Contexto: Há muito tempo se conhecem os malefícios do tabaco, seja para a saúde individual, coletiva e para o meio ambiente. Por outro lado, a sua produção é também considerada uma cultura das mais rentáveis e gera milhares de empregos e renda, tanto para trabalhadores e empresários, quanto para o Estado, através do recolhimento de valores importantes de impostos. Conhecer relações de exposição ao tabaco e seus possíveis danos à comunidade passa a ser uma ação importante, a fim de se avaliar relações de custo-benefício de tal produção. Objetivos: Georreferenciar os casos de internação hospitalar entre 2010 e 2012 da cidade de Santa Cruz do Sul, uma das maiores produtoras de tabaco do país, para encontrar um padrão de distribuição espacial da moradia destas pessoas e as indústrias do tabaco. Métodos: Foi utilizado um estudo ecológico, com georreferenciamento de casos, através do programa Terraview do Instituto Nacional de Pesquisas Espaciais, de acordo com patologias específicas, através do banco de dados informatizado dos dois hospitais da cidade. Foram gerados mapas representativos, de Kernel, além da utilização de técnicas específicas para detecção de autocorrelações espaciais, como o Índice Global e Local de Moran, Médias Móveis, G e G* e Taxas Bayesianas Empíricas. As unidades de área estudadas foram os bairros da cidade, com informações do censo do Instituto Brasileiro de Geografia e Estatística de 2010. Resultados: Constavam nos registros hospitalares brutos 49.347 registros, sendo 33.377 do Hospital Santa Cruz e 15.970 do Hospital Ana Nery. Após a limpeza dos bancos, através dos critérios de exclusão determinados, foram elegíveis para o georreferenciamento dos casos de internação por neoplasias 285 (0,34%) casos e por doença respiratória 1.013 (2,05%). Em ambos os contextos de causas para internação, não houve uma distribuição espacial que determinasse uma autocorrelação, ou seja, não se demonstrou, no período estudado e para estes dois motivos de internação, que os casos estivessem correlacionados entre si, em se tratando de distribuição no espaço geográfico, tanto da cidade, quanto do entorno das fumageiras. Alguns aspectos relativos a taxas de incidência foram observados entre os anos, com a apresentação de aglomerados (clusters). Conclusões: O uso do delineamento ecológico como forma de se iniciar uma observação entre padrões de eventos dentro de grupos populacionais continua a ser uma ótima ferramenta. Suas fraquezas incluem a alta dependência da qualidade dos dados secundários registrados, que, se não forem cuidadosamente coletados e avaliados, podem diminuir em muito as forças dos achados. Parece não haver um padrão de distribuição espacial das residências de pessoas que foram internadas em um dos hospitais da cidade de Santa Cruz do Sul entre os anos de 2010 e 2012, em relação a neoplasias e doenças respiratórias, tampouco uma correlação com proximidades às indústrias fumageiras. / Background: The dangers of smoking are well known, both for individual, collective health, and for the environment. On the other hand, its production is also considered one of the most profitable crop and generates thousands of jobs and income for both workers and employers, and in the State, through the gathering of important tax values. Meet the relationships of tobacco exposure and the possible damage to the community becomes an important action in order to evaluate the cost-benefit of such production. Objectives: To georeference cases of hospitalization between 2010 and 2012 in the city of Santa Cruz do Sul, one of the largest tobacco producing in Brazil, to find a pattern of spatial of housing distribution of these people and the location of tobacco industries. Methods: An ecological approach with georeferenced cases by the Terraview software from the National Institute for Space Research, under specific conditions, through the computerized database of the two city hospitals. Representative maps were generated, like Kernel’s map, and the use of specific techniques to detect spatial autocorrelation, such as the Moran Global and Local Index, Moving Averages, G and G * and Empirical Bayesian Exchange. The units studied area were the city's neighborhoods with census data from the Brazilian Institute of Geography and Statistics, 2010. Results: There were available 49.347 records in hospital records, being 33.377 from the Santa Cruz Hospital and 15,970 from The Ana Nery Hospital. After cleaning the database, through certain exclusion criteria, 285 neoplasms admissions and 1,103 respiratory diseases were eligible for the georeferencing of hospitalization. In both contexts, there was no one that would determine spatial autocorrelation, ie, was not shown, during the study period and for these two reasons for hospitalization, the cases were correlated with each other, in the case of distribution in geographical space, both for the city, and the surrounding of the tobacco companies. Some aspects of the incidence rates were observed between years, with the presentation of clusters observed. Conclusions: The use of the ecological design as a way to start a note between patterns of events within population groups continues to be a great tool. Their weaknesses include the high dependence of the quality of secondary data, which, if not carefully collected and evaluated, may strongly decrease the strength of findings. There seems not to be a pattern of spatial distribution of the residences of people who were admitted to a hospital in the city of Santa Cruz do Sul between the years 20100 and 2012 in relation to cancer and respiratory diseases, nor a correlation with the nearby tobacco industries.

INTRODUÇÃO: O tabagismo é reconhecido, atualmente, como um dos maiores problemas de saúde em todo o mundo. Há uma \"epidemia\" global de uso de tabaco nos países em desenvolvimento, no século 21. OBJETIVOS: Analisar: as características gerais dos indivíduos matriculados espontaneamente em um ambulatório antitabágico; a eficácia geral do tratamento antitabágico e dos medicamentos; as mudanças nas características dos participantes antes e após a Lei Ambiente Fechado Livre do Cigarro em São Paulo e os níveis de cotinina urinária em fumantes ativos, passivos e controles. CASUÍSTICA E MÉTODOS: Foi realizado um estudo de coorte histórica cujo critério de inclusão foi a matrícula no ambulatório antitabágico do HU USP, no período de 2004 a 2011. Os dados foram coletados por meio de consulta a protocolos padronizados e ao sistema informatizado do serviço. Foram analisados os resultados de dosagens de cotinina e creatinina realizadas em amostras biológicas. RESULTADOS: Dentre os 1736 pacientes atendidos houve predomínio de mulheres (62,1%), brancos (75,3%) e indivíduos com idade entre 41 e 60 anos (63,1%). Aproximadamente 80% iniciaram o tabagismo antes dos 20 anos e 75% apresentaram grau de dependência moderado a grave. Dentre os 620 indivíduos acompanhados a partir de 2009, 34,5% abandonaram o tabagismo. Dentre eles, 21,5% obtiveram êxito até o quarto contato com o ambulatório. O uso de vareniclina e terapia de reposição de nicotina (TRN) aumentaram a probabilidade de sucesso (RRR= 2,73 e 2,78, respectivamente; p < 0,001 para ambas). Quanto maior o número de reuniões frequentadas no ambulatório, maior a probabilidade de sucesso terapêutico (p < 0,001). A análise da dosagem da cotinina urinária mostrou concentrações de cotinina urinária 18,7 vezes maior no grupo de tabagistas ativos comparados aos tabagistas passivos. CONCLUSÃO: O sucesso do ambulatório antitabágico do HU manteve-se em acordo com grande parte dos índices de sucesso terapêutico presentes na literatura médica. O abandono do hábito de fumar foi fortemente associado ao número de contatos dos fumantes com o grupo e a terapêutica medicamentosa. A cotinina urinária mostrou-se um bom marcador do tabagismo ativo / INTRODUCTION: Smoking is recognized today as one of the major health problems worldwide. There is a global \"epidemic\" of tobacco use in developing countries in the 21st Century. OBJECTIVES: Analyze: the general characteristics of individuals spontaneously enrolled in an outpatient smoking cessation clinic; the overall effectiveness of the smoking cessation treatment and medication; the changes in the characteristics of participants before and after the Smoke-Free Environment Act in São Paulo and the levels of urinary cotinine in active and passive smokers and controls. CASES AND METHODS: A historical cohort study was conducted, of which the inclusion criterion was the registration in the outpatient smoking cessation Clinic in the HU USP, in the period from 2004 to 2011. Data were collected by consultation of standardized protocols and of the computerized service system. The results of cotinine and creatinine measurements performed on biological samples were analyzed. RESULTS: Among the 1736 patients treated, there was a predominance of women (62.1%), whites (75.3%) and individuals aged between 41 and 60 years (63.1%). Approximately 80% began smoking before age 20 and 75% showed moderate to severe degree of dependence. Among the 620 individuals monitored from 2009 on, 34.5% quit smoking. Among them, 21.5% obtained success up to the fourth contact with the clinic. The use of varenicline and nicotine replacement therapy (NRT) increased the probability of success (RRR= 2.73 and 2.78, respectively; p < 0.001 for both). The greater the number of meetings attended at the clinic, greater the probability of treatment success (p < 0.001). The analysis of urinary cotinine dosage showed urinary cotinine concentrations 18.7 times higher in the active smokers group, compared to the passive smokers group. CONCLUSION: The success of the smoking cessation clinic in the HU remained largely in accordance with most therapeutic success rates found in medical literature. Quitting smoking was strongly associated to the number of contacts of the smokers with the group and drug therapy. Urinary cotinine proved to be an accurate marker for active smoking

Abstract Little is known about a) the differences in allergic and respiratory diseases between the Finnish and Russian populations, and the environmental factors associated with those differences, and b) exposure to pollen grains indoors and the efficiency of penetration of pollen from outdoor to indoor air. This thesis is based on a cross-sectional population-based epidemiological study conducted in Imatra (Finland) and Svetogorsk (Russia) in 2003 and a rotorod-type-sampler-based pollen study conducted in the province of South Karelia (Finland) between 2003 and 2004. The prevalence of allergic diseases was higher among Finnish than Russian schoolchildren. The symptoms among allergic children were more severe, and the occurrence of respiratory infections was in general more frequent in Russia than in Finland. In the logistic regression analyses the risk of asthma was particularly related to high maternal smoking exposure, and the risk of the common cold was related to high combined parental smoking during infancy (adjusted OR 1.83, 95% CI 1.06–3.17) in Finnish children. Among Russian children, allergic conjunctivitis was related to maternal smoking, while the common cold was inversely related to paternal and parental smoking (0.60, 0.37–0.98 and 0.31, 0.11–0.83, respectively) during the study period. The risk of asthma was inversely related to any indoor dog-keeping in Finland (0.35, 0.13–0.95), whereas in Russia the risk of asthma was increased in relation to combined indoor cat exposure during infancy and the study period (4.56, 1.10–18.91). The concentrations of pollen grains decreased from abundant (0–855 pollen grains per cubic meter, pg/m3) to low (0–3 pg/m3), when moving from outdoors to indoors and further. The differences in diseases and symptoms in these two closely related populations could be ascribed to differences in culture, exposures, diagnostic criteria and treatment. The concentrations of pollen in indoor air during the flowering period were mostly on a level high enough to cause reactions in only the most sensitive subjects. The results suggest that more efforts should be directed to reducing parental smoking, to studying the role and effects of nationally different animal exposures in childhood, and to assessing the importance of different penetration routes of pollen grains. / Tiivistelmä Suomen ja Venäjän välisistä allergioiden ja hengitystietulehdusten esiintymiseroista ja esiintymiseen vaikuttavista ympäristötekijöistä tiedetään varsin vähän. Myös tutkimuksia siitepölyille altistumisesta sisätiloissa ja siitepölyjen tunkeutumiskyvystä ulkoilmasta sisäilmaan on niukasti. Tutkimus yhdistää sekä lääketieteellisen että luonnontieteellisen tutkimusalan tutkimustraditiot sekä atooppisten sairauksien ja/tai hengitystietulehdusten tärkeimpien määrittäjien tarkastelun yhdeksi tutkimuskokonaisuudeksi. Väestö- ja kyselylomakepohjainen poikkileikkaustutkimus toteutettiin Suomen ja Venäjän rajan molemmin puolin sijaitsevissa Imatran ja Svetogorskin kaupungeissa vuonna 2003. Tutkimusväestö koostui 512 suomalaisesta ja 581 venäläisestä 7–16-vuotiaasta koululaisesta (osallistumisaste 79 %). Rotorod-tyyppisen keräimen käyttöön perustuva siitepölytutkimus toteutettiin erilaisissa ulko- ja sisätiloissa Lappeenrannan ja Imatran kaupungeissa, Rautjärven kunnassa ja valtatie 6:lla vuosina 2003 ja 2004. Atooppisten sairauksien esiintyvyys oli runsaampaa suomalaisten koululaisten keskuudessa. Sitä vastoin allergisten lasten kokemat oireet olivat voimakkaampia ja hengitystietulehdusten esiintyvyys oli runsaampaa venäläisten koululaisten keskuudessa. Astmariski kytkeytyi erityisesti äidin runsaalle tupakoinnille altistumiseen raskauden (vakioitu OR 3.51, 95 % luottamusväli 1.00–12.3), ensimmäisen elinvuoden (3.34, 1.23–9.07) ja tutkimuksen aikana (3.27, 1.26–8.48). Nuhakuumeen riski oli suurentunut suomalaisten koululaisten keskuudessa, jotka olivat altistuneet molempien vanhempien runsaalle tupakoinnille ensimmäisen elinvuoden aikana (1.83, 1.06–3.17). Äidin tupakoinnille ensimmäisen elinvuoden (4.53, 1.49–13.8) ja tutkimuksen aikana (2.82, 1.07–7.44) altistuneilla venäläisillä oli suurentunut allergisen silmän sidekalvotulehduksen riski. Tutkimuksen aikainen isän ja vanhempien tupakointi vähensi nuhakuumeen riskiä (0.60, 0.37–0.98; 0.31, 0.11–0.83) Venäjällä. Suomessa koiranpito sisätiloissa vähensi astmariskiä (0.35, 0.13–0.95), vastaavasti Venäjällä raskauden jälkeinen sisätiloissa tapahtuva kissa-altistus lisäsi koululaisten astmariskiä (4.56, 1.10–18.91). Siitepölyjen pitoisuudet pienenivät siirryttäessä ulkoa (0–855 siitepölyhiukkasta ilmakuutiossa; sp/m3) sisätiloihin (0–17 sp/m3). Ympäristöaltisteisiin ja sairauden ennusteeseen vaikuttavat sekä kansallinen kulttuuri ja vakiintuneet tavat, että erot diagnosointikriteereissä, yleisessä tautitietoisuudessa ja lääkkeiden saatavuudessa. Näin ollen altisteiden voimakkuus ja kesto sekä terveysvaikutukset voivat vaihdella merkittävästi lähellä toisiaan sijaitsevien alueiden välillä. Siitepölypitoisuudet sisätiloissa olivat pääosin tasolla, jolle altistuminen aiheuttaa oireita vain kaikkein herkimmille allergisille. Tutkimuksen tulosten mukaan lisää voimavaroja tulisi suunnata passiiviselle tupakoinnille altistumisen vähentämiseen erityisesti yksilökehityksellisesti herkkien varhaisvaiheiden aikana, kansallisten eläinaltistuserojen terveysvaikutusten selvittämiseen sekä siitepölyjen erilaisten kulkeutumisreittien merkityksen tutkimiseen.

! BACKGROUND: Exposure to Environmental Tobacco Smoke (ETS) is elevating blood levels of inflammatory mediators and chemoattractants which seem to play an important role in the development of several diseases (e.g. Chronic Obstructive Pulmonary Disease). First evidences showed that men and women might differ in their proneness for these diseases. The aim of this study was to investigate whether there are effects of ETS during pregnancy on inflammatory cytokines in cord blood and in mother’s blood and if there are any differences between male and female newborns. METHODS: Within the LiNA (Lifestyle and environmental factors and their influence on Newborn Allergy Risk) study, whole blood samples of 460 mother-child pairs were analyzed for the concentrations of IL-6, IL-8, IL-10, IL-12, IL-4, IL-5, INF-gamma, TNF-alpha and MCP-1 using cytrometic bead asseys. The association between ETS exposure and cytokines was calculated using the Mann-Whitney-U-test and adjusted with a multiple regression model for parental atopy, parental education status and cat ownership. The exposure assessment is based on questionnaire data on smoking behaviour of the parents and measurement of indoor benzene concentration. RESULTS: Female newborn, being exposed in utero to 10 cigarettes a day or more, had significantly higher blood concentrations of IL-8, IL-6 and MCP-1 whereas there have been no elevations in male newborn being exposed to the same amount of cigarettes. Furthermore a significantly decreased amount of INF-gamma was found in cord blood of male newborns but not in female newborns. General increasing levels of TNF-alpha in cord blood where found for daily smoke exposure without relating it to the exact number of cigarettes. CONCLUSION: The data of this study refer to gender-specific differences in the susceptibility to ETS exposure. The induction of inflammatory signals in cord blood in response to cigarette smoke exposure is stronger in female than in male newborn. / Die vorliegende Arbeit ist Teil einer umweltepidemiologischen Kohortenstudie (LiNA), in der der Einfluss von Umwelt- und Lebensbedingungen auf die Entwicklung von Immunsystem und Allergien bei Neugeborenen unter Einbezug der vorgeburtlichen Zeit untersucht wird. In welchem Maße sich eine Rauchbelastung während der Schwangerschaft auf die Zytokinmuster der Neugeborenen im Nabelschnurblut auswirkt und inwiefern dies mit dem Zytokinmuster der Mutter korreliert, sollte das Ziel dieser Dissertation sein. Dafür wurden Daten von insgesamt 629 Mutter-Kind-Paaren erhoben, Zytokin- und Chemokinbestimmungen, sowie die des Gesamt-IgE aus den Blutproben der 34. SSW und denen der Nabelschnur vorgenommen. Interessanterweise konnten geschlechterspezifische Unterschiede im Zytokinspektrum der Neugeborenen gefunden werden. Bei den weiblichen Neugeborenen zeigte sich eine deutliche Erhöhung proinflammatorischer Marker, wenn deren Mütter dem Rauch von mehr als 10 Zigaretten pro Tag ausgesetzt waren. Dieser Anstieg war weder im Blut der männlichen Neugeborenen noch im Blut der Schwangeren in der 34. SSW zu beobachten. Zusätzlich konnte beobachtet werden, dass auch einzig die männlichen Neugeborenen stark negativ mit ihrer IFN-gamma-Produktion auf die passive Rauchbelastung reagieren. Die mit dieser Arbeit ermittelten Daten, dass das Immunsystem beim Neugeborenen geschlechterspezifisch unterschiedlich auf Tabakrauch zu reagieren scheint, sind erstmals in der Literatur zu finden. Die Erforschung des Immunsystems und dessen Beteiligung an zahlreichen Erkrankungen, besonders den chronisch Inflammatorischen, ist durchaus relevant im medizinischen Alltag. Diese Arbeit trägt einen weiteren Baustein dazu bei und gibt Anstoß für weitere Studien.

<p> Lung disease is the leading threat to human health worldwide. In particular, two threats are responsible for the majority of the pulmonary disease burden: infection and tobacco smoke exposure. Efforts to combat these diseases have been hampered by gaps in our understanding of the complex interactions between environmental threats and the host's own immune defences. Indeed, much of the pulmonary disease burden should be ascribed not to direct smoke-, virus-or bacteria-induced damage, but to maladaptive host defence responses against these threats. This is an understudied topic. Efforts to redress this deficiency have been hampered by the lack of available animal models. Thus, the present studies developed and examined models of Heterologous pulmonary infection, in which hosts must defend against two different infections, and of tobacco smoke exposure. In the first study, a critical role for MIP-2 driven pulmonary neutrophilia was elucidated in the pathology associated with bacterial superinfection of influenza virus infection. This study further demonstrated that the timing and sequence in which pathogens were encountered played important roles in determining the outcome of disease, and that viral and bacterial infections have different but long-lived impacts on alveolar macrophages. In the second study, it was determined that cigarette smoke exposure impacts host defence without exhausting T-or B-cells. Collectively, these studies have advanced our understanding of complex lung pathologies, and suggest an important role for the innate immune system in mediating such diseases. </p> / Thesis / Doctor of Philosophy (PhD)

Biological markers (i.e., biomarkers) are essential in clinical and epidemiological studies as they may provide mechanistic insights into the developmental origins of disease, as well as improve diagnostic testing and risk assessment for disease prevention. However, major challenges remain due to the lack of rapid yet selective analytical methods for high throughput screening that are also amenable to volume-restricted specimens. This thesis includes two major research themes that take advantage of capillary electrophoresis (CE) separations, including (1) the targeted analysis of urinary iodide and thiocyanate for assessment of nutritional adequacy and tobacco smoke exposures in the population, and (2) the discovery of new biomarkers in sweat specimens that may improve universal newborn screening programs for cystic fibrosis (CF) infants beyond impaired chloride transport. Chapter II examines the prevalence and risk factors associated with iodine deficiency in 24 h urine samples collected from 800 participants across four clinical sites in Canada as part of the Prospective Urban and Rural Epidemiological (PURE) study when using CE with UV detection in conjunction with sample self-stacking. Importantly, regional variations in iodine status were revealed with participants from Quebec City and Vancouver at greater risk for iodine deficiency than Hamilton and Ottawa. Overall, iodine supplement use, thyroxine prescription, urinary sodium excretion, and self-reported dairy intake were found to be protective factors against iodine deficiency. Chapter III applied a validated CE assay to measure urinary thiocyanate as a biomarker of tobacco smoke and dietary exposures in an international cohort of 1000 participants from the PURE study spanning 14 countries with varied income status, smoking habits, and diet quality. Current smokers residing in high-income countries had the highest extent of cyanide exposure indicative of greater harms from tobacco smoke compared to middle- and low-income countries after adjusting for smoking intensity and other covariates. Chapter IV introduces a rapid CE method with indirect UV detection to simultaneously measure sweat chloride and bicarbonate from presumptive CF infants’ residual sweat samples. Although bicarbonate did not provide clinical value in neonatal CF diagnosis, sweat chloride testing by CE may reduce test failure rates due to insufficient volumes from infants in a clinical setting. Lastly, Chapter V applied an untargeted strategy to characterize the sweat metabolome from presumptive CF infants when using multisegment injection-capillary electrophoresis-mass spectrometry (MSI-CE-MS). A panel of sweat metabolites were found to discriminate CF from non-CF (i.e., unaffected carriers) infants, including aspartic acid, glutamine, oxoproline, and pilocarpic acid, which also correlated with sweat chloride. The clinical utility of these sweat metabolites to prognosticate late-onset CF infants from indeterminate sweat chloride test results was also explored. In summary, this thesis contributes innovative separation methods for biomarker screening and discovery in clinical and epidemiological studies for the prevention and early treatment of human diseases that benefit from optimal nutrition. / Dissertation / Doctor of Philosophy (PhD)

No description available.

published_or_final_version / Community Medicine / Doctoral / Doctor of Philosophy

Background: Identifying associations of being within or currently out of the labor force in relation to health risk behaviors are important in terms of planning and monitoring health preventive measures. This master thesis aims to investigate whether there is an association between labor market status, as in being within- or currently outside the labor force, in relation to daily smoking and alcohol risk consumption. Methodology: Data from the cross-sectional Health on Equal Terms survey and Life &amp; Health survey in Uppsala county council from individuals aged 16-65 were used (n=4 666). Data was retrieved from 2012. Binary logistic regression analysis was conducted to investigate the association between labor market status with alcohol consumption and tobacco use, controlling for possible confounding factors. Results: The unadjusted analysis using daily smoker as the dependent variable indicated that those being currently out of the labor force had higher odds of being a daily smoker (OR 1.91, 95 % CI 1.52-2.39) compared to those within the labor force. This was still significant when controlling for demographic factors and economic situation (OR 1.38, 95 % CI 1.07-1.79, p=0.013), but not significant when controlling for self-rated health (OR 1.28, 95 % CI 0.97-1.70, p=0.075). For alcohol, the unadjusted analysis indicated that those being currently outside the labor force had lower odds of having risk consumption (OR 0.54, 95 % CI 0.44-0.66). This was highly significant even after adjusting for the all confounding factors (OR 0.55, 95 % CI 0.43-0.69, p=0.000) Conclusion: The findings suggest that there is an association between being outside the labor force and higher odds of daily smoking and a lower consumption of alcohol, when compared to being in the labor force. These findings address the need for health preventive measures aimed at institutions involving those outside the labor force, and at workplaces. Studies using longitudinal design should be conducted to investigate this relationship further.

Bakgrund: Rökning står för mer än vart tionde dödsfall i Sverige och hälften av alla långsiktiga rökare avlider av rökrelaterade sjukdomar. Lungcancer är den femte vanligaste cancersjukdomen i Sverige och orsakas i första hand av rökning. Kronisk obstruktiv lungsjukdom (KOL) orsakas också i första hand av rökning och är den tredje vanligaste dödsorsaken i världen. Fler kvinnor än män dör av KOL i Sverige men förklaringen till detta är oklar. Den komplexa kemiska blandningen som inhaleras vid förbränning av tobak orsakar negativa hälsoresultat, särskilt cancer och lungsjukdomar. Risken för och svårighetsgraden av många negativa hälsoeffekter orsakade av rökning kan variera beroende på om man själv är rökare eller bara exponeras för tobaksrök. Rökavvänjningen är potentiellt den mest effektiva av alla förbyggande åtgärder. Rökning påverkar också metabolisering av olika läkemedel. Nikotin är den beroendeframkallande substansen i tobak som orsakar abstinensbesvär. Rökfri tobak t.ex. snustobak orsakar också sjukdomar men i mycket mindre utsträckning än cigaretter. Syfte: Syftet med detta examensarbete var att ytterligare belysa kända hälsoproblem med rökning samt att beskriva eventuella ytterligare, tidigare okända, hälsoproblem. Metod: Detta arbete är en litteraturstudie baserat på 6 vetenskapliga artiklar. Resultat: Rökning ökar mortalitet och förkortar därmed livslängd. En stor del av dessa dödsfall orsakas av hjärt-kärl sjukdomar, kronisk obstruktiv lungsjukdom och många olika cancersjukdomar. Det finns ingen riskfri nivå av exponering för tobaksrök. Slutsats: Rökning ökar risken för alla typer av hjärt-kärl sjukdomar, låg födelsevikt för barn och många olika typer av cancer. Risken för pankreascancer i samband med rökning är relaterat till mängden av tobak som rökts dagligen. Minskning av antal rökta cigaretter per dag eller förpackningar per år har annars ingen större effekt på att minska risken för sjukdomar eller minska mortaliteten.