JAMA : the journal of the American Medical Association
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Comparative Study
Smoke exposure in pipe and cigar smokers. Serum thiocyanate measures.
Pipe or cigar smoking traditionally has been considered a less risky alternative to cigarette smoking. Some surveys and experimental studies have suggested, however, that former cigarette smokers who switch to cigars and/or pipe (CP) are more likely to inhale then CP users who never smoked cigarettes; but this relationship has not been consistently noted. To clarify smoke-exposure levels from CP smoking, smoking histories and serum thiocyanate (SCN) levels were studied in 9,106 adults aged 25 to 74 years in population-based surveys of seven upper Midwestern communities. ⋯ However, the number of pipe bowls or cigars smoked per day was also significantly related to SCN levels, and this could account for much of the association between SCN and previous cigarette smoking status. Individuals currently smoking four or more pipe bowls or four or more cigars per day had an elevated smoke exposure equivalent to about ten cigarettes per day, whether or not they previously smoked cigarettes. Because of these findings and because former cigarette smokers were more likely to report heavy CP usage, cigarette smokers should be advised to quit rather than to switch to a pipe or cigar.
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Life tables in which the probability of dying of injuries in the United States from 1985 to 1999 are determined may be useful for clinicians in counseling persons concerning the risk of fatal injuries. Overall, more than 1% of persons aged 10 to 34 years in 1985 probably will die of injuries by the year 2000. For white males aged 5 to 29 years in 1985, white females aged 5 to 19 years in 1985, and black males aged 5 to 24 years in 1985, over half of all the estimated deaths during the next 15 years will be probably due to injuries.
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High rates of hepatitis B virus infection and primary hepatocellular carcinoma are present among Alaskan Natives. To determine if primary hepatocellular carcinoma could be detected at an early surgically resectable stage, serological screening for elevated alpha-fetoprotein levels was done semiannually among Alaskan Natives infected with hepatitis B virus. ⋯ Six of these nine persons were asymptomatic for primary hepatocellular carcinoma and four had small tumors (less than 6 cm) that were surgically resected. After surgery, the alpha-fetoprotein levels in all four patients fell to normal and have remained normal after a follow-up of four to 20 months (median, ten months). alpha-Fetoprotein screening proved to be an effective approach in this population in detecting primary hepatocellular carcinoma at a potentially curable stage and should be considered in other individuals or populations infected with hepatitis B virus.