Showing papers by "Frank E. Speizer published in 1983"

Cigarette smoking, relative weight, and menopause

Abstract: To examine the interrelationships of cigarette smoking, relative weight, and the occurrence of natural menopause, the authors prospectively evaluated the experience of 66,663 female US registered nurses who were premenopausal in 1976. Over a two-year period, 5004 women became post-menopausal. Current smokers were more likely than past or never smokers to develop menopause, although the effects of smoking diminished with age. The rate ratios of menopause for current smokers vs. never smokers (with 95% confidence limits) for women aged 30-39, 40-44, 45-49, and 50-55 years were 1.90 (1.10-3.28), 2.16 (1.73-2.69), 1.53 (1.41-1.67), and 1.20 (1.12-1.28). These rate ratios were not appreciably affected by adjustment for relative weight. Median ages at menopause were 52.4 for never smokers and 51.9, 51.0, 50.7, and 50.4 years for women who currently smoked 1-14, 15-24, 25-34, and 35 or more cigarettes per day. A crude linear relationship between relative weight and occurrence of menopause was observed. Comparing the leanest and heaviest quintiles, rate ratios for menopause among women aged 30-39, 40-44, 45-49, and 50-55 years were 1.42 (0.74-2.75), 1.26 (0.95-1.69), 1.25 (1.13-1.41) and 1.08 (0.99-1.19). The effect of relative weight was in part explained by the tendency of current smokers to weigh less than nonsmokers. After adjustment for current cigarette consumption a weak linear relationship between relative weight and menopause remained among women who smoked, although no such association was seen among nonsmokers.

The relevance in adults of air-flow obstruction, but not of mucus hypersecretion, to mortality from chronic lung disease. Results from 20 years of prospective observation.

Abstract: From 1954 to 1961, pulmonary function was assessed in 2,718 British men by forced expiratory maneuvers, and mucus hypersecretion and smoking habits were assessed by questionnaires. In 20 to 25 yr of follow-up, 104 men (all of whom had smoked) died of chronic obstructive pulmonary disease (COPD). The risk of death from COPD was strongly correlated with the initial degree of air-flow obstruction. Among men with similar initial air-flow obstruction, however, age-specific COPD death rates were not significantly related to initial mucus hypersecretion, supporting the concept that air-flow obstruction and mucus hypersecretion are largely independent disease processes. A moderate relationship existed between initial mucus hypersecretion and subsequent lung cancer mortality, but it is not known whether this was due solely to a common correlation of both conditions with the effective degree of exposure of the large bronchi to causative factors such as tobacco smoke.

Longitudinal study of the effects of maternal smoking on pulmonary function in children.

Abstract: We investigated the effects of maternal cigarette smoking on pulmonary function in a cohort of children and adolescents observed prospectively for seven years. A multivariate analysis revealed that after correction for previous forced expiratory volume in one second (FEV1), age, height, change in height, and cigarette smoking in the child, or adolescent, maternal cigarette smoking significantly lowered the expected average annual increase in FEV1 (P = 0.015). On the basis of this analysis, it is estimated that if two children have the same initial FEV1, age, height, increase in height, and personal cigarette-smoking history, but the mother of one has smoked throughout the child's life whereas the mother of the other has not, the difference in the change in FEV1 over time in the exposed child, as compared with that in the unexposed child, will be approximately 28, 51, and 101 ml after one, two, and five years, respectively, or a reduction of 10.7, 9.5, and 7.0 per cent, respectively, in the expected increase. These results suggest that passive exposure to maternal cigarette smoke may have important effects on the development of pulmonary function in children.

Distribution of forced vital capacity and forced expiratory volume in one second in children 6 to 11 years of age.

Abstract: We analyzed 44,664 annual measurements of forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) in 12,258 white children and 1,041 black children between 6 and 11 yr of age in 6 communities. Sex- and race-specific lung function development is described for this sample of preadolescent children. For both races, girls have lower median values of FVC and FEV1 than do boys of the same height. However, for the same level of FVC, girls have a higher FEV1/FVC ratio. Blacks have median levels of lung function lower by approximately 13% than whites of the same sex and standing height. Regression analysis showed that height, race, and sex are the most important predictors of lung function. Lung function also increases with weight and age, but the effect of these two variables on predicted lung function is small. The residuals from the regression model, which describe the distribution of lung function values, follow a Gaussian distribution in the logarithmic scale. A simple model is presented...

Risk factors for childhood respiratory disease. The effect of host factors and home environmental exposures.

Abstract: Standardized respiratory disease questionnaires (ATS-DLD-78-C) were completed by the parents of 4,071 children 5 to 14 yr of age, and risk factors for respiratory symptoms were evaluated by logistic analysis. Younger age, male sex, and lower socioeconomic status (SES) were independent risk factors for most respiratory symptoms and illnesses. All respiratory outcomes were significantly more prevalent in children with a physician's diagnosis of asthma. Asthma was more prevalent in male (4.5%) than in female (2.6%) children, and the greater prevalence of most respiratory symptoms in males did not persist in children with the same asthma status. Children whose questionnaires were completed by their fathers were reported to have significantly fewer respiratory symptoms than children with mother-completed questionnaires. We postulate that fathers underreport symptoms for their children. A positive parental history of allergy or respiratory illness was an independent predictor of respiratory symptoms and illnesses in the children. Chest illness before 2 yr of age and chest illness in the past year showed a significant positive linear trend with the number of parental smokers, and these effects of passive smoking were confirmed in the logistic analysis. The use of gas cooking stoves, inversely associated with SES, was not an independent risk factor for any respiratory symptoms or illnesses.

The health effects of involuntary smoking.

Abstract: Involuntary smoking is defined as the exposure of nonsmokers to tobacco combustion products in the indoor environment. Involuntary smokers are exposed to a quantitatively smaller and qualitatively different smoke exposure than active smokers. Quantitation of exposure is particularly difficult in both physiologic and epidemiologic studies. Acute physiologic studies have documented minimal physiologic changes in healthy subjects. However, individuals with heart or lung disease may be differentially affected. A relatively large body of data relates parental (particularly maternal) cigarette smoking to the occurrence of both acute respiratory illnesses and chronic respiratory symptoms in children. The effect seems to be greatest early in life and cannot be separated from in utero exposure. Data linking parental smoking to lower levels of pulmonary function are all cross-sectional and less conclusive. What is apparent is that the magnitude of the direct effect of passive smoke exposure is likely to be relatively small (from 1 to 5% reduction in maximally obtained lung function level in exposed children). Data on adults are insufficient to allow for a quantitative estimate. The important effects of passive smoke exposure in childhood are twofold. The slight reduction in pulmonary function level may predispose individuals to increased risks from environmental agents later in life. In addition, having a parent who smokes substantially increases the likelihood that a child will become a smoker. Finally, two studies have linked lung cancer in nonsmokers to exposure to spouses' cigarette smoke. Further research is needed to confirm these findings. Involuntary smoking may have important health effects, either direct or indirect, which deserve further study.

Spirometry in children. Methodology for obtaining optimal results for clinical and epidemiologic studies.

Abstract: Spirometric methodology for clinical and epidemiologic use in children was evaluated in 123 third and fourth grade school children 8 and 9 yr of age. They performed spirometric testing in the middle of October and again in the middle of November 1979. The results demonstrated that spirometric standards developed from adult studies can be applied to children. In addition, a minimum of 5 and a maximum of 8 maneuvers should be attempted to provide at least 3 acceptable tracings. In children, the allowable difference between the 2 best acceptable tracings of 5% or 100 ml, whichever is greater, was demonstrated to be a reasonable guideline. The results are equally reproducible when the maximal values, the mean of the 2 or 3 best values, or the values from the "best sum" tracing (the tracing with the highest value for the sum of the FVC and FEV1) are used.

Assessment of the epidemiological data relating lung cancer to air pollution.

Abstract: The epidemiological data linking air pollution and lung cancer are derived from statistical associations concerning rates of cancer among urban and rural residents, migrant studies and studies of occupational groups exposed to effluents from fossil fuel combinations. Few, if any of these studies, are adequately adjusted for both relatively simple measures of cigarette smoking or the potentially more subtle effects of the duration of smoking. Because urbanization and industrial sources of air pollution correspond chronologically with the major increases in cigarette smoking, it is not likely that the specific attributable risk to each component can be adequately assessed. Interactions between cigarette smoking and specific air pollutants, similar to those seen between cigarette smoking and asbestos and or radiation, may be occurring. Considering the various estimates made over the last 25 years, it is likely that the effect of air pollution on lung cancer is something greater than zero; however, it is unlikely that the estimate exceeds 2% of all lung cancers or 5/100,000 cases in urban males. Thus, the effect on all cancers is likely to be less than 1% of all cases.

Health effects of air pollution due to coal combustion in the Chestnut Ridge Region of Pennsylvania: results of cross-sectional analysis in adults.

Abstract: Respiratory questionnaires (ATS-DLD-78) were administered to 5557 adult women in a rural area of Western Pennsylvania to evaluate the health effects of air pollution resulting from coal combustion. Air pollution data were derived from 17 air quality monitor sites and stratified to define low, medium, and high pollution areas. The means of 4 yr (1975-1978) annual averages for sulfur dioxide in each strata were 62, 66, and 99 micrograms/m3, respectively. Total suspended particulates were not tested as a risk factor because they reflected air pollution from sources other than coal combustion (e.g., agricultural, road dusts). Risks of respiratory symptoms were evaluated in a multiple logistic model that adjusted for several potential confounding factors. The risk of "wheeze most days or nights" in nonsmokers residing in the high and medium pollution areas was 1.58 and 1.26 (P = .02), respectively, relative to residents in the low pollution area. In the subset of residents who had lived in the same location for at least 5 yr, relative risks increased to 1.95 and 1.40 (P less than .01), respectively. An increased risk of grade 3 dyspnea in nonsmokers was associated with sulfur dioxide but did not achieve statistical significance (P = .11), and there was no association of cough or phlegm and air pollution in nonsmokers. Cigarette smoking characteristics were the major determinant of respiratory symptoms in smokers, and no independent association of air pollution was found. This study suggests that wheezing may be associated with ambient exposure to sulfur dioxide in nonsmokers, but no effect of sulfur dioxide on cigarette smokers was observed.(ABSTRACT TRUNCATED AT 250 WORDS)

The Health Effects of Automobile Exhaust. VI. Relationship of Respiratory Symptoms and Pulmonary Function in Tunnel and Turnpike Workers

Abstract: To examine the effect of automobile exhaust on respiratory symptoms and pulmonary function, the authors studied 175 tunnel and turnpike workers employed by the Massachusetts Turnpike Authority on two occasions 3 yr apart beginning in 1972. A standard respiratory symptom and illness questionnaire was administered, spirometry was performed, and proximal hair lead and blood lead content were measured as biologic indices of automobile exhaust exposure. One hundred nine (63%) workers were current cigarette smokers, 41 (23%) were exsmokers, and 24 (14%) had never smoked. Smoking was strongly related to respiratory symptoms of cough (P < .001) and phlegm production (P < .001), but not to wheezing (P = .41), breathlessness (P = .14), bronchial asthma (P = .13), or frequent chest colds (P = .14). When workers were stratified by smoking status, no effect could be seen between high automobile exhaust exposure as measured by a variety of parameters and all of the above respiratory symptoms and illnesses. The...

The Six-City Study: Examples of Problems in Analysis of the Data

Abstract: This paper presents some of the results from cross-sectional analyses and studies during air pollution alerts obtained as a part of the Six-City Study, a longitudinal study of the respiratory effects of air pollution. These analyses illustrate some of the limitations and uncertainties of epidemiologic studies. For example, an earlier report noted increased respiratory illness rates for children living in homes where gas was used for cooking. A later analysis did not confirm this. Reasons for this are explored by using different criteria and variables to be controlled for. The results illustrate that the strength of the association between cooking fuel and illness was sensitive to the definitions of the variables and the number of subjects and city cohorts. Similar examples are presented for illness rates for four respiratory diseases: asthma, bronchitis, illness before age 2 and illness last winter. These examples of cross-sectional analyses emphasize the ambiguities of studies of possible health effects of air pollution exposures close to the present ambient air quality standards.

Validation of a dietary questionnairewith plasma carotenoid and a-tocopherol levels13

Abstract: We assessed the validity ofa self-administered semiquantitative food frequency questionnaire by comparing carotene and vitamin E intake scores derived from this form with plasma carotenoid and es-tocopherol levels among a group of 59 men and women. The simple correlation between carotene intake and plasma carotenoid was 0.29 (p = 0.02) and the partial correlation was 0.35 (p = 0.005) after adjustment for age, sex, total caloric intake, and plasma cholesterol and triglycerides. The simple correlation between vitamin E intake and plasma a- tocopherol was 0. 12 (p = 0. 19). However, adjustment for total caloric intake and plasma lipids each substantially increased this association so that the partial correlation adjusting simultane- ously for caloric intake, plasma lipids, age, and sex was 0.34 (p = 0.006). As expected on the basis of previous randomized trials, the correlation between preformed vitamin A intake and plasma retinol was weak and not statistically significant. These data support the utility of self- administered food frequency questionnaires for use in epidemiological studies. In addition, they illustrate the importance ofadjusting blood a-tocopherol levels for lipid concentrations when the former are used as surrogates for vitamin E intake. Am J Cliii Nutr 1983:38:631-639.