Passive smoking linked to infertility and earlier menopause

With the end of another year almost up, many of us will be thinking about our New Year’s Resolutions for 2016. Perhaps they could include losing weight, cutting down on alcohol, giving up chocolate…but the most common resolution is usually quitting smoking.

This is not such a bad thing though; smoking is linked to numerous forms of cancer, in addition to heart disease, stroke and many more serious health problems, and a new study has demonstrated that even passive (second-hand) smoking could be the cause of infertility and an earlier menopause in women.

Published online in the Dec. 15 edition of the journal Tobacco Control, the new study reports that women with exposure to high levels of tobacco – either smoking themselves or passively – could have a menopause that occurs one or two years earlier compared to those who have never smoked or exposed to passive smoking.

For the study, researchers assessed data on 79,690 women in the age range of 50 to 79 that had completed the Women’s Health Initiative Observational Study (WHI OS) – a large study began in 1991 to monitor the health of over 160,000 healthy, postmenopausal women. 88,000 women were analysed for fertility effects, with another 80,000 analysed for the onset of natural, or nonsurgical, menopause.

All of the women had experienced a ‘natural’ menopause – meaning the woman had not had a period for 12 consecutive months and they had not had surgery to remove their ovaries.

Previous research has identified a connection between smoking and higher rates of infertility and earlier menopause. However, “second-hand smoke is less researched,” especially among never-smoking women, commented the study author Andrew Hyland, chair of health behaviour at Roswell Park Cancer Institute, in Buffalo, N.Y.

Researchers discovered that smoking and exposure to second-hand smoke were found to be associated with fertility problems and an earlier onset of menopause (i.e. prior to the typical age of 50).

Current or ex-smokers were found to be around 14% more likely to be infertile and 26% more likely to experience an earlier menopause in comparison to those that had never smoked. Hyland stressed that early menopause has been linked with a higher risk of death from all causes.

The study also found that for the never-smokers exposed to the highest levels of second-hand smoke – such as living with a smoker for a decade or more – were an estimated 18% more likely to have fertility problems and early menopause.

Women who had previously smoked, reached the menopause on average about 22 months before the women that had neither smoked or been exposed to smoke. Moreover, it was found those exposed to the highest level of passive smoke reached menopause 13 months earlier than those not exposed.
This latest study is just one of many important reminders that we should avoid all smoke, said Patricia Folan, director of the Center for Tobacco Control at North Shore-LIJ Health System in Great Neck, N.Y.

“This study provides additional motivation and incentive for women of all ages to avoid smoking and exposure to second-hand smoke, as well as to quit smoking,” she said. Both are associated with premature birth, low birth weight, infant death and certain birth defects, she added.

“This evidence, in addition to the data from the current study, offers health care providers, particularly ob-gyn practitioners, the information needed to counsel women about the hazards of smoking and second-hand smoke, and to encourage cessation,” Folan said.

Smoking ban for cars due October 2015

From October 2015 it will be illegal to smoke in cars with children present under the biggest crackdown on smoking from the Government since the introduction of the 2007 ban on smoking in public places.

The Department of Health (DoH) said the tighter regulations laid before Parliament to make private vehicles carrying under-18s smoke-free were formulated with the aim to “protect young people from the serious health harms of smoked tobacco”.

The new plans will result in a fixed fine of £50 being given to people who smoke, or those who fail to prevent others from lighting up within private vehicles also carrying children.

Early in the New Year there will be a vote on the subject, involving both MPs and peers. Following this, there will be a period of three weeks for them to thoroughly assess the proposals put forth by the Department of Health.

This appears to be a formality though following a majority approval by MPs earlier in the year. Back in February MPs voted 376 to 107 – a majority of 269 – in favour of the ban, first suggested by Labour as an amendment to the children and families bill. The majority vote even eclipsed that which resulted in the smoking ban from July 2007, forbidding smoking in areas such as pubs, restaurants and nightclubs.

Most of the country could be behind the ban according to a YouGov poll for the anti-smoking group Action on Smoking and Health (ASH), which discovered that 77% of adults – including 64% of those who actually smoke – were behind the plans to make it illegal to light up in cars carrying anyone under the age of 18.

The legislation would criminalise smoking from parents, carers or other adults in a car where there is anyone present under 18. According to the British Lung Foundation, there are about 430,000 children that are exposed to second-hand smoke each week in a family car.

Dr Penny Woods, the charity’s chief executive, raved about the Government’s plans, saying she was “delighted” by the proposals.

She said: “We are now closer than ever to helping protect the hundreds of thousands of children exposed to dangerous concentrations of second-hand smoke in cars every week.”

ASH were also happy with the plans to ban smoking in cars with children, but said the legislation should go one step further and stretch to a blanket ban which would also comprise of adults in vehicles too.

ASH chief executive Deborah Arnott said: “We are delighted that the Government is to press ahead with regulations to prohibit smoking in cars containing children.

“As with the smoke-free public places law, this is a popular measure that will largely be self-enforcing. However, second-hand smoke is just as harmful to adults as children and it makes it more difficult to enforce if it only applies to some cars, not all. Seatbelt laws don’t just apply to children, why should smoke-free car laws?”

Plans to ban smoking in prisons – riots predicted

Smoking looks set to be banned in all prisons across England and Wales following the ministry of justice confirming a pilot scheme will be rolled out next year that will forbid smoking in every part of a prison, including cells and exercise yards.

Instead, inmates will be offered nicotine patches in an attempt to help them beat any cravings. The pilot scheme will commence in the spring of 2014, starting in Exeter and Eastwood Park Women’s Prison, before gradually introduced in more prisons over the course of a 12-month period.

The plans have been formulated out of fear that those inmates and prison officers who do not smoke may decide to launch compensation claims against the Prison Service because of the secondhand/passive smoking they are being subjected to. The dangers of secondhand smoking  is a topic that Medical Specialists Pharmacy have previously highlighted.

However, the issue of forbidding prison inmates from smoking could be viewed as a human rights issue and cause a string of legal challenges. Some even fear there is a very real prospect of inmates rioting in prisons all across England in Wales. If some criminals have a violent nature to begin with, denying them a highly addictive substance such as nicotine could cause total pandemonium.

Not only are cigarettes addictive – and about 80% of the 84,300 prison inmates smoke – but it is also seen as a valuable prison currency that is regularly traded on the prison wings. Not being able to light up as they see fit, will probably not go down too well.

Prisoners are currently given the freedom to smoke outside in the exercise yards and within their cells due to the fact it is deemed to be their “permanent or temporary home”. Bad behaviour can already result in a temporary smoking ban but the universal ban will anger the more exemplary, well-behaved inmates who look forward to cigarette breaks as an escape from the tedium of prison life.

Steve Gillan, general secretary of the Prison Officers’ Association, agrees with the proposed smoking ban but told The Times it would be difficult to implement.

He said: “There is no pretending otherwise. It could cause disturbances but they have done it successfully in Canada and in young offender institutions in England and Wales. We welcome this move. It is our policy to have smoke-free prisons for our members. We will work with the ministry to make sure it works effectively.”

In addition, there are those who say that prisoners already have a cushy life. It seems it is a weekly occurrence for stories to emerge of inmates posting pictures to their Facebook accounts showing just how cushy their life actually it.

Dee Edwards, of the R and K Foundation, a crime victims’ group, said: “Prisoners are already better fed and cared for than pensioners so why should they be treated any different to the rest of society? It’s getting to point where you can’t even smoke outside a building now so I don’t see why prisoners shouldn’t be banned. If you have a low level criminal who smoke 20 a day may be it will even act as a deterrent if they think they could do to jail and not be able to smoke.”

However, Mark Johnson, chief executive of the prisoner charity User Voice, says that smoking is a “human right” and believes that prisoners who smoke may decide to take legal action if it is banned.

Secondhand smoke could impair childhood kidney function

Whilst many teenagers may believe that smoking cigarettes will improve their popularity amongst friends and gain them misguided admiration in the playground, they should also be aware of the damage that cigarettes do to their adolescent bodies after a study has linked secondhand smoke exposure to effects on kidney function beginning in childhood.

The study, led by Esther Garcia-Esquinas, MD, of the Department of Environmental Health Sciences at John Hopkins University Bloomberg School of Public Health and published April 8 in the journal Pediatrics, was conducted to see if secondhand smoke exposure could be attributed to chronic kidney disease in children.

A cross-sectional study was therefore carried out, comprising of an analysis of 7,516 adolescents aged between 12 and 17; all of whom were involved in the 1999-2010 National Health and Nutrition Examination Survey.

The teens all had blood tests to determine any creatinine and cotinine levels. Creatinine is a waste break-down product from muscle tissue in the body that is filtered through the kidneys. Doctors look at a person’s blood creatinine level as a test to determine kidney function and the kidneys’ ability to handle creatinine is known as the ‘creatinine clearance rate’.

‘Cotinine’, an anagram of nicotine, is an alkaloid chemical contained in tobacco and is also a product that is created by metabolising nicotine. By measuring the levels of cotinine in an individual’s bloodstream, it is possible to extract information on their recent use of tobacco in addition to assessing how much secondhand smoking the person has been exposed to.

The teens within the study who admitted that they smoked or those with serum cotinine levels found to be over 10 ng/mL, were regarded as ‘active smokers’. Those who lived with at least one person who smoked or had cotinine levels measuring at least 0.05 ng/mL, were classified as being exposed to secondhand smoke. In addition, any study participants with serum cotinine levels under 0.05 ng/mL, not living with a smoker and had not smoked in the previous month, were viewed as being unexposed to tobacco.

Researchers analysed the glomerular filtration rate, or eGFR, level by looking at the creatinine levels. This helps to understand how much blood a person’s kidneys are filtering to get a better picture of kidney function.

It was discovered that the teens’ eGFR declined at the same rate that their cotinine concentration in the blood increased. This pattern was evident even after the participants’ weight was taken into account as well as and socioeconomic and demographic factors.

Jeffrey Fadrowski, MD, MHS, co-author of the study and an assistant professor in Pediatric Nephrology at the Johns Hopkins School of Medicine, commented: “Small changes in the distribution of estimated glomerular filtration rate levels in the population could have a substantial impact in kidney-related illness, as it is well known for changes in blood pressure levels and hypertension-related disease. Evaluating potential secondhand smoke exposure and providing recommendations to minimize exposure should continue to be incorporated as part of children’s routine medical care.”

Other researchers in the study added: “Evidence from studies in adult populations suggest that smoking, particularly heavy smoking and cumulative smoking exposure, is an independent risk factor for chronic kidney disease in both genders, as shown in large, prospective observational studies.”