FREE THE EARTH FROM DEVIL SMOKE

Failed intellectuals, arm-chair revolutionaries, frustrated utopians, tyrannical tycoons, spoilt spitritualists, profiteers, corrupt capitalists, lecherous leftists- all have ganged up against humanity in an unholy alliance.

whatever your views, whatever your religion, language, caste, color, creed, credo, nationality, profession, ideology, culture or any idiocyncracy --remember one thing that you will have to live, breathe, drink and eat on this planet EARTH. Therefore you have an obligation and equal right like anyone else to keep this planet livable and breathable. Cigarette smoking is one of the major causes that are making this planet unlivable. Rid yourself of this satanic evil if you are gripped by it and stand up against it. Join my blog and let our voices become one. Let there be synergy in our efforts.

Your non-smoking, non-drinking friend
webscout




Monday, May 31, 2010

SMOKING RISKS

Smoking risks

Smoking is recognized as the leading preventable cause of death, causing or contributing to the deaths of approximately 430,700 Americans each year. Anyone with a smoking habit has an increased chance of lung, cervical, and other types of cancer; respiratory diseases such as emphysema, asthma, and chronic bronchitis; and cardiovascular disease, such as heart attack, high blood pressure, stroke, and atherosclerosis (narrowing and hardening of the arteries). The risk of stroke is especially high in women who take birth control pills.
Smoking can damage fertility, making it harder to conceive, and it can interfere with the growth of the fetus during pregnancy. It accounts for an estimated 14% of premature births and 10% of infant deaths. There is some evidence that smoking may cause impotence in some men.
Because smoking affects so many of the body's systems, smokers often have vitamin deficiencies and suffer oxidative damage caused by free radicals. Free radicals are molecules that steal electrons from other molecules, turning the other molecules into free radicals and destabilizing the molecules in the body's cells.


Smoking is recognized as one of several factors that might be related to a higher risk of hip fractures in older adults.
Studies reveal that the more a person smokes, the more likely he is to sustain illnesses such as cancer, chronic bronchitis, and emphysema. But even smokers who indulge in the habit only occasionally are more prone to these diseases.
Some brands of cigarettes are advertised as "low tar," but no cigarette is truly safe. If a smoker switches to a low-tar cigarette, he is likely to inhale longer and more deeply to get the chemicals his body craves. A smoker has to quit the habit entirely in order to improve his health and decrease the chance of disease.
Though some people believe chewing tobacco is safer, it also carries health risks. People who chew tobacco have an increased risk of heart disease and mouth and throat cancer. Pipe and cigar smokers have increased health risks as well, even though these smokers generally do not inhale as deeply as cigarette smokers do. These groups haven't been studied as extensively as cigarette smokers, but there is evidence that they may be at a slightly lower risk of cardiovascular problems but a higher risk of cancer and various types of circulatory conditions.
Recent research reveals that passive smokers, or those who unavoidably breathe in secondhand tobacco smoke, have an increased chance of many health problems such as lung cancer, ischemic heart disease, and asthma; and in children, sudden infant death syndrome. A Swedish study published in 2001 found that people who were exposed to environmental tobacco smoke (ETS) as children were both more likely to develop asthma as adults, and to become smokers themselves. In the fall of 2001 the Environmental Protection Agency (EPA) partnered with the American Academy of Allergy, Asthma, and Immunology (AAAAI) to educate parents about the risks to their children of secondhand smoke, and to persuade parents to sign a Smoke Free Home Pledge. The AAAAI reported that many parents cut down on or gave up smoking when they recognized the damage that smoking was causing to their children's lungs. A study of secondhand smoke in the workplace done by the European Union found that it can affect workers as severely as smoke in the home can affect children. The study noted that workers exposed to secondhand smoke from their colleagues had significantly higher rates of asthma and upper respiratory infections than those who were employed in smoke-free workplaces.

TOBACCO ADDICTION

Causes & Symptoms Of Tobacco Addiction

No one starts smoking to become addicted to nicotine. It isn't known how much nicotine may be consumed before the body becomes addicted. However, once smoking becomes a habit, the smoker faces a lifetime of health risks associated with an addiction that has been shown to be stronger than alcohol addiction and at least as strong as narcotics addiction.
About 70% of smokers in the United States would like to quit; in any given year, however, only about 3.6% of the country's 47 million smokers quit successfully.
Although specific genes have not yet been identified as of 2003, researchers think that genetic factors contribute substantially to developing a smoking habit. Several twin studies have led to estimates of 46–84% heritability for smoking. It is thought that some genetic variations affect the speed of nicotine metabolism in the body and the activity level of nicotinic receptors in the brain.

THERAPIES FOR SMOKING CESSATION-1




THERAPIES FOR TREATING SYMPTOMS OF SMOKING CESSATION
Treatment Description Symptom treated
Lobelia Used as a nicotine substitute, it can bolster the nervous system Withdrawal and craving
Wild oats or kava kava Relaxant Withdrawal
Licorice Can be chewed to help withdrawal Oral fixation
Hawthorn, gingko biloba, and bilberry All contain bioflavonoids that can help repair free radical damage Damage to lungs and cardiovascular system
Acupuncture Stimulation of points in ears and feet helps cessation Addiction and withdrawal
Vitamin C Antioxidant that helps fight infection Boosts immune system
Vitamin B12 Helps protect body from disease Smoking-induced cancers
Omega-3 fatty acids Helps protect body from disease Smoking-related illness, such as emphysema, and depression














Nicotine by itself increases the risk of heart disease. However, when a person smokes, he or she is ingesting a lot more than nicotine. Smoke from a cigarette, pipe, or cigar is made up of many additional toxic chemicals, including tar and carbon monoxide. Tar is a sticky substance that forms into deposits in the lungs, causing lung cancer and respiratory distress. Carbon monoxide limits the amount of oxygen that the red blood cells can convey throughout the body. Also, it may damage the inner walls of the arteries, which allows fat to build up in them.
Besides tar, nicotine, and carbon monoxide, tobacco smoke contains 4,000 different chemicals. More than 200 of these chemicals are known be toxic. Nonsmokers who are exposed to tobacco smoke also take in these toxic chemicals. They inhale the smoke exhaled by the smoker as well as the more toxic sidestream smoke—the smoke from the end of the burning cigarette, cigar, or pipe.
Here's why sidestream smoke is more toxic than exhaled smoke: When a person smokes, the smoke he or she inhales and then breathes out leaves harmful deposits inside the body. But because lungs partially cleanse the smoke, exhaled smoke contains fewer poisonous chemicals. That's why exposure to tobacco smoke is dangerous even for a nonsmoker.











DEFINING SMOKING-1

Definition

Smoking is the inhalation of the smoke of burning tobacco encased in cigarettes, pipes, and cigars. Casual smoking is the act of smoking only occasionally, usually in a social situation or to relieve stress. A smoking habit is a physical addiction to tobacco products. Many health experts now regard habitual smoking as a psychological addiction, too, and one with serious health consequences.

Description

The U.S. Food and Drug Administration (FDA) has asserted that cigarettes and smokeless tobacco should be considered nicotine delivery devices. Nicotine, the active ingredient in tobacco, is inhaled into the lungs, where most of it stays. The rest passes into the bloodstream, reaching the brain in about ten seconds and dispersing throughout the body in about 20 seconds.
Depending on the circumstances and the amount consumed, nicotine can act as either a stimulant or tranquilizer. This can explain why some people report that smoking gives them energy and stimulates their mental activity, while others note that smoking relieves anxiety and relaxes them. The initial "kick" results in part from the drug's stimulation of the adrenal glands and resulting release of epinephrine into the blood. Epinephrine causes several physiological changes—it temporarily narrows the arteries, raises the blood pressure, raises the levels of fat in the blood, and increases the heart rate and flow of blood from the heart. Some researchers think epinephrine contributes to smokers' increased risk of high blood pressure.

ECONOMIC CONSEQUENCES OF SMOKING-2


Fires sparked by careless smokers cost $4.1 million

 

 
 
 


For people who smoke outside on their decks or balconies, Wayne Pawlowski has a message.

"Don't dispose of your smokers' materials in peat moss planters," Pawlowski, chief of fire investigations, said Thursday.

Improper disposal of cigarettes led to fires that caused $4.1 million in damage in the first five months of 2010.

That's more than the amount of damage caused in the previous two years combined.

Carelessly throwing away cigarettes, matches and other smoking materials has caused 20 fires this year.

The fires have killed one person and injured another.

In 2009, 65 fires caused $1.8 million in damage, and in 2008, $1.9 million in damage was caused by 67 fires.

Pawlowski said tossing a cigarette into a planter filled with peat moss may not immediately start a fire, but the peat will hold heat and continue to smoulder.

That heat could then melt the plastic of a plant pot and start a fire.

"Those fires that are outside, they often go undetected. There's no smoke alarms out there," he said.

The fire may not be noticed until it gets into a house or building or somebody drives by and sees it, Pawlowski added.

Ashtrays or empty coffee tins with sand or water are recommended over plant pots or throwing a cigarette on the ground.

A March fire caused $3.5 million in damage to a condo complex on 116th Street and 107th Avenue.

It was started by the improper disposal of smokers' materials, Pawlowski said
.

apeters@thejournal.canwest.com

Sunday, May 30, 2010

ECONOMIC CONSEQUENCES OF SMOKING-1



Cigarette butts cause forest fires
News Date: 27th May 2010


Cigarette butts thrown carelessly on forest roads have devastated around 60 hectares of lush forest in Kerala during February and March, the wild-fire season in the state.

According to the data of State Wildlife Department, around four per cent of the forest loss during the period was because of such carelessness.

Apart from cigarettes, lightning, discharge from electric lines, spreading of fire due to careless handling of fire and intentional fire have also caused fire largely across forests

in the state, the data says.

"Cigarette butts caused fire mainly in places near roads in 'kooppu' (place for taking woods from forests using elephants), the in-roads which are used by both tribal and non-tribal people. Match boxes and cigarette packets have been recovered many times from such roads," Chief Conservator of Forest, K J Varghese said.

Many people who went to forest to collect wood, honey or cattle grass would throw away cigarettes without pre-thinking that it could cause a huge fire, he said, adding that such

people caused a loss of around 27 hectare in the present season alone.

This happened despite the wildlife department taking precautionary measures to check the spread of forest fire this year, in consideration of the scorching heat wave and lack of summer showers.

'Vana Samrakshana Samities' and Eco evelopment

Committees had jointly executed various methods in this regard.

According to the Forest Survey of India (FSI), 1,324.59 hectares of forest land has been destroyed in wildfire of which 751.05 hectares was lost in April alone.

In the period between December 2009 and May 2010, 106 fire incidents have been reported across various forests of Kerala, the data says.
 
        Courtesy:http://www.businessghana.com

Friday, May 7, 2010

WOMEN's AND TOBACCO---REFERENCE-2

  • thetruth.com    - American Legacy Foundation tobacco education campaign covers cigarettes, smoking, other tobacco products. "The truth about how the cigarette industry operates".
  • Tobacco BBS    - Cigarettes, tobacco, and smoking-related news and issues, addresses, tobacco history, information on quitting, and a quote of the day section.
  • Addicted to Nicotine: A National Research Forum - Includes presentation summaries of papers presented at the conference held in 2001 at the (US) National Institutes of Health. Topics include nicotine delivery systems, pharmacology, individual and environmental risk factors, the psychobiology of addition, and treatment of nicotine dependence.
  • Ammonia Added to Cigarettes Can Significantly Boost Availability of Nicotine - Independent research confirms that ammonia added to cigarettes can boost the availability of nicotine up to 100 times.
  • Cancer Facts and Figures - Concise summary from the American Cancer Society of tobacco use, cigarettes, trends in smoking, profiling smokers, costs of tobacco, nicotine addiction, secondhand smoke, spit tobacco, and industrial hazards.
  • CDC's TIPS: Tobacco Information and Prevention Source - Maintained by the CDC's Office on Smoking and Health. Covers tobacco-related issues, statistics, news, research, data, reports, quitting tips, educational materials, publications, . Also sections dedicated to youth.
  • A Collection of Articles on Nicotine Addiction - Articles about research studies funded by the National Institute on Drug Abuse.
  • eMedicine - Nicotine Addiction - Medical facts on the physiology of nicotine addiction, and the effect tobacco products have on the brain, lungs, and other vital organs, and a treatment options section.
  • Good Health -- Healthy Lifestyle - This site is dedicated to convincing people to live a healthy lifestyle, to improve their quality of life, and avoid (or reduce the severity of) chronic disease.
  • 'Impact Booster': Tobacco Firm Shows How Ammonia Spurs Delivery of Nicotine - 1996 Pulitzer prize-winning reporting on how the tobacco industry uses ammonia to engineer cigarettes for addiction.
  • Infofax - Cigarettes and Other Nicotine Products - NIH short summary of nicotine effects.
  • Low Tar Exposed - Site explains why "low tar", "light" and "mild" cigarettes are just as harmful as regular cigarettes.
  • M. D. Anderson Cancer Center - Tobacco & Cancer - University of Texas medical center factsheets on effects of smoking and tobacco, and tips and support for quitting. One-third of M. D. Anderson patients have tobacco-related cancers.
  • Nicotine Addiction - Concise factsheet.
  • Nicotine Addiction in Britain - Complete online book by the Royal College of Physicians; covers physical. pharmacological, and psychological effects; addiction; the smoker's career; regulation of intake; treatment; regulatory approaches; recommendations.
  • Nicotine Addiction in Britain - Includes report produced by the Royal College of Physicians. "Nicotine addiction is one of the major reasons why people continue to smoke cigarettes, and cigarettes are in reality extremely effective and closely controlled nicotine delivery devices".
  • Nicotine and Addiction - ASH-UK factsheet on nicotine, its properties, difficulty in quitting, measures of dependence, withdrawal systems, genetic influence, and tobacco industry recognition of the its importance. [PDF]
  • Nicotine and the Tobacco Industry - Science Week article focuses on 3 decades of tobacco industry efforts to engineer cigarettes for addiction.
  • Nicotine Junkies - Information on kids and smoking, facts about smoking and addiction.
  • Quit Victoria - "Tobacco smoking is the single most important cause of ill health and premature death in Australia." Not just quitting information -- health questions answered; effects of cigarettes; quit evaluation studies; information in languages other than English; smokefree workplaces and dining.
  • Reducing the Addictiveness of Cigarettes - Can cigarettes be made less addictive? Scientific paper examines the question.
  • Report of the UK Scientific Committee on Tobacco and Health - Report covers the scientific evidence on active smoking, passive smoking, nicotine addiction, price and marketing of cigarettes and other tobacco products, cessation, key conclusions.
  • Research Report: Nicotine Addiction - Information from the National Institute on Drug Abuse about nicotine, addiction, the extent and impact of tobacco use, how nicotine delivers its effect, consequences of continued use, treatments, and gender differences.
  • Smoking And Tobacco Factsheets - From the Missouri Health Department, a large set of factsheets on cigarettes, tobacco advertising, health effects, and secondhand smoke.
  • Smoking Is Ugly - Created and sustained by Christy Turlington, an online resource guide, providing information and links to numerous lung cancer and smoking-cessation related websites. SmokingIsUgly.com is part of Turlington's campaign to raise awareness about the effects of smoking, smoking related diseases and lung cancer.
  • TCSG - Tobacco and The Elderly - Papers and factsheets on: tobacco and minorities, state tobacco settlement funds, tobacco and older persons.
  • Tobacco Advertising and Document Collections - Growing set of resources presenting and organizing tobacco industry documents; shows what the industry says in private about youth, advertising, promotions; features a poster on the history of youth cigarette brands.
  • Tobacco Control Online - A quarterly scientific journal covering all aspects of tobacco use prevention and control.
  • Tobacco in Australia: Facts and Issues - A complete, online, book, with all citations to the literature. Covers cigarettes, other tobacco products; statistics and trends; health effects; smoking in the workplace and public places; public policy; addiction; quitting; anti-smoking campaigns; and the tobacco industry.
  • Tobacco Industry Hall of Shame - List of stars and performers killed by tobacco.
  • The Tobacco Reference Guide - Online book provides quotes, summaries, and factsheets about hazards of smoking.
  • TobaccoFree - Offers smoking cessation tips, research results, and tips for staying smoke free.
  • WHO: The Tobacco Atlas - History of tobacco, types of use, male and female smoking, youth, cigarette consumption, health effects, secondhand smoke, deaths, costs; the trade, the industry, smuggling, tobacco promotion and marketing, Internet sales, politics; activism, research, tobacco control, policy initiatives; quitting, litigation, pricing, and futures.
  • WHO Tobacco Free Initiative (TFI) - A WHO cabinet project created to focus international attention, resources and action on global tobacco use and problems caused by that use.
  • WhyQuit - Cold Turkey Quitting - A support group and education forum dedicated exclusively to the science and art of successful abrupt nicotine cessation.
  • "Crack" Nicotine in Cigarettes Varies Widely - New research measures amount of free-base nicotine in "the modern cigarette, a highly engineered nicotine delivery device". (July 28, 2003)
  • OncoLink: The Control and Manipulation of Nicotine and Cigarettes - 1994 news article. Kessler report on how the tobacco industry controls and manipulates nicotine in its product. (June 21, 1994)
  • ABC DayOne: Smoke Screen - Now-famous segment on nicotine manipulation in cigarettes. (February 28, 1994)

WOMEN's AND TOBACCO---REFERENCE

Tuesday, May 4, 2010

SMOKING AND HAIR LOSS-2

Smoking and Hair Loss


 

I guess it's silly for me to tell you that smoking is bad for your health. Who doesn't know? I was a heavy smoker for 13 years before quitting just a few years ago and I know it really takes some commitment to quit. So how are smoking and hair loss related to each another? The simple answer is, the more you smoke, the more hair you are going to lose.
No long time smokers want to smoke, it's just that they are already addicted to it and it has become a part of their life. Life is hectic and stressful and it so happens that smoking can help people feel that they are in control.



Why I Stopped Smoking




You most probably have heard of all the health problems associated with smoking. Then you should also know that lung cancer wasn't even considered a common disease back in those days where there were no tobacco? Now, lung cancer is the world's top killer besides heart attacks. It just so happens that these two top killers are directly associated by smoking.






Did you also know that a single stick of cigarette has over 4000 poisonous chemicals and your body is absorbing all of them with each smoke you inhale?






You are probably wondering why I am going off topic here since this page is supposed to be about smoking and hair loss. Shouldn't I be focusing on that topic instead?






Well, I just hope to share some experiences I had before as a smoker and how my health and hair benefited from stopping. So let's get straight to the point, as an ex-smoker and a hair loss survivor myself, there are 4 main reasons on why I quit smoking which are






I have seen a few good friends passed at a relatively young age due to smoking related illnesses.


I looked much older and my hair growth was slower even with treatments.


I am hoping to live a long, enjoyable and guilt-free life until I am old.


Many researches point that smoking and hair loss are directly related and I chose my hair over smoking. (I will explain below)






It's the truth, ask yourself this! How many people that you know who smokes look much older and losing their hair? Take some time to notice and you'll know what I mean.

Sunday, May 2, 2010

SMOKING AND WEIGHT LOSS-2

Gaining Weight after Quitting Tobacco

When smokers quit, it's not uncommon to gain a little weight. Excessive gain is avoidable though, and this section will help you with tips about how to keep your weight under control as you go through the process of quitting tobacco.

Life After Cigarettes

In her book, Life After Cigarettes, Dr. Cynthia Pomerleau explores the unique issues that face women when they want to quit smoking.

Two Years Smoke-Free

Weight gain often goes hand-in-hand with smoking cessation. Learning to let go enough to love ourselves even when we gain a few quit-related pounds is a part of the recovery process for many of us, and is poignantly reflected in this quit story from About.com Smoking Cessation support forum member, Dee.

Quitting Smoking and Weight Gain - 

Managing Weight Gain When

For most of us, quitting smoking and weight gain go hand-in-hand. With some attention toward a healthy diet and a kitchen stocked with nutritious snacks however, you can manage nicotine withdrawal and beyond without gaining a lot of weight.

Smoking Cessation and Weight Gain

Learn how smoking affects metabolism and what you can do to minimize weight gain due to smoking cessation.

Smoking and Metabolism

The act of smoking increases a person's metabolic rate by forcing the heart to beat faster. When a cigarette is inhaled, the smoker's heart may beat 10 to 20 times more per minute for a period of time.

Weight Gain When You Quit Smoking -

Questions and Answers

Let's take a look at some of the commonly asked questions and answers regarding weight gain due to smoking cessation.

Why do People Gain Weight 

When They Quit Smoking?

Most people experience a small amount of weight gain when they quit smoking. This is due to metabolic changes our bodies go through when we quit. A gain of 5 to 10 pounds is normal.

What are the Health Risks of 

Weight Gain When I Quit Smoking?

If I quit smoking and gain weight, won't that be just as dangerous to my health as smoking is?

Why do I Want to Snack So

Much When I Quit Smoking?

I just quit smoking and I want to eat all of the time! It's frustrating and yet I can't seem to stop. Why does this happen and what can I do to avoid gaining a lot of weight?

Will Quit Aids Help Me Avoid 

Weight Gain When I Quit Smoking?

I'm so afraid I'll gain weight when I quit smoking. I've heard that Zyban or Wellbutrin will help me avoid weight gain. Is this true?

What Else Can I Do to Minimize

Weight Gain When I Quit Smoking?

I'm trying to be careful to eat a healthy diet. I've cut out a lot of junk foods and am eating more fruits and vegetables. What else can I do to minimize weight gain after I quit smoking?

The Chubster

Weight gain doesn't have to happen when one quits. I believe we have used smoking for so much emotional repression, that food just sort of takes the place of the fumes in filling the void.

Maia's Thoughts on Weight Loss

at Six Months Smoke Free

"Quitting smoking will create such amazing change in the rest of your life. It is not always an easy path, but it is SO worth it. I celebrated my 6 month milestone yesterday, and I can promise that I will NEVER go back to smoking."

10 Reasons it's Hard to Lose Weight

From About Guide to Exercise, Paige Waehner: "The idea behind weight loss is simple--burn more calories than you eat. This can be accomplished by replacing a couple of sodas with water and adding 20 minutes of walking each day. Sounds simple...and it is. If it's that simple, why can't we seem to do it?"

10 Tips to Control Portions

Healthy eating will help you avoid weight gain when you quit smoking. A well-balanced diet with plenty of water will also help to minimize the discomforts of nicotine withdrawal. Enjoy the foods you love, but don't overdo. These tips for controlling portion size come from About.com Guide to Weight Loss, Jennifer Scott.

Intuitive Eating

From About.com Guide to Alternative Medicine, Cathy Wong, N.D.: "The SAD diet (standard American diet) really is sad. Most of us consume so much damaged fat, toxic chemicals, sugar, and processed, unhealthy foods that we have lost touch with what our bodies really need."

15 Weight Loss Facts

Weight Loss Guide, Jennifer R. Scott shares 15 tips to help you get your weight loss program off to a good start.

The Top 10 Dieting Myths

From About.com Guide to Weight Loss, Jennifer R. Scott: "We've all heard them ... and, unfortunately, believed a few of them. From calorie counting to fending off fat, these are the 10 most common dieting myths ... and the true facts that will set the record straight."

The Top 50 Foods for Fat Fighters

Are you trying to lose some weight? About.com Guide to Weight Loss, Jennifer R. Scott has come up with this list of 50 low fat foods to stock your kitchen with.

Drinking Water to Maintain Good Health

From About.com Guide To Nutrition, Shereen Jegtvig: "Our bodies are estimated to be about 60 to 70% water. Blood is mostly water, and our muscles, lungs, and brain all contain a lot of water. Water is needed to regulate body temperature and to provide the means for nutrients to travel to all our organs."

Weight Control and Diet

In-depth report on weight control and diet from A.D.A.M.

Explore the USDA Food Pyramid

From About.com Guide to Nutrition, Shereen Jegtvig: "Do you know which food groups make up the USDA food pyramid? Learn about the different food groups and what the best choices are for a healthy diet. Compare the USDA food pyramid to alternative food pyramids designed by leading universities."

Why You Need Cardio Exercise

People who quit smoking often become much more aware and interested in improving their health in general. Attention to your diet and daily exercise will help to reinforce your quit program.

Saturday, May 1, 2010

RESEARCH STUDY-1

A Research Study In Saint louis University, America
Cigarette Smoking And Weight Loss In Nursing Home Residents
By



Margaret-Mary G. Wilson, MD,MRCP 
Assistant Professor
Division of Geriatric Medicine,
Saint Louis University
Shahnaz Habib MBBS,
Clinical research assistant
Division of Geriatric Medicine,
Saint Louis University
Carolyn Philpot CGNP
Clinical Nurse Practitioner
Division of Geriatric Medicine,
Saint Louis University


OBJECTIVE:

To evaluate body weight trends of elderly smokers following admission into a Long Term Care Facility.

STUDY DESIGN AND POPULATION:

Cross-sectional survey of 88 nursing home residents with six month follow-up.

MAIN OUTCOME MEASURES:

Fifty-one of 88 residents were included in the study. Body weight, height, body mass index (BMI) and serum albumin were documented on admission into the nursing home. Data collection was repeated at monthly intervals over a six-month period.
RESULTS: The study population comprised 17(8M, 9F) smokers and 34(19M, 15F) non-smokers. Smokers had a lower body mass index on admission compared with non-smokers (24.2"3 and 27.4"9 respectively; p=0.04; Odds ratio [95% CI] for smokers versus non-smokers = 1.629 [0.498 to 5.32] ).Twelve (71%) smokers and 20 (59%) non-smokers gained weight (p=0.2). Four (24%) smokers and 12 (35%) non-smokers lost weight (p=0.3). Smokers who lost weight did so at a faster rate than non-smokers (13.3 "3.8 lbs and 7.8"2.4 lbs respectively over six months; p=0.02). Similarly, weight gain occurred at a slower rate in smokers compared with non-smokers (5.6"1.3lbs and 8.2lbs respectively over six months; p=0.004)

CONCLUSIONS:

Weight loss in cigarette smokers may occur at a more rapid in residents who smoke compared with non-smokers. Similarly, weight gain occurs at a slower rate in smokers. Smoking cessation should be encouraged as a critical adjunct to nutritional intervention in nursing home residents with nicotine dependence and weight problems.

Introduction

Intensive public health education has led to a decline in cigarette smoking over the past four decades. Increasingly, organizations and institutions are adopting non-smoking policies 1,2. Within long-term care (LTC), residents' rights to autonomy and self-determination preclude the enforcement of mandatory non-smoking policies 3. Epidemiological studies show that cigarette smoking is associated with progressive weight loss 4,5,6. However, although weight loss is an index of poor outcomes and increased mortality in nursing home residents, smoking cessation strategies are excluded from most nutritional and weight management LTC pathways 7,8. 9,10.
Our study was designed to examine the relationship between cigarette smoking and body weight of residents admitted to a long-term care facility over a six-month period. Non- smokers were compared with smokers.

Methods

The study was conducted in a long-term care geriatric facility affiliated with Saint Louis University. All residents of the facility were screened for the study. Exclusion criteria included congestive cardiac failure, malabsorption syndrome, chronic diarrhea, chronic obstructive airway disease, cor pulmonale, liver cirrhosis, or chronic renal failure. Residents with a Mini-mental State Examination score < 18 or a Geriatric Depression score > were also excluded 11,12. Enteral tube feeding and life expectancy less than six months were additional exclusion criteria.
Data collated included admission weight and monthly weights for six months following admission into the facility. The height and body mass index (BMI) on admission and monthly thereafter for six months were also obtained. Serum albumin levels within one month of admission and within one month of termination of the study were obtained. Residents were identified as smokers or non-smokers. Smokers were defined as residents who had smoked 10 cigarettes daily for at least ten years. Non-smokers were defined as residents who had not smoked any cigarettes over the preceding ten years. Residents who fell into neither category were excluded from the study. Data obtained from non-smokers were compared with data obtained from smokers. Significant differences between groups was evaluated using Sato's method to determine odds ratios (OR) and 95% confidence intervals (CI) and the Student's t-test with two-tailed tests of significance for continuous variables 13. A p value of less than 0.05 was considered significant. Informed consent was obtained from all subjects. The study was approved by the Institution Review Board of the Saint Louis University and the Executive Board of the Long Term Care facility.

Results

Eighty-eight residents were screened for the study. Fifty-one residents were eligible for inclusion, comprising 17 (8M, 9F) residents who smoked and 34 (19M, 15F) residents who were non-smokers. Eight (7M, 1F) smokers were admitted with body mass indices (BMI) less than 22, compared with 12 (7M, 5F) non-smokers (OR [95% CI] for smokers versus non-smokers = 1.629[0.498 to 5.32] ).
Table 1 shows the admission data for both smokers and non-smokers.
Fig 1 shows the trend of weight change over the six-month study period among smokers and non-smokers. Among the subset of residents that gained weight the mean weight gain among smokers was 5.6 "1.3lbs compared with 8.2"2.4lbs among non-smokers (p=0.004). Among the subset of residents that lost weight over the study period, the mean weight lost among smokers was 13.3"3.8lbs compared with 7.8"2.4lbs among non-smokers (p=0.02).

Discussion

Approximately 25% of nursing home residents smoke cigarettes 10, 14. Available evidence indicates that smoking cessation strategies are less successful within the long-term care setting. Studies show that adults who continue to smoke into late life are less likely to cease smoking out of concern for long-term health effects. Some older smokers erroneously believe that the passage of time has proven that they are no longer susceptible to the adverse health consequences of smoking. Likewise, older adults who suffer from smoking related illness often consider the damage permanent and irreversible and are therefore difficult to convince of the benefits of smoking cessation 15. Within the nursing home environment, low levels of perceived self-efficacy, the presence of other smokers and the reluctance of some health professionals to aggressively educate residents regarding the dangers of smoking pose additional obstacles to smoking cessation 16.
Currently, in most long-term care facilities in the United States, the institutional smoking policy is driven mainly by fire and safety concerns 17,18. Thus, residents are more likely to perceive smoking cessation policies as intrusive legislation rather than as an integral component of effective health maintenance. Development of more comprehensive smoking policies that highlight specific adverse health effects relevant to nursing home residents may be more successful in encouraging smoking cessation.
Body weight is a critical parameter of care and outcomes determinant within the nursing home setting. Convincing evidence indicates increased mortality in long term care residents with weight loss 19,20,21. Our data showed that smokers admitted into long term care had a BMI compared with non-smokers possibly as a result of the long-term effect of smoking on suppressing weight gain 5,8,22. In addition, although the prevalence of weight loss was not significantly different between smokers and non-smokers, smokers who lost weight in the nursing home, did so at a faster rate than non-smokers (Fig 1). Our study also showed that nursing home residents who smoked gained weight at a slower rate, compared with their non-smoking counterparts. It is conceivable that negative effects of smoking on food intake, such as anorexia and reduced olfactory and gustatory receptor sensitivity, may have a synergistic effect in the presence of other adverse nutritional risk factors, thereby accelerating weight loss 23,24,25, 26.


Cytokine-mediated weight loss is an attractive hypothesis to explain smoking related weight loss. However, available data is controversial. Cancer related cachexia is driven by increased elaboration of pro-inflammatory cytokines. The resultant metabolic abnormalities have been thought to account for the failure of conventional nutritional supplementation to maintain weight in affected cancer patients 27. Similar studies in smokers have failed to reveal a consistent alteration in cytokine levels 28,29. However, evidence indicates that smoking reduces baseline levels of soluble IL-1 receptor antagonist serum levels thereby resulting in reduced antagonism of pro-inflammatory interleukins 30. Weight loss in smokers may therefore result from a dual mechanism involving increased catabolism and reduced energy consumption.

Applications

These findings justify a more aggressive approach to nutritional support in smokers with low body weight or significant weight loss. Effective strategies include the administration of fortified meals and frequent nutritional supplementation with energy dense food supplements. Additionally, flavor-enhanced foods may be effective in increasing energy intake in older smokers as enhanced gustatory stimulation may combat the hypoageusia associated with both smoking and aging 31.
In smokers who continue to lose weight despite aggressive nutritional supplementation, orexigenic agents, such as megesterol acetate and dronabinol, may be helpful. Recent evidence indicates that megesterol acetate may enhance weight gain in nursing home residents. However, the absence of relevant data mandates cautious use of megesterol in smokers to avoid the possibility of a synergistic or additive increase in the risk of thrombo-embolic events. Dronabinol (delta-9-tetrahydrocannabinol) is the active ingredient of Cannabis sativa, approved for use by the Food and Drug Administration (FDA) as an orexigenic agent in Acquired Immune Deficiency Syndrome (AIDS). Recent evidence indicates that Dronabinol induces weight gain in older persons with dementia. However, it remains unclear whether weight gain in such patients is due to a direct orexigenic effect or a reduction in physical energy expenditure. Further research is needed to determine the precise role of Dronabinol as an orexigenic agent in older persons 32,33,34.


Effective weight loss intervention programs in long term care must incorporate parallel smoking cessation strategies. Clinical Practice Guidelines, such as those issued by the United States Department of Health and Human Services offer practical templates for such strategies 35,36, 37. In addition, emphasis should be placed on the immediate benefits of discontinuing smoking, such as enhanced taste, increased appetite, weight gain and an increased feeling of well-being. Residents with weight loss who opt to participate in a smoking cessation program may benefit from a structured support group directed toward both smoking cessation and weight maintenance.
The role of medication in LTC residents with weight loss is unclear. Nicotine replacement therapy may not be appropriate, as animal studies have shown that nicotine administration reduces food consumption and decreases body weight 38. Data in humans is lacking. However, residents who lose weight on nicotine replacement therapy may benefit from a trial of Bupropion in the absence of a history of seizures or co-existent antidepressant therapy.


Limitations of this study include lack body weight measurements prior to admission, small sample size and the imbalance in numbers between smokers and non-smokers. Larger prospective studies may prove helpful.

Conclusion

Smokers in long-term care facilities lost weight more rapidly than non-smokers. Similarly, weight was regained more slowly in smokers. Long term care health professionals must be cognizant of the role of smoking in perpetuating weight loss. Interdisciplinary programs that integrate nutritional support and smoking cessation strategies should be an integral component of resident care in LTC facilities that permit smoking. 
Acknowledgements: The authors gratefully acknowledge the valuable editorial assistance of Janice D. Hicks.

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