医院健康教育与烟草控制培训.ppt

医院健康教育与烟草控制培训.ppt

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yellowpigmentationofthenailplateinchronicsmokersKeyPointExposuretoenvironmentaltobaccosmokeincreasestheriskofheartdiseaseamongnonsmokersby30%.Whincupetalprospectivelyevaluatedtherelationshipbetweenenvironmentaltobaccosmokeexposure（quantifiedbyserumcotininelevels）andriskofcoronaryarterydisease（CAD）andstrokein4729subjectsenrolledintheBritishRegionalHeartStudy.Participantsweremalenonsmokersaged40to59years,initiallyevaluatedfrom1978to1980.Baselineexaminationincludedassessmentofbloodpressureandnonfastingcholesterolandcotininelevelsinadditiontoanurse-administeredquestionnaire,fromwhichdataonsmokingandmedicalhistorywereobtained.Menwereclassifiedas“currentnonsmokers”atbaselineiftheyreportedthattheydidnotsmokeandhadacotinineconcentration14.1ng/mL.Nonsmokerswerefurthersubclassifiedintolightandheavypassivesmokers.Lightpassivesmokerswerenonsmokerswhohadthelowestlevelsofcotinineconcentration（0-0.7）.Heavypassivesmokerswerenonsmokerswhohadthehighestcotinineconcentration（0.8to14.0）.Lightactivesmokersweremenwhoreportedsmoking1to9cigarettesaday,irrespectiveofcotinineconcentration.Allmenwerefollowedupforall-causemortalityandcardiovascularmortality.ThegraphdepictstheKaplan-MeierplotshowingthecumulativeproportionsofmenwithmajorCADovertimeamongthelightactive,heavypassiveandlightpassivesmokers.Age,systolicbloodpressure,diastolicbloodpressure,totalcholesterol,high-densitylipoprotein（HDL）cholesterol,forcedexpiratoryvolumein1second（FEV1）,height,preexistingCAD,bodymassindex,triglycerides,WBC,diabetes,physicalactivity（none,occasional,light,moderate,ormore）,alcoholintake（none/occasional,light/moderate,heavy）,andsocialclass（I,II,IIInon-manual,IIImanual,IV,V,andArmedForces）werefittedasdichotomousvariables.HeavypassiveandlightpassivesmokershadthehighestincidenceofmajorCAD.Althoughthegroupsdivergedmarkedlyintheearlyfollow-upperiod,theyremainedalmostparallelduringlateryears.TheauthorsconcludedthatenvironmentaltobaccosmokeexposureisassociatedwithanincreasedriskofCADofapproximately25%to30%.