Prior to September 11, 2001, I along with many other Americans viewed the potential
of terrorist attacks as something that occurred "over there" and "not here." On that
day, we began to understand that we are all part of a global community where events
in one part of the world impact so many others. And, that we – all citizens of the
world – share problems and plagues, as well as the potential for solutions and health.
Our differences are, perhaps, outweighed by our similarities. Clearly, the impact
of tobacco induced disease has been an equal opportunity visitor to all countries
of the globe. The current issue of this journal reflects that global concern.
In this issue of the journal there are seven excellent contributions to the global
task of addressing the problem of tobacco addiction and its health consequences. They
are from all corners of the world – Canada (two contributions), Sweden, the United
Kingdom, Germany, the United States and Japan – and are representative of the Society
for the Prevention of Tobacco Induced Diseases (PTID) membership. They also illustrate
the broad range of interest, topics, and research methods needed to examine the issue
of tobacco addiction, with studies ranging from behavioral interventions to basic
science examinations.
Drs. Chan and Koren from Canada address the many concerns associated with smoking
during pregnancy, including miscarriage, preterm delivery and stillbirth. In this
extensive review of published studies – 122 are reviewed – the results reveal greater
nicotine metabolism in pregnant individuals who continue to smoke during pregnancy.
The studies support current guidelines from several health organizations, which uniformly
recommend that Nicotine Replacement Therapy should be considered if non-pharmacological
therapies have been unsuccessful. The authors conclude with a call for further studies
on the safety and effectiveness of Nicotine Replacement Therapy and bupropion use
during pregnancy. However, they stress that given the current research and guidelines,
pharmacological cessation aids should be considered if non-pharmacological therapies
have not been effective.
Drs. Johansson, Halling, and the LinQuest Study Group from Sweden point out that smoking
prevalence and smoking behaviours have changed in society, and an increased awareness
of the importance of protecting children from environmental tobacco smoke (ETS) is
reported. Their study aims to determine if smoking prevalence and smoking behaviours
were influenced by parenthood, and if differences in health-related quality of life
differed between smoking and non-smoking parents. The researchers find that parenthood
did not seem to be associated with lower smoking prevalence. Logistic regression models
showed that smoking prevalence was significantly associated with education, gender
and mental health. Smoking behaviour, as well as attitudes toward passive smoking,
seemed to be influenced by parenthood. Johansson and colleagues conclude that smoking
behaviour, but not smoking prevalence, seems to be influenced by parenthood, and they
stress the importance of commonly-used precautions when children's risk for ETS exposure
is estimated.
Drs. Unal, Critchley, and Capewell from the United Kingdom explore how much of the
coronary heart disease (CHD) mortality fall in England and Wales can be attributed
to changes in smoking prevalence. Their study uses a previously validated cell-based
IMPACT CHD mortality model to estimate the deaths prevented or postponed by changes
in population smoking prevalence in England and Wales between 1981 and 2000. They
report that large declines in smoking prevalence accounted for 29,460 fewer CHD deaths
in England and Wales in 2000 compared with 1981. This emphasizes the importance of
employing a national strategy with comprehensive tobacco control programs to further
reduce smoking. It would be prudent for those in other countries to consider these
recommendations as well.
There are four basic science contributions in this issue. Dr. Meisel and colleagues
from Germany address the significant dose-effect relationship between the exposure
to tobacco smoke and the extent of periodontal disease, assessed as attachment loss
and tooth loss. They provide support for the hypothesis that subjects who smoke and
who bear genetic variants of polymorphically expressed phenotypes are at an increased
risk of periodontitis. This may occur through the influence of smoking-related impairment
on defense mechanisms, rather than on the pathogenic pathways.
Drs. Lam and colleagues from Canada demonstrate the direct in vitro release of the
free radical nitric oxide (•NO) from extracts and components of smokeless tobacco,
in phosphate buffered saline and human saliva using electron spin resonance and chemiluminescence
detection. Their findings suggest that tobacco xenobiotics represent as yet unrecognized
sources of •NO in the body.
Dr. Chowdhury from the United States addresses the critical issue of cigarette smoking
as a known major risk factor for pancreatic cancer and pancreatitis. He systematically
studied the pathogenesis of pancreatitis and pancreatic cancer using a rodent model.
His results suggest that alterations in metabolic, hormonal and pathologic parameters
following nicotine treatment appear consistent with diagnostic criteria of human pancreatitis.
Thus, it is likely that rats could be considered as a potential animal model to study
the pathogenesis of pancreatitis.
Finally Drs. Aoshiba and Nagai from Japan review and discuss oxidative stress, cell
death, and other damage to alveolar epithelial cells as induced by cigarette smoke.
These excellent articles provide the reader with an opportunity to explore issues
that arise during the global task of improving the world health. We welcome letters
to the editor regarding these contributions as yet another method to further our knowledge
of these important lines of inquiry.
Daniel R. Longo, ScD
Editor
Columbia, Missouri, US
Competing interests
The authors declare that they have no competing interests.