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Background: To date, cigarette smoking is the most consistent risk factor for pancreatic cancer. We prospectively examined the role of active cigarette smoking, smoking cessation, and passive smoking as determinants for pancreatic cancer. Methods: The Netherlands Cohort Study consisted of 120,852 men and women who completed a baseline questionnaire in 1986. After 16.3 years of follow-up, 520 incident pancreatic cancer cases were available for analysis. A case-cohort approach was employed using the person-years of follow-up of a random subcohort (n = 5,000), which was chosen immediately after baseline. Results: Compared with never cigarette smokers, both former and current cigarette smokers had an increased pancreatic cancer risk [multivariable-adjusted hazard rate ratio (HR), 1.34; 95% confidence interval (CI), 1.02-1.75 and HR, 1.82; 95% CI, 1.40-2.38, respectively]. We observed an increased pancreatic cancer risk per increment of 10 years of smoking (HR, 1.15; 95% CI, 1.08-1.22) and an HR of 1.08 per increment of 10 cigarettes/d (95% CI, 0.98-1.19). Quitting smoking gradually reduced pancreatic cancer risk and approached unity after ≥20 years of quitting. No association was observed for passive smoking exposure and pancreatic cancer risk in women; in men, this association was not investigated because >90% of the men were ever smokers. Conclusions: Overall, our findings confirmed that cigarette smoking is an important risk factor for pancreatic cancer, whereas quitting smoking reduced risk. No association was observed between passive smoking exposure and pancreatic cancer risk in women. Impact: Quitting smoking would benefit the burden on pancreatic cancer incidence. ©2010 AACR.

Smoking is a highly addictive behaviour, often initiated during adolescence. It is suggested that smoking is associated with behavioural and emotional problems. This study aims to assess the impact of psychosocial problems on smoking initiation and vice versa. Method: We obtained data on self-reported psychosocial problems and smoking of adolescents at the age of 13 years and 2 years later. The baseline questionnaire was completed by 1789 students. 68% of the baseline questionnaire could be linked to a questionnaire of the second measurement. Results: 15% smoked at baseline and 29% two years later. Respectively 8% and 9% had a clinical Externalizing problem score or a clinical Internalizing problem score at baseline, 14% had these problems two years later. Externalizing problems at baseline predicted the onset of smoking two years later. Internalizing problems only predicted smoking among girls. This association between psychosocial problems and smoking is most obvious for the onset of regularly smoking and less for the onset of experimenting. Reversibly smoking at baseline is only associated with the onset of externalizing problems two years later. Conclusion: Clinical Externalizing and Internalizing problems make the initiation of regular smoking more likely. The effects on experimental smoking are less obvious. © 2006 Elsevier Ltd. All rights reserved.

Objective. To establish smoking prevalence of fertile-aged women; before and during pregnancy, and 6 months after delivery. Design. Cross-sectional. Method. Yearly surveys by questionnaires handed out during 2001-2003 to mothers visiting a Well Baby Clinic with infants aged 0-6 months. Results. Out of a total of 14,540 questionnaires, 9,133 (63%) were completed and returned. Before pregnancy 25% of all the women concerned smoked, 6% stopped 6 months before getting pregnant; this percentage rose between 2001 (5%) and 2003 (7%). During pregnancy, 14% of the women smoked. This percentage was significantly lower in 2002 and 2003 (13%) compared to 16% in 2001. 11% smoked while pregnant (average 5 cigarettes daily), and 3% stopped some time during pregnancy. Of the mothers who quitted smoking before or during pregnancy, two thirds did so permanently. Nevertheless 15% of all women smoked during the first half year after delivery. This percentage was lowest in 2003 (14%) and highest in 2001 (17%). 28% of all mothers with infants aged 0-6 months had partners who smoked (daily 10 cigarettes average), these women were more likely to start smoking again (RR: 2). Conclusion. Minor positive changes were observed within the study period. A smoking partner contributed to smoking relapse after delivery.

A smoking prevention program was developed to prepare children in elementary school for secondary school. This study assessed the effects on smoking in secondary school. Methods: In 2002, 121 schools in The Netherlands were randomly assigned to the intervention or control group. The intervention group received 3 lessons in 5th grade of elementary school and a second 3 lessons in 6th grade. The control group received "usual care". Students completed 5 questionnaires: before and after the lessons in 5th and 6th grade and in the first class of secondary school. At baseline, 3173 students completed the questionnaire; 57% completed all questionnaires. Results: The program had limited effect at the end of elementary school. One year later in secondary school significant effects on behavioral determinants and smoking were found. The intervention group had a higher intention not to smoke (β= 0.13, 95% confidence interval = 0.01-0.24) and started to smoke less often than the control group (odds ratio = 0.59, 95% confidence interval = 0.35-0.99): smoking increased from 2.5% to 3.6% in the intervention group and from 3.2% to 6.5% in the control group. Girls showed the largest differences in smoking between intervention and control condition. Conclusions: A prevention program in elementary school seems to be effective in preventing smoking. © 2010 Elsevier Inc.

The objective of the study was to assess the prevalence of passive smoking in infancy. This was done by self-report questionnaires completed by parents who attended the well-baby clinic in the period February-May 1996. A total of 2720 questionnaires were spread among parents with babies between 1 and 14 months: smoking and non-smoking parents. The questionnaires contained questions on smoking habits, smoking at home, smoking in presence of the baby. A total of 1702 parents filled in and returned the questionnaire (63%); 24% of the mothers and 33% of their partners smoked. In 44% of the families, one or more persons smoked; 22% of the mothers and 26% of the partners smoked at home. In 39% of the families, one or both parents smoked at home; 42% of the babies were exposed to tobacco smoke in the living-room, 8% were exposed in the car, and 4% during feeding. In cases where only the mother smoked, 13% of the infants were exposed to tobacco smoke during feeding. In the families where only the partner smoked, the babies were predominantly exposed to smoke in the car (18%). If both parents smoked, the child was most frequently exposed to tobacco smoke in the living-room (73%). It can be concluded that health workers, nurses, pediatricians and family physicians should be advised to inform parents systematically of the harmful effects of passive smoking in infancy. If parents are unable or unwilling to stop smoking, it is important to advise them to refrain from smoking in the presence of the baby. Copyright (C) 2000 Elsevier Science Ireland Ltd. Chemicals/CAS: Tobacco Smoke Pollution

Background and Objective: To estimate the effects of reducing the prevalence of smoking in lower educated groups on educational differences in life expectancy. Methods: A dynamic Markov-type multistate transition model estimated the effects on life expectancy of two scenarios. A "maximum scenario" where educational differences in prevalence of smoking disappear immediately, and a "policy target-scenario" where difference in prevalence of smoking is halved over a 20-year period. The two scenarios were compared to a reference scenario, where smoking prevalences do not change. Five Dutch cohort studies, involving over 67,000 participants aged 20 to 90 years, provided relative mortality risks by educational level, and smoking habits were assessed using national data of more than 120,000 persons. Results: In the reference scenario, the difference in life expectancy at age 40 between highest and lowest educated groups was 5.1 years for men and 2.7 years for women. In the "maximum scenario" these differences were reduced to 3.6 years for men and 1.7 years for women (reduction ≈30%), and in the "policy target-scenario" differences were 4.7 years for men and 2.4 years for women (reduction ≈10%). Conclusion: Theoretically, educational differences in life expectancy would be reduced by 30% at maximum, if variations in smoking prevalence were eliminated completely. In practice, tobacco control policies that are targeted at the lower educated may reduce the differences in life expectancy by approximately 10%. © 2006 Elsevier Inc. All rights reserved.

Background. Narrative reviews have concluded that there is a small association between coffee consumption and an increased risk of urinary tract cancer, possibly due to confounding by smoking. No association for tea consumption has been indicated. This systematic review attempts to summarize and quantify these associations both unadjusted and adjusted for age, smoking and sex. Method. Thirty-four case-control and three follow-up studies were included in this systematic review. Summary odds ratios (OR) were calculated by meta-regression analyses. Results. The unadjusted summary OR indicated a small increased risk of urinary tract cancer for current coffee consumers versus non-drinkers. The adjusted summary OR were: 1.26 (95% CI : 1.09-1.46) for studies with only men, 1.08 (95% CI : 0.79-1.46) for studies with only women and 1.18 (95% CI : 1.01-1.38) for studies with men and women combined. Neither unadjusted nor adjusted summary OR provided evidence for a positive association between tea consumption and urinary tract cancer. Even though studies differed in methodology, the results were rather consistent. We did not perform dose-response analyses for coffee and tea consumption due to sparse data. Conclusions. In accordance with earlier reviews, we found that coffee consumption increases the risk of urinary tract cancer by approximately 20%. The consumption of tea seems not to be related to an increased risk of urinary tract cancer.

Background: Sudden infant death syndrome (SIDS) is the unexpected death of an infant that remains unexplained after a thorough investigation of the circumstances, family history, paediatric investigation and complete autopsy. In Western society, it is the leading cause of post-neonatal death below 1 year of age. In the Netherlands, the SIDS incidence is very low, which offers opportunities to assess the importance of old and new environmental risk factors. For this purpose, cases were collected through pathology departments and the working group on SIDS of the Dutch Paediatrician Foundation. A total of 142 cases were included; these occurred after the parental education on sleeping position (1987), restricted to the international age criteria and had no histological explanation. Age-matched healthy controls (N?=?2,841) came from a survey of the Netherlands Paediatric Surveillance Unit, completed between November 2002 and April 2003. A multivariate analysis was performed to determine the risk factors for SIDS, including sleeping position, antenatal maternal smoking, postnatal parental smoking, premature birth, gender, lack of breastfeeding and socio-economic status. Postnatal smoking was identified as an important environmental risk factor for SIDS (OR one parent?=?2.5 [1.2, 5.0]; both parents?=?5.77 [2.2, 15.5]; maternal?=?2.7 [1.0, 6.4]; paternal?=?2.4 [1.3, 4.5] ) as was prone sleeping (OR put prone to sleep?=?21.5 [10.6, 43.5]; turned prone during sleep?=?100 [46, 219]). Premature birth was also significantly associated with SIDS (OR?=?2.4 [1.2, 4.8]). Conclusion: Postnatal parental smoking is currently a major environmental risk factor for SIDS in the Netherlands together with the long-established risk of prone sleeping. © 2011 The Author(s).

Objective: Many studies have shown that poor health status and harmful heolth behaviour occur more frequently in deprived neighbourhoods. Most studies show modest associations between area level socioeconomic factors, the neighbourhood context, and health outcomes. However, estimates for the contextuol effects vary. It is unclear if this variation is attributable to differences in methodology. This study examines whether contextual neighbourhood differences in heolth outcomes really vary between cities or that differences in methodology may account for these differences. Design: Secondary onalysis of data from health interview surveys in seven large Dutch cities in the 1990s comprising 23 269 residents of 484 neighbourhoods, using multilevel logistic models. Setting: Generol population aged 16 and over. Main outcome measures: Self reported health, smoking of cigarettes. Main results: The socioeconomic context of neighbourhoods is associated with health outcomes in all large Dutch cities. The strength of the association varies between cities, but variation is much smaller in the age group 25-64. Furthermore, neighbourhoad differences vary in size between native and other residents. Contextual neighbourhaod differences are about two times larger for self reported health than for the smoking of cigarettes, but for native Dutch people they are of similar size. Conclusions: A comparatively large improvement in health may be gained in deprived neighbourhoods, because of the poorer health status to which the context of these neighbourhoods also contributes. Health promoting interventions should be aimed at the residents and at the context of deprived neighbourhoods, taking differences between ethnic groups and age groups into account.

Background: A number of epidemiological studies have shown that smoking is a risk factor for periodontal disease. Little is known about the relationship between smoking duration and alveolar bone loss. The purpose of this research was to describe the prevalence of alveolar bone loss according to smoking status in Norway. A dose-response model for duration of tobacco smoking on alveolar bone loss was then developed and discussed. Methods: The study population consisted of 812 individuals living in Norway aged 45 to 64 years old (248 current smokers, 245 former smokers and 319 non-smokers). Alveolar bone loss was measured on bite-wing radiographs. Simple descriptive statistics were used to describe the central tendency and variation in alveolar bone loss. Regression analyses were performed to study the relationship between smoking duration and alveolar bone loss. Results: Mean alveolar bone loss varied between 1.51 mm and 2.64 mm depending on smoking status and age. Mean alveolar bone loss was lowest in non-smokers and highest in current smokers. Given identical smoking status, the mean alveolar bone loss increased with increasing age except for the 2 oldest age groups of current smokers. Conclusions: Our results generate the hypothesis that the relationship between smoking duration and alveolar bone loss was "S-shaped." Assuming that alveolar bone loss is irreversible after smoking cessation, it could be hypothesized that there is a threshold period for tobacco smoking after which the accumulated effect of smoking becomes clinically observable. After a certain number of years of smoking, the effect on alveolar bone loss seems to level out. To test this hypothesis, the relationship between smoking duration and alveolar bone loss should be studied in a prospective study design.

Inverse associations between fruit and vegetable consumption and lung cancer risk have been consistently reported. However, identifying the specific fruits and vegetables associated with lung cancer is difficult because the food groups and foods evaluated have varied across studies. We analyzed fruit and vegetable groups using standardized exposure and covariate definitions in 8 prospective studies. We combined study-specific relative risks (RRs) using a random effects model. In the pooled database, 3,206 incident lung cancer cases occurred among 430,281 women and men followed for up to 6-16 years across studies. Controlling for smoking habits and other lung cancer risk factors, a 16-23% reduction in lung cancer risk was observed for quintiles 2 through 5 vs. the lowest quintile of consumption for total fruits (RR = 0.77; 95% CI = 0.67-0.87 for quintile 5; p-value, test for trend < 0.001) and for total fruits and vegetables (RR = 0.79; 95% CI = 0.69-0.90; p-value, test for trend = 0.001). For the same comparison, the association was weaker for total vegetable consumption (RR = 0.88; 95% CI = 0.78-1.00; p-value, test for trend = 0.12). Associations were similar between never, past, and current smokers. These results suggest that elevated fruit and vegetable consumption is associated with a modest reduction in lung cancer risk, which is mostly attributable to fruit, not vegetable, intake. However, we cannot rule out the possibility that our results are due to residual confounding by smoking. The primary focus for reducing lung cancer incidence should continue to be smoking prevention and cessation. © 2003 Wiley-Liss, Inc.

The objective of the evidence-based guidelines 'Asthma in children (ages 0-19)' for youth healthcare (CHC) is the prevention and reduction of asthma symptoms. The guidelines contain a lot of recommendations that apply to all disciplines in healthcare that deal with children. Primary prevention (preventing asthma): the main proven effective intervention is no smoking, neither passive nor active. Breastfeeding has a small protective effect. Starting at the first home visit at two weeks, the CHC nurse advises no smoking and to breastfeed. Secondary prevention (early detection): at all routine check-ups, the professional at CHC should inquire about signs of dyspnoea and wheezing. Patients suspected of having asthma should be referred to the GP. Tertiary prevention (reducing symptoms in children with asthma): the main advice is no smoking (neither passive nor active) and to follow the advice of the treating physician.

Objective: To examine the association between alcohol consumption, cigarette smoking, and endometrial cancer. Methods: In 1986, the Netherlands Cohort Study was initiated. A self-administered questionnaire on dietary habits and other cancer risk factors was completed by 62,573 women. Follow-up for cancer was established by record linkage to the Netherlands Cancer Registry. Results: After 11.3-years of follow-up, 280 incident endometrial cancer cases were available for analyses. In multivariate analysis, the rate ratio (RR) for alcohol users versus non-users was 1.06 (95% Confidence Interval (95% CI)= 0.78-1.43). There were neither dose-dependent trends nor associations with different types of beverages. The RR for former and current smokers versus never-smokers was 0.83 (95% CI = 0.58-1.20) and 0.59 (95% CI = 0.40-0.88), respectively. These estimates did not change significantly when body mass index (BMI) and age at menopause were added to the models. Conclusions: There is no association between alcohol consumption and endometrial cancer. Current smoking is associated with a reduced risk of endometrial cancer. This association is neither mediated by BMI nor by age at menopause. © 2007 Springer Science+Business Media B.V.

What is already known about this subject There is an association between maternal smoking during pregnancy and higher body mass index (BMI) and overweight in childhood. What this study adds The association between maternal smoking during pregnancy and childhood overweight develops with age, starting with a lower birth weight, followed by weight catch-up in the first year after birth, finally leading to overweight at school age. Children of mothers who had smoked during pregnancy had a higher risk of exceeding the 85th percentile of BMI, waist circumference and total skinfold thickness at school age. Background Maternal smoking during pregnancy is associated with childhood overweight, but the association with fat distribution is not clear. Objective To explore the longitudinal association between smoking during pregnancy and childhood overweight and fat distribution. Methods In the KOALA Birth Cohort Study, repeated questionnaires were administered to 2698 mother-child pairs, including questions on smoking at 14 and 34 weeks of pregnancy. Main outcomes were birth weight, weight gain in the first year, body mass index (BMI) z-scores and overweight (BMI ≥85th percentile) at 1, 2, 4-5 and 6-7 years (n=1730) and waist circumference and four skinfold thicknesses measured at home visits at age 6-7 years in a subgroup (n=418). We used multivariable linear and logistic regression, with generalized estimating equations (GEE) for repeated measurements. Results Maternal smoking was associated with lower birth weight, higher weight gain in the first year and increasing overweight after infancy (change with age P=0.02 in the GEE). Maternal smoking vs. non-smoking during pregnancy was associated with a higher risk of the child exceeding the 85th percentile of BMI (adjusted odds ratio [aOR] 3.72; 95% CI 1.33-10.4), waist circumference (aOR 2.65; 95% CI 1.06-6.59) and sum of skinfold thicknesses (aOR 4.45; 95% CI 1.63-12.2) at the age of 6-7 years. Conclusions Maternal smoking during pregnancy is associated with lower birth weight, weight catch-up and development of overweight into childhood. © 2012 The Authors.

We investigated whether the prevalence of health-related behaviors and overweight in neighborhoods is associated with changes in smoking, sports participation and overweight over 13 years of follow-up in Dutch adults residing in 86 neighborhoods of Eindhoven in 1991. We showed that living in neighborhoods with a high prevalence of non-smoking, no sports participation and overweight increased the odds of quitting smoking, quitting sports and becoming overweight. After adjustments for age, gender, education and neighborhood deprivation this association remained significant for becoming overweight. Neighborhood prevalence of health-related behaviors and overweight appears to be a currently neglected but relevant determinant of changes in health-related behaviors. © 2013 Elsevier Ltd.

Objective To estimate the prevalence of alcohol consumption during pregnancy in the Netherlands in 2007 and 2010. Method During two identical, nation-wide surveys in 2007 and 2010, questionnaires were handed out to mothers of infants aged ≤6 months who visited a Well-Baby Clinic. By means of the questionnaire mothers were, in addition to questions on infant feeding practices and background variables, asked about their alcohol consumption before, during and after pregnancy. Logistic regression analyses were used to look into relationships of alcohol consumption with maternal and infant characteristics. Results We obtained 2,715 questionnaires in 2007, and 1,410 in 2010. Within 6 months before pregnancy, 69 % of women consumed alcohol (data from 2010). During pregnancy 22 % consumed alcohol in 2007, 19 % in 2010. During the first three months of pregnancy, 17 % (2007) and 14 % (2010) of mothers consumed alcohol. Alcohol consumption was mainly one glass (~10 g alcohol) on less than one occasion per month. Compared to 2007, in 2010 more women consumed 1–3 or >3 glasses alcohol per occasion (resp. 11 % to 7 % and 1.4 to 0.7 %). Older women and those with a higher education consumed more alcohol, as did smokers. Birth weight, gestational age and weight for gestational age were not associated with alcohol consumption. In 2007 and 2010, 2.5 % resp. 2.4 % of pregnant women both smoked and consumed alcohol; resp. 70 % and 75 % did neither. Conclusion In contrast to Dutch guidelines which advice to completely abstain from alcohol, one in five women in the Netherlands consume alcohol during pregnancy.

Intake of flavonoids is associated with a reduced cardiovascular risk. Oxidation of LDL is a major step in atherogenesis, and antioxidants may protect LDL from oxidation. Because tea is an important source of flavonoids which are strong antioxidants, we have assessed in a randomized, placebo-controlled study the effect of consumption of black and green tea and of intake of isolated green tea polyphenols on LDL oxidation ex vivo and on plasma levels of antioxidants and lipids. Healthy male and female smokers (aged 34 ± 12 years, 13 to 16 per group) consumed during a 4-week period 6 cups (900 mL) of black or green tea or water per day, or they received as a supplement 3.6 grams of green tea polyphenols per day (equivalent to the consumption of 18 cups of green tea per day). Consumption of black or green tea had no effect on plasma cholesterol and triglycerides, HDL and LDL cholesterol, plasma vitamins C and E, β-carotene, and uric acid. No differences were found in parameters of LDL oxidation. Intake of green tea polyphenols decreased plasma vitamin E significantly in that group compared with the control group (-11% P=.016) but had no effect on LDL oxidation ex vivo. We conclude that consumption of black or green tea (6 cups per day) has no effect on plasma lipids and no sparing effect on plasma antioxidant vitamins and that intake of a high dose of isolated green tea polyphenols decreases plasma vitamin E. Although tea polyphenols had a potent antioxidant activity on LDL oxidation in vitro, no effect was found on LDL oxidation ex vivo after consumption of green or black tea or intake of a green tea polyphenol isolate.

A high intake of β-carotene has been associated with a decreased risk for cardiovascular disease. To evaluate whether β-carotene may exert a protective effect through an impact on haemostasis a randomized, placebo-controlled trial was conducted in male smokers (n = 149) using 20 mg/day β-carotene for 14 weeks. For comparisons, haemostatic indicators were also evaluated in a group of non-smokers (n = 54). Smokers compared with non-smokers had higher fibrinogen (3.5 vs. 3.1 mg/ml, P < 0.01), higher tissue-type plasminogen activator antigen (t-PA: 8.03 vs. 6.60 ng/ml, P < 0.05), lower levels of soluble fibrin (3.40 vs 5.16 μg/ml, P < 0.01) and slightly higher plasma levels of total degradation products of fibrin and fibrinogen (TDP: 47.0 vs. 41.3 ng/ml, P = 0.21). Within the group of smokers, there were no initial differences in the four haemostatic indicators between the placebo (n = 77) and β-carotene (n = 72) groups, and in both groups there was virtually no change in the indicators during the 14 weeks treatment. It is concluded that the different haemostatic profile in smokers may partly explain their increased risk for cardiovascular disease. β-Carotene has no influence on the measured haemostatic indicators, and cardiovascular protection for β-carotene via a beneficial effect on haemostasis seems improbable.

Objective. To determine the exposure to cigarette smoke of infants aged 0-14 months. Design. Cross-sectional. Setting. The area of Westfriesland, the Netherlands. Method. All parents of infants 8 days, 3, 5, 9, and 14 months old who visited the infant welfare centre in 1992 were asked to fill in a questionnaire. Results. The questionnaire was filled in by 75% of the parents. Smoking before pregnancy was reported by 38% of the mothers, 25% smoked for more than 12 weeks during pregnancy. Almost 50% of all infants were exposed to cigarette smoke at home: 31% of the fathers, 27% of the mothers and 21% others smoked at home. The number of parents who smoked ≥16 cigarettes a day at home was significantly higher in the weekend than on working days. Nobody smoked in the bedroom of the infant, 42% smoked in the living room, 21% smoked during nursing the infant and 11% smoked in the car in the presence of the infant. Conclusion. Infants are often exposed to cigarette smoke at home, during nursing and in the car.