Smoking May Cancel Stroke Benefit of Drinking - from MedPage Today

By Michael Smith, North American Correspondent, MedPage Today

Moderate drinking may protect against stroke, but not if the drinker is also a smoker.

An analysis of stroke incidence in a long-running cohort study showed that both nondrinkers and heavier drinkers were at higher risk than moderate drinkers, according to Yangmei Li, a PhD candidate at Cambridge University.

That effect -- known as a U-shaped curve -- has been seen in some studies but not in others, Li told reporters at the annual meeting here of the American Academy of Neurology.

The reason, she said, may be the impact of smoking.

She and colleagues looked at data from the European Prospective Investigation into Cancer (Norfolk) study, which also included information on cardiovascular outcomes.

Volunteers ages 39 through 79 began taking part in the study between 1993 and 1997. At baseline, they were free of heart attack, stroke, and cancer and were followed up for incident stroke until 2008.

All told, the researchers looked at the relationship between alcohol and stroke in 10,171 men and 12,353 women.

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Don't Give Up on Older Smokers

Older smokers may make better quitters.

That’s the surprising finding from an analysis of a 16-week smoking cessation program at Florida State University (FSU). Contrary to conventional wisdom, which holds that older adult smokers are “lost causes” when it comes to quitting, researchers found that older smokers are more receptive to and often more successful at quitting than younger smokers.

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State Medicaid Tobacco Coverage Survey

Tobacco use remains the leading preventable cause of death in the United States despite the availability of evidence-based treatments for tobacco dependence, which include counseling and FDA-approved pharmacotherapies. Medicaid recipients have approximately 50% greater smoking prevalence than the overall U.S. adult population, and they are disproportionately affected by tobacco-related disease and disability. Substantial action to improve coverage of tobacco-dependence treatments through Medicaid will be needed if the United States is to achieve the 2010 National Health Objective of 12% smoking prevalence among adults. CDC plans to request reinstatement of OMB approval to collect information about Medicaid coverage of tobacco-dependence treatments during the years 2008-2010. Respondents will be Medicaid directors in all 50 states and the District of Columbia. To minimize burden, each respondent will receive an electronic copy of the survey pre-filled with the previous year's results. Respondents will only be asked to record changes that occurred since the time of the previous submission. In addition, respondents will be asked to answer new questions pertaining to the recommendations made in the updated PHS clinical practice guideline issued in May of 2008 regarding coverage for combination therapies, smokeless tobacco use, and their familiarity with and use of the 2000 PHS guideline.

Smoking and Cancer

A new report from CDC, Surveillance for Cancers Associated with Tobacco Use — United States, 1999–2004, finds a high rate of tobacco-related cancer among older adults. Results: Approximately 2.4 million cases of tobacco-related cancer were diagnosed during 1999–2004. Age-adjusted incidence rates ranged from 4.0 per 100,000 persons (for AML) to 69.4 (for lung and bronchial cancer). High rates occurred among men, black and non-Hispanic populations, and older adults. Higher incidence rates of lung and laryngeal cancer occurred in the South compared with other regions, particularly the West, consistent with high smoking patterns in the South. Interpretation: The high rates of tobacco-related cancer observed among men, blacks, non-Hispanics, and older adults reflect overall demographic patterns of cancer incidence in the United States and reflect patterns of tobacco use. Public Health Action: The findings in this report emphasize the need for ongoing surveillance and reporting to monitor cancer incidence trends, identify populations at greatest risk for developing cancer related to tobacco use, and evaluate the effectiveness of targeted tobacco control programs and policies.