUSIONS:
If the observed associations are causal, these findings suggest that high perceived social capital at work may facilitate smoking cessation among smokers in higher-status jobs.

Social support, network heterogeneity, and smoking behavior in women: The 10-town study

Purpose. Examine the associations among social support, network heterogeneity, and smoking behavior in a large sample of Finnish female municipal employees.

Average household income, crime, and smoking behaviour in a local area: The Finnish 10-Town study

Social environments, like neighbourhoods, are increasingly recognised as determinants of health. While several studies have reported an association of low neighbourhood socio-economic status with morbidity, mortality and health risk behaviour, little is known of the health effects of neighbourhood crime rates. Using the ongoing 10-Town study in Finland, we examined the relations of average household income and crime rate measured at the local area level, with smoking status and intensity by linking census data of local area characteristics from 181 postal zip codes to survey responses to smoking behaviour in a cohort of 23,008 municipal employees. Gender-stratified multilevel analyses adjusted for age and individual occupational status revealed an association between low local area income rate and current smoking. High local area crime rate was also associated with current smoking. Both local area characteristics were strongly associated with smoking intensity. Among ever-smokers, being an ex-smoker was less likely among residents in areas with low average household income and a high crime rate. In the fully adjusted model, the association between local area income and smoking behaviour among women was substantially explained by the area-level crime rate. This study extends our knowledge of potential pathways through which social environmental factors may affect health. (c) 2007 Elsevier Ltd. All rights reserved.

Organisational justice and smoking: the Finnish public sector study

Objective: To examine the extent to which the justice of decision-making procedures and interpersonal relationships is associated with smoking.

Work stress, smoking status, and smoking intensity: an observational study of 46 190 employees

Study objective: To examine the relation between work stress, as indicated by the job strain model, and the effort-reward imbalance model, and smoking.