[Effects of tobacco use on systemic health: relevant information for dentistry (II)--part 2: cardiovascular diseases and public health issues]

This is the sixth and concluding part of a series of publications from the Swiss task force named "Smoking - Intervention in the private dental office" on the topic "tobacco use and dental medicine". The focus of this review is the effects of smoking for the development of atherosclerosis as pathohistological correlate for acute coronary syndrome (ACS), arterial occlusive disease, and cerebrovascular diseases (stroke). Additionally, a causal relationship between tobacco use and an increased rate for complications during pregnancy and child birth will be discussed. Next to causal therapy of local and systemic diseases in general, an emphasis must be given to tobacco use prevention and cessation. Finally, important public health issues concerning smoking and tobacco use will be demonstrated, and options to improve the current situation will be presented.

[Effects of tobacco use on general health: relevant information for dentistry (I)--part 1: pulmonary diseases and other malignancies]

This fifth part of a series of publications from the Swiss task force named "Smoking--Intervention in the private dental office" on the topic "tobacco use and dental medicine" focuses on the effects of tobacco use on general health. A significant increase of tobacco use associated morbidity and mortality for many cardiovascular and pulmonary diseases has been well documented in the literature. In this review, the epidemiologic background as well as the pathophysiological fundamentals for tobacco-mediated pulmonary diseases is presented, focusing especially on chronic obstructive pulmonary disease (COPD) and lung cancer. In addition, a causal relationship between nicotine abuse and an increased carcinoma incidence for other malignancies but lung cancer will be discussed. Regarding the evidence in the present literature, it is undisputable that smoking is the most preventable cause for COPD and lung cancer.

Tobacco use cessation provided by dental hygienists

Second to regular mechanical plaque control, tobacco use cessation has become the most important measure for the treatment of periodontal diseases. In contrast to general medical professionals, dental hygienists are seeing their patients regularly and are therefore available for supporting their patients to quit tobacco use. Tobacco use disease consists of both a physical addiction and a psychological dependence. Therefore, the combination of behaviour change support with pharmacotherapy is recommended for tobacco use cessation counselling. The use of brief motivational interviewing for tobacco use short interventions in the dental practice appears to be suitable. In addition to behavioural support, the use for nicotine replacement therapy is the treatment of choice for the dental practice. Following a critical review of the literature on this topic, a step by step approach for tobacco use cessation is presented for the dental hygienists to be implemented in their daily practice routine.

Behaviour change counselling for tobacco use cessation and promotion of healthy lifestyles: a systematic review

AIM To systematically assess the efficacy of oral health behaviour change counselling for tobacco use cessation (TUC) and the promotion of healthy lifestyles. MATERIALS AND METHODS Systematic Reviews, Randomized (RCTs), and Controlled Clinical Trials (CCTs) were identified through an electronic search of four databases complemented by manual search. Identification, screening, eligibility and inclusion of studies were performed independently by two reviewers. Quality assessment of the included publications was performed according to the AMSTAR tool for the assessment of the methodological quality of systematic reviews. RESULTS A total of seven systematic reviews were included. With the exception of inadequate oral hygiene, the following unhealthy lifestyles related with periodontal diseases were investigated: tobacco use, unhealthy diets, harmful use of alcohol, physical inactivity, and stress. Brief interventions for TUC were shown to be effective when applied in the dental practice setting while evidence for dietary counselling and the promotion of other healthy lifestyles was limited or non-existent. CONCLUSIONS While aiming to improve periodontal treatment outcomes and the maintenance of periodontal health current evidence suggests that tobacco use brief interventions conducted in the dental practice setting were effective thus underlining the rational for behavioural support.

Adolescent tobacco use: Studies of prevalence, factorial validity, and factorial invariance between African Americans and Whites

In the last thirty years, increasing efforts have been made to reduce the prevalence of adolescent tobacco use in the United States. Although the prevalence has declined dramatically over the past decade, there are still sharp differences in adolescent smoking-initiation rates across racial/ethnic groups. Large-scale surveys frequently assess smoking-related attitudes, self-efficacy, and intentions to explain the differences in smoking rates between African Americans and Whites. However, there is little agreement about which constructs are significant. Moreover, the psychometric properties of smoking-related attitude, self-efficacy, and intention constructs have not been fully examined. More studies are needed to understand existing patterns of tobacco use and to validate and fully exploit the constructs' relationship to adolescent smoking initiation across racial/ethnic groups. ^ This dissertation reports on a secondary analysis of data from a large multi-ethnic convenience sample of sixth- through eighth-grade students in 22 schools in East Texas and the city of Houston. The specific aims of this dissertation were to (1) describe smoking and alternate tobacco product use rates by race/ethnicity, gender, age, and grade level (Article 1); (2) test the factorial validity of smoking-related attitudes, self-efficacy, and intentions using confirmatory factor analysis techniques (Article 2); and (3) test the factorial invariance of smoking-related attitudes, self-efficacy, and intentions between African Americans and Whites (Article 3). ^ The prevalence findings confirm the disparities in tobacco use among African American, Hispanic, and White adolescents that other surveys have reported (Article 1). This study also demonstrates the usefulness of examining use patterns of not only cigarettes but also alternative tobacco products in younger multiethnic populations, as well as of providing epidemiological data estimates about different phases of smoking. The confirmatory factor analysis provides evidence of construct validity of attitude, self-efficacy, and intention scales for the multiethnic sample (Article 2). Finally, the factorial invariance analyses indicates that some measures representing smoking-related attitudes, self-efficacy, and intentions may not be appropriate for use among both African Americans and Whites (Article 3). Additional research is needed to further our understanding of the patterns and predictors of youth tobacco use initiation. ^

Tobacco use and related psychosocial risk factors among youth in urban India: Assessment of Project MYTRI follow-up surveys

Project MYTRI (Mobilizing Youth for Tobacco-Related Initiatives in India) was a large 2-year randomized school-based trial with a goal to reduce and prevent tobacco use among students in 6th and 8th grades in Delhi and Chennai in India (n=32 schools). Baseline analyses in 2004 showed that 6th grade students reported more tobacco use than 8 th grade students, opposite of what is typically observed in developed countries like the US. The present study aims to study differences in tobacco use and psychosocial risk factors between the 6th grade cohort and 8th grade cohort, in a compliant sub-sample of control students that were present at all 3 surveys from 2004-06. Both in 2004 and 2005, 6th grade cohort reported significantly greater prevalence of ever use of all tobacco products (cigarettes, bidis, chewing tobacco, any tobacco). These significant differences in ever use of any tobacco between cohorts were maintained by gender, city and socioeconomic status. The 6th grade cohort also reported significantly greater prevalence of current use of tobacco products (cigarettes, chewing tobacco, any tobacco) in 2004. Similar findings were observed for psychosocial risk factors for tobacco use, where the 6th grade cohort scored higher risk than 8th grade cohort on scales for intentions to smoke or chew tobacco and susceptibility to smoke or chew tobacco in 2004 and 2005, and for knowledge of health effects of tobacco in all three years.^ The evidence of early initiation of tobacco use in our 6th grade cohort in India indicates the need to target prevention programs and other tobacco control measures from a younger age in this setting. With increasing proportions of total deaths and lost DALYs in India being attributable to chronic diseases, addressing tobacco use among younger cohorts is even more critical. Increase in tobacco use among youth is a cause for concern with respect to future burden of chronic disease and tobacco-related mortality in many developing countries. Similarly, epidemiological studies that aim to predict future death and disease burden due to tobacco should address the early age at initiation and increasing prevalence rates among younger populations. ^

Smokeless tobacco use in 2005 US Military population

U.S. Military personnel are more likely to use smokeless tobacco than civilians. The purpose of this study was to describe the relationship between smokeless tobacco use and sociodemographic, behavioral, and occupational variables, using data from the 2005 Department of Defense Survey of Health Related Behaviors among Active Duty Military Personnel. The DoD survey was comprised of representative active duty U.S. military members (N=16,146). In adjusted multivariate logistic regression models, this study found smokeless tobacco use to be more prevalent in younger age, males, whites, and enlisted-rank members. By service, higher rates were reported among members of the Army and Marine Corps than among the Air Force and Navy members. Smokeless tobacco use among those who also smoke or drink heavily was also much higher than among those who did not report smoking or heavy alcohol use. Results also showed increased prevalence of smokeless tobacco use among those who reported moderate or high impulsive behavior and among those who recently deployed. These findings contribute to improving the understanding of factors related to smokeless tobacco use in the military and may help design strategies to reduce the use of this potentially toxic substance and improve health for military members.^

An evaluation of a behavioral change intervention for smokeless tobacco use

During the last three decades considerable attention has been placed on the reduction of tobacco use due to cigarette smoking. During this time, studies have been funded and programs have been developed that focus on both prevention and cessation of cigarette smoking. This intense focus has led to a significant decline in cigarette smoking. But now, use of another form of tobacco--smokeless tobacco--is gaining in popularity.^ In 1989, the National Cancer Institute funded a research study at The University of Texas M. D. Anderson Cancer Center, called Working Well, to develop, implement, and evaluate worksite health promotion programs aimed at reducing cancer risks. As part of this program, a behavioral intervention for smokeless tobacco use was developed. This dissertation evaluates the impact of that behavioral change intervention for smokeless tobacco use.^ Data collected during the Working Well program were analyzed to determine the effect of the intervention. The primary outcomes analyzed were smokeless tobacco cessation, stages of change movement, and prevalence. The secondary outcomes analyzed included the prediction of smokeless tobacco use, stage movement, and cessation. Primary outcome analyses were conducted using the worksite as the unit of analysis, while the secondary analyses were conducted using the individual as the unit of analysis.^ Approximately 20% of the male population used smokeless tobacco. Results of intervention analyses indicate that the Working Well program produced no intervention effect on any of the primary outcomes. At the final observation, the experimental worksites achieved a quit rate of 27%, while the control worksites achieved a quit rate of 26% (P = 0.78). Stage movement for the experimental worksites was 49%, while the control worksites experienced stage movement of 43% (P = 0.20). The results of the analyses on smokeless tobacco prevalence followed the same pattern. Predictors of smokeless tobacco use, cessation, and stage movement were also identified.^ Based on the results found in this study, smokeless tobacco should remain a research priority. Future research should focus on smokeless tobacco use, including the identification of the determinants of smokeless tobacco use and the development of measures and effective intervention strategies. ^

Development and evaluation of a video-based modeling strategy for the dissemination phase of a school health tobacco -use prevention program

Even the best school health education programs will be unsuccessful if they are not disseminated effectively in a manner that encourages classroom adoption and implementation. This study involved two components: (1) the development of a videotape intervention to be used in the dissemination phase of a 4-year, NCI-funded diffusion study and (2) the evaluation of that videotape intervention strategy in comparison with a print (information transfer) strategy. Conceptualization has been guided by Social Learning Theory, Diffusion Theory, and communication theory. Additionally, the PRECEDE Framework has been used. Seventh and 8th grade classroom teachers from Spring Branch Independent School District in west Houston participated in the evaluation of the videotape and print interventions using a 57-item preadoption survey instrument developed by the UT Center for Health Promotion Research and Development. Two-way ANOVA was used to study individual score differences for five outcome variables: Total Scale Score (comprised of 57 predisposing, enabling, and reinforcing items), Adoption Characteristics Subscale, Attitude Toward Innovation Subscale, Receptivity Toward Innovation, and Reinforcement Subscale. The aim of the study is to compare the effect upon score differences of video and print interventions alone and in combination. Seventy-three 7th and 8th grade classroom teachers completed the study providing baseline and post-intervention measures on factors related to the adoption and implementation of tobacco-use prevention programs. Two-way ANOVA, in relation to the study questions, found significant scoring differences for those exposed to the videotape intervention alone for both the Attitude Toward Innovation Subscale and the Receptivity to Adopt Subscale. No significant results were found to suggest that print alone influences favorable scoring differences between baseline and post-intervention testing. One interaction effect was found suggesting video and print combined are more effective for influencing favorable scoring differences for the Reinforcement for the Adoption Subscale.^ This research is unique in that it represents a newly emerging field in health promotion communications research with implications for Social Learning Theory, Diffusion Theory, and communication science that are applicable to the development of improved school health interventions. ^

Treating tobacco use and dependence /

"This guideline is an updated version of the 1996 Smoking Cessation Clinical Practice Guideline No. 18."--P. ii.

Tobacco use among U.S. racial/ethnic minority groups : African Americans, American Indians and Alaska natives, Asian Americans and Pacific Islanders, Hispanics : a report of the Surgeon General.

Shipping list no.: 98-0250-P.

Effects of dopamine receptor D4 variation on alcohol and tobacco use and on novelty seeking: Multivariate linkage and association analysis

The dopamine D4 receptor gene contains a polymorphic sequence consisting of a variable number of 48-base-pair (bp) repeats, and there have been a number of reports that this polymorphism is associated with variation in novelty seeking or in substance abuse and addictive behaviors. In this study we have assessed the linkage and association of DRD4 genotype with novelty seeking, alcohol use, and smoking in a sample of 377 dizygotic twin pairs and 15 single twins recruited from the Australian Twin Registry (ATR). We found no evidence of linkage or association of the DRD4 locus with any of the phenotypes. We made use of repeated measures for some phenotypes to increase power by multivariate genetic analysis, but allelic effects were still non-significant. Specifically, it has been suggested that the DRD4 7-repeat allele is associated with increased novelty seeking in males but we found no evidence for this, despite considerable power to do so. We conclude that DRD4 variation does not have an effect on use of alcohol and the problems that arise from it, on smoking, or on novelty seeking behavior. (C) 2003 Wiley-Liss, Inc.

Course of substance misuse and daily tobacco use in first-episode psychosis

Background: Study of the course of substance misuse and daily tobacco use in first-episode psychosis may enhance detection and treatment of these substance-related problems. Methods: This 15-month follow-up study examined the course of substance misuse and daily tobacco use in 103 individuals treated for first-episode psychosis. Results: Three-quarters (72.6%) of patients with lifetime substance misuse, or half (51.5%) of all patients, continued substance misuse (primarily cannabis) during the 15-month follow-up period. There was a significant reduction in the rate of any substance misuse (70.9% versus 53.4%) but not daily tobacco use (76.7% versus 75.7%) between baseline and 15-month follow-up. Patients who continued substance misuse showed a significant reduction in the severity and frequency of substance use between baseline and follow-up. Patients who continued substance misuse were more likely to be younger, male and single, less likely to have completed secondary school, and more likely to have had more severe cannabis use prior to entry to treatment compared to patients who ceased substance misuse. Discussion: A significant proportion of young patients treated for first-episode psychosis are at risk of mental and physical health problems associated with substance misuse and/or regular tobacco use. (c) 2005 Elsevier B.V. All rights reserved.