Read the following passage from a paper discussing the effects of discarded cigarettes. Governments have to foot large bills to clean up cigarette butts and other tobacco-related litter: the city of San Francisco alone spends seven million dollars a year cleaning up after outdoor smokers. The cost to the environment is even higher. In 2014, as in every previous year studied, the Ocean Conservancy identified cigarette butts as the #1 most littered item: in just one day, volunteers picked up more than two million butts on beaches worldwide. Less obvious but even more troubling, cigarettes cause soil and water pollution and threaten wildlife. Animals frequently swallow butts, and are sickened or killed by indigestible fibers and dangerous levels of nicotine and other chemicals. Discarded cigarettes are a long lasting source of toxic materials that leach out into soils and waterways. The National Institutes of Health reports that cigarettes contain 4000 chemicals, including heavy metals, carcinogens, pesticides, and herbicides, and can act as long lasting point sources of pollution. This paragraph provides evidentiary support for which argument below? Cigarette litter looks and smells bad, leaves stains, and is difficult to clean up. Cigarette taxes should be raised to pay for the high costs of cleaning up after smokers. Cigarettes should be banned because smoking kills not just smokers but the people and animals around them. Cigarette smoking pollutes the environment more than any other outdoor activity.
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The following abstract appears in The New England Journal of Medicine: BACKGROUND. The relation between passive smoking and lung cancer is of great public health importance. Some previous studies have suggested that exposure to environmental tobacco smoke in the household can cause lung cancer, but others have found no effect. Smoking by the spouse has been the most commonly used measure of this exposure. METHODS. In order to determine whether lung cancer is associated with exposure to tobacco smoke within the household, we conducted a case-control study of 191 patients with lung cancer who had never smoked and an equal number of persons without lung cancer who had never smoked. Lifetime residential histories including approximately 17 percent of lung cancers among nonsmokers information on exposure to environmental tobacco smoke can be attributed to high levels of exposure to cigarette were compiled and analyzed. Exposure was measured in smoke during childhood and adolescence. terms of "smoker-years;" determined by multiplying the (a) What is the research objective? number of years in each residence by the number of smokers in the houschold. RESULTS. Houschold cxposurc to 25 or morc smokcr-ycars (c) What is the response variable in the study? Is it during childhood and adolescence doubled the risk of lung cancer. Approximately 15 percent of the control subjects who (d) What is the explanatory variable in the study? Is it had never smoked reported this level of exposure. Household exposure of less than 25 smoker-years during childhood and adolescence did not increase the risk of lung cancer. Exposure to a spouse's smoking, which constituted less than one third $\quad$ (f) What is the conclusion of the study? Can we conclude of total household exposure on average, was not associated that exposure to smoke in the household causes lung with an increase in risk. CONCLUSIONS. The possibility of recall bias and other (g) Would it be possible to design an experiment to answer methodological problems may influence the results of case the research question in part (a)? Explain. control studies of environmental tobacco smock. Nonetheless. our findings regarding exposure during Carly life suggest that
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Observational Studies versus Designed Experiments
A causal relationship between cigarette smoking and lung cancer was first suspected in the 1920s on the basis of clinical observations. To test this apparent association, numerous epidemiologic studies were undertaken between 1930 and 1960. Two studies were conducted by Richard Doll and Austin Bradford Hill in Great Britain. The first was a case-control study begun in 1947 comparing the smoking habits of lung cancer patients with the smoking habits of other patients. The second was a cohort study begun in 1951 recording causes of death among British physicians in relation to smoking habits. This case study deals first with the case-control study, then with the cohort study. Data for the case-control study were obtained from hospitalized patients in London and vicinity over a four-year period (April 1948 – February 1952). Initially, 20 hospitals, and later more, were asked to notify the investigators of all patients admitted with a new diagnosis of lung cancer. These patients were then interviewed concerning smoking habits, as were controls selected from patients with other disorders (primarily nonmalignant) who were hospitalized in the same hospitals at the same time. Data for the cohort study were obtained from the population of all physicians listed in the British Medical Register who resided in England and Wales as of October 1951. Information about present and past smoking habits was obtained by questionnaire. Information about lung cancer came from death certificates and other mortality data recorded during ensuing years. Over 1700 patients with lung cancer, all under age 75 were eligible for the case-control study. About 15% of these persons were not interviewed because of death, discharge, severity of illness, or inability to speak English. An additional group of patients were interviewed by later excluded when initial lung cancer diagnosed proved mistaken. The final study group included 1,465 cases (1,357 males and 108 females). The following table shows the relationship between cigarette smoking and lung cancer among male cases and controls: Table 1 Cases Controls Cigarette Smoker 1,350 1,296 Nonsmoker 7 61 Total 1,357 1,357 Accurately calculate the odds ratio, with the correct equation. What do you infer from the odds ratio about the relationship between smoking and lung cancer?
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In modules 3 and 4, we learned about two concepts—risk ratios and confounding—that are important in epidemiology for studying the health effects of exposure to drugs. A risk ratio (or relative risk) tells us how much exposure to a certain factor increases one’s risk of a health outcome. In previous lessons, we have examined how living in the U.S. vs. Saudi Arabia puts one at increased risk of alcohol use disorder, and how drinking alcohol in 19th century America put Cartwright’s medical colleagues at increased risk of death over a 30 year period. We also learned how the increased risk we observe, for example among drinkers vs. abstainers, may result from confounding by another variable, such as cigarette smoking or being prone to other risk behaviors. Here you will practice both (1) estimating risk ratios and (2) assessing confounding by a third variable using data on alcohol use, cigarette smoking, and lung cancer in participants of the Framingham study (see optional readings in Lesson 4b). The study followed 4973 men and women, asking them about their alcohol and cigarette use, and then tracking who was diagnosed with lung cancer over several decades. **For this assignment, you should complete the exercises and answer the questions below in this document and submit.** Calculating Crude Risk Ratio. First we will calculate three risk ratios: 1) the increased risk of lung cancer associated with cigarette smoking 2) the increased risk of cigarette smoking if one drinks 3) the increased risk of lung cancer associated with drinking alcohol Table 1. Contingency (or 2 x 2) table showing how lung cancer occurred among Framingham participants who were current smokers and those who were not. In the first row, we calculate that the risk of lung cancer among people who are not smokers is 0.009 or less than 1%. In the second row, we calculate that the risk of lung cancer among current smokers is 0.074 or about 7.4%. In the third row, we calculate the risk ratio for the increased risk of lung cancer among current smokers, which is the risk among smokers divided by the risk among non-smokers. We divide the risk of lung cancer among smokers by the risk of lung cancer among non-smokers, because we want to see how much more of a risk smokers have relative to non-smokers. | | Total participants | Lung cancer cases | Risk of lung cancer | | :--- | :--- | :--- | :--- | | Current smoker | 2358 | 176 | 176/2358 = 0.074 | | Not a current smoker | 1907 | 18 | 18/1907 = 0.009 | | | | Risk ratio | 0.074/0.009 = 8.22 | Interpretation: Based on this, we find that current smokers have a 8.22 times greater risk of lung cancer relative to non-smokers. Comparing to results from epidemiological studies about other factors and diseases, this is a very large risk ratio. However, this does not necessarily mean that smoking causes
Adi S.
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