# data[].attributes.body
6.  evaluate how human health is affected by: inherited factors and environmental factors including nutrition; lifestyle choices; examine the role of micro-organisms in human health.

# data[].attributes.body
BW 4 - also deals with the human respiratory system
PW 4 - similar to BW 6, this involves students conducting research studies and being critical of secondary data
NoS 4:  Students must be critical when choosing data to use
NoS 6: Deals with the judgement of secondary data also
NoS 7: Students must design their posters to cater for their audience. Should include scientific terminology and representations.
NoS 10: particularly in elation to diet and exercise - scientific research is constantly being improved in these areas

# data[].attributes.body
This was used to unpack the learning outcome by identifying the action verbs and deciding upon knowledge, skills and value criteria to be met during the unit

# data[].attributes.body
Topics: Respiratory System and Energy

# data[].attributes.body
The second class using the Jigsaw method to design a suitable poster

# data[].attributes.body
Being Creative: Students must use their imaginations and art skills to design a suitable poster. They must ensure it is visually appealing to the class. They will use technology to do their research
Working With Others: Students must create their posters as a group. They will discuss how to lay out the poster, which content to include and how the poster will be presented.
Communicating: Students must communicate with one another while designing to ensure all students are participating they must also work on their presentation skills.
Managing Information and Thinking: Students must collect secondary data. They should be critical of the sources providing the information and use their intuitive.

# data[].attributes.attachment_link.readable_text
OVERVIEW

The jigsaw classroom is a research-based cooperative learning technique invented and developed in the early 1970s by Elliot Aronson and his students at the University of Texas and the University of California. Since 1971, thousands of classrooms have used jigsaw with great success.

The jigsaw classroom has a four-decade track record of successfully reducing racial conflict and increasing positive educational outcomes such as improved test performance, reduced absenteeism, and greater liking for school.

Just as in a jigsaw puzzle, each piece - each student's part - is essential for the completion and full understanding of the final product.

If each student's part is essential, then each student is essential; and that is precisely what makes this strategy so effective.

JIGSAW IN 10 EASY STEPS

The jigsaw classroom is very simple to use. If you're a teacher, just follow these steps:

STEP SEVEN

Bring the students back into their jigsaw groups.

STEP EIGHT

Ask each student to present her or his segment to the group.

Encourage others in the group to ask questions for clarification.

STEP NINE

Float from group to group, observing the process.

If any group is having trouble (e.g., a member is dominating or disruptive), make an appropriate intervention. Eventually, it's best for the group leader to handle this task. Leaders can be trained by whispering an instruction on how to intervene, until the leader gets the hang of it.

STEP TEN

At the end of the session, give a quiz on the material.

Students quickly come to realize that these sessions are not just fun and games but really count.

ABOUT ELLIOT ARONSON

Elliot Aronson is currently Professor Emeritus at the University of California in Santa Cruz. He has long-standing research interests in social influence and attitude change, cognitive dissonance, research methodology, and interpersonal attraction. Professor Aronson's experiments are aimed both at testing theory and at improving the human condition by influencing people to change dysfunctional attitudes and behaviors.

Professor Aronson received his B.A. from Brandeis University in 1954, his M.A. from Wesleyan University in 1956, and his Ph.D. in psychology from Stanford University in 1959. He has taught at Harvard University, the University of Minnesota, the University of Texas, and the University of California. In 1999, he won the American Psychological Association's Distinguished Scientific Contribution Award, making him the only psychologist to have won APA's highest awards in all three major academic categories: distinguished writing (1973), distinguished teaching (1980), and distinguished research (1999).

MORE ABOUT
ELLIOT ARONSON

# data[].attributes.attachment_link.description
The jigsaw technique is a cooperative learning approach that reduces racial conflict among school children, promotes better learning, improves student motivation, and increases enjoyment of the learning experience.

# data[].attributes.attachment_link.provider_name
Faculty Focus | Higher Ed Teaching & Learning

# data[].attributes.attachment_link.title
Student Presentations: Do They Benefit Those Who Listen?

# data[].attributes.attachment_link.description
Seventy-three percent of the students agreed or strongly agreed that peer evaluations made them pay more attention to the presentations.

# data[].attributes.attachment_link.readable_text
The symptoms of cystic fibrosis can be considerably relieved through diet and exercise, with guidance from staff at a specialist cystic fibrosis centre.

Nutrition

For people with cystic fibrosis, getting the right nutrition is vital. A healthy body weight is necessary to help fight off infections, and it is important that there is enough reserve energy to rely on when the person is ill.

Cystic fibrosis causes mucus to build up and block the small channels that carry digestive juices and enzymes. Over time, this causes the pancreas to become damaged. The effect of cystic fibrosis on the pancreas varies from person to person, but most people have to take digestive enzymes from birth to help them digest food and get the nutrients they need.

The diet of someone with cystic fibrosis should be high in calories, as they will not be able to digest all the food they eat.

A special diet should start as soon as cystic fibrosis is diagnosed, which will need to be adapted as people get older.

Babies with cystic fibrosis

Babies with cystic fibrosis may be breastfed as usual, otherwise most baby milks and formulas will be suitable. In some cases, if the baby is not gaining enough weight, a high-energy formula may be needed or nutritional supplements added to milk feeds to give the baby more calories (energy). The parent should ask a dietitian at their cystic fibrosis centre if they are unsure about this.

Before a baby moves onto solid foods, they may need extra salt as both breast milk and baby milk are very low in salt. Cystic fibrosis makes sweat five times saltier, and more salt than normal is lost through skin. If the baby needs extra salt, the dietitian or doctor at the cystic fibrosis centre will advise on the appropriate amount and prescribe a salt solution. A parent should never add salt to their baby's food or drink without specific advice from their cystic fibrosis specialists.

A parent can feed their baby any normal solid baby foods, but they will need vitamin supplements to compensate for the loss of vitamins A, D, E and K in their stools. These are available in two liquid preparations. Vitamins A and D are usually combined in one, and there is usually a separate one for vitamin E. Vitamin K is now prescribed by many doctors.

A baby with cystic fibrosis will also need pancreatic enzymes to help them digest food. These take the place of the food-digesting enzymes missing from their digestive system. They usually come in the form of microspheres or minimicrospheres (granules), which can be mixed with a little formula, expressed breast milk or fruit puree and spoon fed ideally at the start, during and after the feed. The granules should never be given dry as they can be a choking hazard. A dietitian can advise on the amount to use and the most suitable way to give the enzymes.

Children with cystic fibrosis

Children who have cystic fibrosis should eat a varied diet, but they should also eat a large amount of protein and calories. They should eat plenty of protein such as meat, fish and eggs, as well as starchy foods like bread and pasta. If a child's appetite is poor, give them food little and often, and offer snacks in between meals. Children who find it particularly hard to gain weight can be given dietary supplements in the form of milk shakes or fruit juices. You can talk to a cystic fibrosis dietitian about these.

Like babies, children with cystic fibrosis will need to continue taking vitamin A, D, E and K supplements to compensate for the vitamins they lose.

Children also need to continue taking pancreatic enzymes with all fat-containing meals, snacks and drinks. The capsules should be taken before and during the meal and the number of capsules will vary depending on the fat content of the meal. Enzymes can be taken in easy-to-swallow capsules.

A dietitian may recommend salt supplements for a child with cystic fibrosis, especially in hot weather or if they are going on holiday to a country with a warm climate, where sweating may cause a loss of salt.

Children with cystic fibrosis may eat more sugary foods than normal due to their high-calorie diet, so it is important to make sure they brush their teeth properly and visit the dentist regularly.

If a child cannot gain enough weight and dietary supplements have not helped, they may need to be tube fed. This will usually be either nasogastric (the tube is inserted through the nose and goes down to the stomach), or gastrostomy (the tube is inserted directly into the stomach). The other end of the tube is attached to a bag of high-calorie/nutrient food that is delivered straight to the stomach, usually while the child sleeps.

Adults with cystic fibrosis

Adults who have cystic fibrosis do not need to avoid any particular food, but it is important they have a diet high in protein and energy to maintain their weight. They should eat regular meals and snacks as this helps to maintain energy intake. They should eat three meals a day, including plenty of meat, fish and eggs, and eat several high-calorie snacks in between.

If someone with cystic fibrosis wants to be a vegetarian, they should talk to their dietitian about alternatives to meat. A vegan diet is not advised for people with cystic fibrosis as it tends to be especially low in energy.

Most adults with cystic fibrosis need to continue taking pancreatic enzymes with all fat-containing meals, snacks and drinks. The capsules should be taken before and during the meal and the number of capsules will vary depending on the fat content of the meal. There are different types and strengths so talking to the cystic fibrosis specialist team will help the person find one that suits them. Creon is the usual preparation used in Ireland. People with cystic fibrosis should not stop taking pancreatic enzymes unless they are told to do so by their dietitian or doctor, as this can lead to a serious blockage of the bowel.

Most adults need to continue taking vitamin A, D, E and K supplements. These come in the form of prescribed multivitamin tablets.

People with cystic fibrosis who lose a lot of weight due to an infection or illness may need to be tube fed to help them gain weight. As in tube feeding for children, this will be either nasogastric or gastrostomy, depending on how long the tube must stay in for. A gastrostomy tube (which is inserted directly into the stomach) is best for longer periods of time or repeated courses of treatment as it is unlikely to be dislodged during coughing or physiotherapy.

Exercise

Exercise is recommended for everyone with cystic fibrosis. This may vary from taking part in normal school activities to individualised exercise programmes. Infants and toddlers with cystic fibrosis should have some exercise included in their normal daily routine. Any sport or exercise that gets a person with cystic fibrosis moving is good, but if there are any concerns or worries, they should ask their physiotherapist.

Children and adults are also encouraged to include stretching exercises into their routine to mobilise the joints and muscles around their chest, back and shoulders, and to be aware of maintaining good posture.

# data[].attributes.attachment_link.description
The symptoms of cystic fibrosis can be considerably relieved through diet and exercise, with guidance from staff at a specialist cystic fibrosis centre. For people with cystic fibrosis, getting the right nutrition is vital. A healthy body weight is necessary to help fight off infections, and it is important that there is enough reserve energy to rely on when the person is ill.

# data[].attributes.attachment_link.readable_text
Image: Thinkstock

Taking a few minutes to focus your mind each day can reduce stress, pain, depression, and more.

You can't see or touch stress, but you can feel its effects on your mind and body. In the short term, stress quickens your heart rate and breathing and increases your blood pressure. When you're constantly under stress, your adrenal glands overproduce the hormone cortisol. Overexposure to this hormone can affect the function of your brain, immune system, and other organs. Chronic stress can contribute to headaches, anxiety, depression, heart disease, and even premature death.

Though you may not be able to eradicate the roots of stress, you can minimize its effects on your body. One of the easiest and most achievable stress-relieving techniques is meditation, a program in which you focus your attention inward to induce a state of deep relaxation.

Although the practice of meditation is thousands of years old, research on its health benefits is relatively new, but promising. A research review published in JAMA Internal Medicine in January 2014 found meditation helpful for relieving anxiety, pain, and depression. For depression, meditation was about as effective as an antidepressant.

Meditation is thought to work via its effects on the sympathetic nervous system, which increases heart rate, breathing, and blood pressure during times of stress. Yet meditating has a spiritual purpose, too. "True, it will help you lower your blood pressure, but so much more: it can help your creativity, your intuition, your connection with your inner self," says Burke Lennihan, a registered nurse who teaches meditation at the Harvard University Center for Wellness.

Types of meditation

Meditation comes in many forms, including the following:

Concentration meditation teaches you how to focus your mind. It's the foundation for other forms of meditation.

Heart-centered meditation involves quieting the mind and bringing the awareness to the heart, an energy center in the middle of the chest.

Mindfulness meditation encourages you to focus objectively on negative thoughts as they move through your mind, so you can achieve a state of calm.

Tai chi and qigong are moving forms of meditation that combine physical exercise with breathing and focus.

Transcendental Meditation is a well-known technique in which you repeat a mantra-a word, phrase, or sound-to quiet your thoughts and achieve greater awareness.

Walking meditation turns your focus to both body and mind as you breathe in time with your footsteps.

Lennihan suggests trying different types of meditation classes to see which technique best suits you. "Meditating with a group of people is a much more powerful experience, and having a teacher talk you through the technique will make it much easier at first," she says. Many meditation classes are free or inexpensive, which is a sign that the teacher is truly devoted to the practice.

Starting your practice

The beauty and simplicity of meditation is that you don't need any equipment. All that's required is a quiet space and a few minutes each day. "Start with 10 minutes, or even commit to five minutes twice a day," Lennihan says. "Preferably meditate at the same time every morning. That way you'll establish the habit, and pretty soon you'll always meditate in the morning, just like brushing your teeth."

The specifics of your practice will depend on which type of meditation you choose, but here are some general guidelines to get you started:

Set aside a place to meditate. "You'll build up a special feeling there, making it easier to get into a meditative state more quickly," Lennihan says. Surround your meditation spot with candles, flesh flowers, incense, or any objects you can use to focus your practice (such as a photo, crystal, or religious symbol).

Sit comfortably in a chair or on the floor with your back straight.

Close your eyes, or focus your gaze on the object you've chosen.

Breathe slowly, deeply, and gently.

Keep your mind focused inward or on the object. If it wanders, gently steer it back to center.

Breathe peace and quiet into your heart and mind. "While you're breathing out, imagine your breath as a river or a tide that's carrying your thoughts away," Lennihan says.

You can also chant out loud. Many people use the Sanskrit word "shanti," which means "peace." Or choose a word from your own religious tradition. "Chanting out loud can help drown out thoughts," Lennihan says.

Within just a week or two of regular meditation, you should see a noticeable change in your mood and stress level. "People will start to feel some inner peace and inner poise, even in the midst of their busy lives," says Lennihan.

# data[].attributes.attachment_link.title
What meditation can do for your mind, mood, and health - Harvard Health

# data[].attributes.attachment_link.description
Image: ThinkstockTaking a few minutes to focus your mind each day can reduce stress, pain, depression, and more.You can't see or touch stress, but you can feel its effects on your mind and body. In the short term, stress quickens your heart rate and breathing and increases your blood ...

# data[].attributes.attachment_link.readable_text
Heart Disease - Ireland's No.1 Killer

Heart disease (cardiovascular disease) remains the most common cause of death in Ireland.

It is currently the cause of one-third of all deaths and one in five premature deaths. Approximately 10,000 people die each year from cardiovascular disease - including coronary heart disease, stroke and other circulatory diseases.

At the Irish Heart Foundation, we are fighting to deliver services that will contribute to a 25% reduction in premature deaths from cardiovascular disease by 2025. To do this, we are emphasising action on stroke, obesity, tobacco control, c ardiovascular disease prevention and heart failure as our policy priorities.

Heart Failure in Ireland is set to dramatically increase
90,000 people and 20,000 hospital admissions
Swollen ankles, breathlessness and extreme tiredness are key symptoms of heart failure, a chronic condition affecting 90,000 people living in Ireland and responsible for 20,000 hospital admissions each year.
Prompt assistance would help people live longer
Because so few people understand how common and life-threatening the condition is, they are not seeking the prompt medical assistance that can save their lives. However, with suitable treatment patients can live an active and comfortable life, preventing the heart function getting worse and helping them live longer.
We need to talk about Heart Failure more
In Ireland, heart failure is among the least talked about, the least understood and the least prominent of chronic diseases.

90,000 people have heart failure

There are 10,000 new cases every year

Because of population growth, longevity and disease prevalence the number of Irish people affected by heart failure is set to dramatically increase in the next decade.

What can we do? Focus on community care.
The recommendations for heart failure within the Cardiovascular Disease Policy (2010) are underlined by a desire to shift the centre of heart failure care from the hospital to the community setting. The policy proposes the development of an integrated community-based approach to heart failure management, led by primary care teams.

These recommendations are supported by the Irish Heart Foundation Council on Heart Failure.

# data[].attributes.attachment_link.title
Heart Disease - Ireland's No.1 Killer - Irish Heart Foundation

# data[].attributes.attachment_link.description
Heart Disease - Ireland's No.1 Killer Heart disease (cardiovascular disease) remains the most common cause of death in Ireland. It is currently the cause of one-third of all deaths and one in five premature deaths. Approximately 10,000 people die each year from cardiovascular disease - including coronary heart disease, stroke and other circulatory diseases.

# data[].attributes.attachment_link.title
There are more quitters than smokers in Ireland

# data[].attributes.attachment_link.description
One in eight people who smoked this time last year have since quit.

# data[].attributes.headline
The Respiratory and Circulatory Systems in the News 

# data[].attributes.subject
The Respiratory and Circulatory Systems in the News 

# data[].attributes.attachment_link.readable_text
New figures from the CSO show there has been a rise in the number of deaths from heart disease and strokes since last year.

The Irish Heart Foundation says obesity, lack of physical activity, diabetes and hypertension are causing the increase.

Michael O'Shea, Irish Heart Foundation Chief Executive, said that the latest CSO figures give cause for concern and may be an indication that the falling mortality rates from cardiovascular disease are beginning to reverse.

'To be effective in the fight against cardiovascular disease, society must take responsibility starting with the Government, food industry, Department of Transport, Department of Education, Department of Health and HSE, Department of Finance and parents.'

Mr O'Shea also stressed that a lack of physical activity and smoking are two of the biggest detrimental impacts on heart health and both are preventable.

'Not enough Irish people are taking adequate exercise and this combined with the consumption of the wrong types of food products, is causing our population to increase in weight.

'Meanwhile smokers have two to three times the risk of heart attack compared to non-smokers. Smoking causes a quarter of all coronary heart disease deaths and 11% of stroke deaths.'

# data[].attributes.attachment_link.title
CSO records rise in heart disease deaths

# data[].attributes.attachment_link.description
New figures from the CSO show there has been a rise in the number of deaths from heart disease and strokes since last year. The Irish Heart Foundation says obesity, lack of physical activity, diabetes and hypertension are causing the increase.

# data[].attributes.attachment_link.readable_text
Scientists in Ireland are developing a new treatment for lung diseases, including cystic fibrosis and asthma, as part of an €8.8m international project.

The first of its kind dry powder inhaler will deliver an innovative drug into the lungs in a way that is hoped will effectively break up thick sticky mucus that can cause lung infections.

Cystic fibrosis is caused by a genetic anomaly that leads to the production of a thick sticky mucus in the lungs, which in turn can lead to serious infections.

Ireland has the highest incidence of cystic fibrosis in the world.

While there are therapies that can break up the mucus, there are a limited number of effective ones.

In fact there have been no new versions of these mucolytic therapies in the past 20 years, and only one in the past 50.

Scientists at the University of California and University College Dublin have developed a novel compound which shows great promise as a drug for breaking up mucus.

Professors John Fahy and Stefan Oscarson from those universities have secured €8.8m from the US National Institutes of Health (NIH) for two projects associated with the development of new lung disease treatments.

As part of one of these, scientists from the Science Foundation Ireland-funded AMBER and SSPC centres, led by Prof Anne-Marie Healy, head of the school of pharmacy at TCD have been awarded €600,000 to devise a new method of delivering the drug into the lungs.

They will develop a first of its kind dry powder inhaler that will enable the treatment to reach the mucus and break it up.

Professor Anne Marie Healy, Head of the School of Pharmacy and Pharmaceutical Sciences at Trinity, Investigator in AMBER and SSPC (The Synthesis and Solid State Pharmaceutical Centre, led by the University of Limerick) said,

"I am delighted to be part of a transnational NIH project, which aims to take the research from bench to bedside," said Prof Healy.

"Ireland has the highest incidence of cystic fibrosis in the world, with approximately 1 in 19 Irish people carrying one copy of the altered gene that causes the condition.

"In addition, Ireland has the fourth highest prevalence of asthma in the world, with almost 5,000 asthma admissions to hospital on average each year.

"Our proposed new treatment has the potential to greatly improve the respiratory function of these patients with lung disease, thus improving overall quality of life and reducing hospital admissions."

It is expected that within the five year lifetime of the project the new treatment will be clinically trialled on humans.

It is hoped that as well as being used for treating cystic fibrosis and asthma, the inhaler will also be useful for tackling other lung conditions, like chronic obstructive pulmonary disease.

# data[].attributes.attachment_link.title
Scientists developing new lung disease treatment

# data[].attributes.attachment_link.description
Scientists in Ireland are developing a new treatment for lung diseases, including cystic fibrosis and asthma, as part of an €8.8m international project. The first of its kind dry powder inhaler will deliver an innovative drug into the lungs in a way that is hoped will effectively break up thick sticky mucus that can cause lung infections.

# data[].attributes.headline
The decrease of the prevalence of smokers in Kansas

# data[].attributes.subject
The decrease of the prevalence of smokers in Kansas

# data[].attributes.body
I felt this study was very relevant to this unit as it shows students how education around the topic of smoking and its heavy link to life-threatening damage coupled with the enforcement of anti-smoking procedures in Kansas has led to a dramatic decrease in the amount of smokers in that area. The result of this will be healthier lungs and heart and i'm sure this could be incorporated into some students posters.

# data[].attributes.attachment_link.readable_text
Peer Reviewed

Abstract

Introduction

Overall adult smoking rates are decreasing in the United States for both men and women. This phenomenon has also been observed in Kansas. It is important to know whether recent tobacco prevention and cessation activities, which have focused on nonsmoking ordinances and behavioral changes, have resulted in reductions in cigarette consumption.

Recent prevention and cessation activities in Kansas include tobacco counseling for the general population, smoking cessation activities in private organizations and hospital settings, general community education, support groups for patients hospitalized at numerous area hospitals, an American Lung Association Freedom from Smoking course, an Internet-based smoking cessation course, focused outreach to American Indian and Alaska Native populations that are state residents, local clean indoor air ordinances for workplaces and public places, media campaigns on the hazards of exposure to secondhand smoke, advocacy activities of the Tobacco Free Kansas Coalition, and state and federal excise taxes on cigarettes. Individuals can take various courses online, in person at a clinic, or through self-help workbooks. Additional help is also available for teenagers and children. The state's Chronic Disease Risk Reduction Program has assisted in such areas as youth and adult smoking, implementation of local clean air ordinances, and promotion of the Kansas Tobacco Quitline. These activities have been in place for more than 10 years. However, the effectiveness of these Kansas-specific measures is not described in the scientific literature.

Kansas' excise tax on cigarettes increased from $0.24 to $0.79 per pack from 1995 to 2009. The $0.79 rate has not changed since 2003; the state's excise tax rate ranks 36th in the nation ( 1). The federal excise tax on cigarettes increased from $0.24 to $1.01 per pack from 1997 to 2007. Tobacco prevention spending by the state of Kansas was only 7.8% of the minimum amount recommended by the Centers for Disease Control and Prevention in 2007 ( 2).

Before 2010, Kansas had 36 city and 3 county clean indoor air ordinances, with the first comprehensive municipal ordinance beginning in 2004. The various ordinances were a hodgepodge of requirements, loopholes, and exemptions. These exemptions included allowing smoking in restaurants after 9 pm; allowing certain bars and restaurants to buy out of the regulations; a lack of distance requirements for smoking around doors, operable windows, and air handling systems; allowing smoking in hotels and motels; and exempting certain private clubs ( 3). A comprehensive state statute, the Kansas Clean Indoor Air Act, went into effect on July 1, 2010, six months before the final data collection period for smoking prevalence. The state law has numerous exemptions; for example, 20% of the state's hotel and motel rooms and casino gaming floors are exempted.

From 1997 to 2006, cigarette smoking prevalence among adults (aged ≥18 y) decreased significantly among men in 29 of the 51 US reporting jurisdictions ( 2). Among women, smoking prevalence declined significantly in 30 jurisdictions and increased significantly in one. In Kansas, the annual cigarette smoking rate decreased significantly by 3.0% among men and nonsignificantly by 1.0% among women. No information is available on cigarette consumption in Kansas for that time.

According to Behavioral Risk Factor Surveillance System (BRFSS) survey data from 1996 to 2012, cigarette smoking prevalence declined significantly among men in 39.8% of 3,127 counties and among women in 16.2% of counties ( 4). A study using 2005-2010 National Health Interview Survey (NHIS) data reported that the proportion of adult daily smokers who smoked 1 to 9 cigarettes per day increased, whereas the proportion who smoked 30 cigarettes or more per day decreased ( 5). Neither survey provided data on smoking on some days. Another study using NHIS data reported that smoking prevalence among US adults declined from 20.9% in 2005 to 17.8% in 2013, and the proportion of daily smokers declined from 16.9% to 13.7% ( 6); data on cigarette consumption were not provided.

The objective of our study was to examine cigarette consumption (ie, mean annual number of cigarettes smoked) and smoking prevalence among adults in Kansas using the most recent data available. Our hypothesis was that cigarette consumption decreased as smoking prevalence decreased.

Methods

Data on cigarette smoking prevalence in Kansas were obtained for 1999 through 2010 from the BRFSS file on the Kansas Department of Health and Environment website ( 7). Two survey questions were used by the BRFSS to collect data on smoking prevalence: "Have you smoked at least 100 cigarettes in your entire life?" and "Do you now smoke cigarettes every day, some days, or not at all?" Sample sizes ranged from approximately 4,000 respondents (2000-2003) to approximately 8,000 (2004-2008). The BRFSS response rate in Kansas for 1999 through 2010 ranged from a low of 47.6% in 2000 to a high of 66.3% in 1999. In 2010 the response rate was 59.2%. Details on the survey were described previously ( 8).

Data on cigarette consumption were obtained from the 2002 and 2006 Kansas Adult Tobacco Survey (ATS). The ATS asked the 2 BRFSS smoking-related questions, plus 3 additional questions: "On the average, about how many cigarettes a day do you now smoke?," "During the past 30 days, on how many days did you smoke cigarettes?," and "On the average, on days when you smoked during the past 30 days, about how many cigarettes did you smoke a day?" Both BRFSS data and ATS data were used because neither source alone offered both prevalence and consumption data and because no single longitudinal study on prevalence or consumption offered the kind of data needed for our analysis.

We calculated mean annual cigarette consumption for smoking every day (number of cigarettes per day × 365) and for smoking some days (number of days of smoking in the past 30 days × the mean number of cigarettes smoked per day × 12 months). To obtain a representative set of population data, all responses were population weighted by age, sex, and race ( 8). The ATS survey methodology is unpublished but has been stated to be identical to the BRFSS surveys in 2002 and 2006. The ATS covered the entire state and had the same sample sizes as the BRFSS in both years. In both surveys, potential respondents who were not reached after 15 call attempts were categorized as nonrespondents.

Prevalence rates and 95% confidence intervals (CIs) were weighted by age, sex, and race to population characteristics ( 8). Population data were obtained from the 2000 US Census. We used linear regression for the trend analysis of the 1999-2010 BRFSS data; P values were calculated for sex after adjusting for year. For annual cigarette consumption, differences by sex and by year were tested by using the t test adjusted for survey design and weight. Significance was determined as P < .05, using a 2-tailed test. We did not adjust for multiple comparisons. All statistical analyses were performed using SAS version 9.3 (SAS Institute Inc). The project was approved by the Kansas Department of Health and Environment in 2011.

Results

Data on cigarette smoking prevalence were based on responses from 56,064 women and 35,401 men. Cigarette smoking prevalence was higher among men than among women from 1999 through 2010 ( P < .001) (). The prevalence decreased significantly among men from 24.3% in 1999 to 21.1% in 2010 ( P = .003), a 12.8% reduction, whereas the prevalence decreased (but not significantly) among women from 18.0% to 17.7% ( P = .055), a 2.2% reduction

Among men, the prevalence of every day smoking () decreased from 20.7% in 1999 (95% CI, 18.3%-23.1%) to 12.4% in 2010 (95% CI, 10.8%-14.0%) ( P = .001). Among women, the rate decreased from 15.6% in 1999 (95% CI, 14.0%-17.2%) to 11.5% in 2010 (95% CI, 10.3%-12.7%) ( P < .001).

Among men, the prevalence of smoking on some days fluctuated (), ranging from 3.6% in 1999 (95% CI, 2.6%-4.6%) to 5.8% in 2010 (95% CI, 4.4%-7.2%) ( P = .06). Among women, the prevalence of smoking on some days increased from 2.4% (95% CI, 1.7%-3.1%) to 4.3% (95% CI, 3.5%-5.1%) ( P = .003).

Data on mean annual cigarette consumption were based on responses from 1,114 respondents (542 men and 572 women) in 2002 and 3,684 respondents (1,768 men and 1,916 women) in 2006. From 2002 to 2006, the prevalence of smoking every day decreased from 18.5% to 16.1% among men and from 16.7% to 14.0% among women ().

The weighted mean annual cigarette consumption per person among all adult smokers in Kansas was 5,150 cigarettes in 2002 and 5,290 cigarettes in 2006; the difference in mean consumption by year was not significant ( P = .71) (). Men consumed more cigarettes than did women in each smoking category. Cigarette consumption overall averaged 14.1 to 14.5 cigarettes per day.

Table

Among men, annual consumption among every day smokers decreased from 7,133 (95% CI, 6,306.4-7,960.4) cigarettes to 6,446 (95% CI, 5,799.8-7,092.8) cigarettes ( P = .20). Annual consumption among some day smokers increased from 977 (95% CI, 484.0-1,469.7) cigarettes to 1,465 (95% CI, 935.5-1,994.4) cigarettes ( P = .18).

Among women, annual consumption among every day smokers increased from 5,425 (95% CI, 4,943.1-5,908.3) to 6,056 (95% CI, 5,526.1-6,586.6) cigarettes ( P = .08). Consumption among some day smokers decreased from 872 (95% CI, 498.8-1,245.1) to 648 (95% CI, 448.4-848.4) cigarettes ( P = .29).

Discussion

From 1999 through 2010 current cigarette smoking prevalence among Kansas adults decreased by 12.8% among men and 2.2% among women, compared with a 17.9% decrease nationally for both sexes combined ( 9). Prevalence data from the Kansas BRFSS and ATS are likely to be similar to each other because the sampling frame and catchment areas are similar for both studies. The rate of decrease in Kansas is less than what might be expected and desirable. The decrease in smoking prevalence among women in our study is in general agreement with an earlier national report on smoking prevalence ( 2). However, our data provide information on smoking on some days, which was not provided in the national report. The gender gap in the percentage of every day smokers narrowed over time in our study, similar to overall changes in the United States during the past 6 decades ( 10).

Overall smoking prevalence among men decreased significantly. This decrease included a significant decline in every day smoking and a nonsignificant increase in smoking on some days. Among women, the overall smoking prevalence did not decline significantly. Among women, the trend also included a significant decline in every day smoking and a significant increase in some day smoking, which was unexpected. This increase in some day smoking highlights the need for women to never start smoking.

The total number of cigarettes consumed annually by all adult smokers in Kansas was the same in 2002 and 2006. The decline in smoking prevalence during this period may have resulted in a more intense period of smoking exposure for the overall smoking population.

Given that cigarette consumption in Kansas averaged 14.1 to 14.5 cigarettes per day and assuming that as much as 20 mg of tar is inhaled with each cigarette ( 11), a substantial amount of tar is inhaled by every day smokers in Kansas, particularly over a 20-year period. For some day smokers, a significant fraction of tar could still be deposited. Although inhaled particles may be partially removed over time, pulmonary particle retention can be as high as 80% to 85% if chronic obstructive pulmonary disease is present ( 12). Peripheral parts of the lung (eg, alveolar regions) lack ciliated epithelium and mucus-secreting cells ( 11), possibly resulting in particle retention and increased risk for adenocarcinoma ( 13).

The effect of possibly having a shorter but more intense period of smoking exposure on future lung cancer rates is unknown. In a recent review and study in Norway, the risk for lung cancer among light smokers was higher in women than men (relative risk among women = 5.03, 95% CI, 1.81-13.98 vs relative risk among men = 2.79, 95% CI, 0.94-8.28) ( 14, 15), and the lung cancer risk among light smokers, although lower than that of regular smokers, was elevated ( 14, 15). The definition of light smoking varies, ranging from 1 to 39 cigarettes per week to less than 1 pack per day. The review could not evaluate rates of intermittent smoking because there is no consistent definition of intermittent smoking in the literature and concluded that the "published cohort studies lack a specific focus on intermittent smoking and tend to underrepresent minority populations, in which this type of tobacco use is most prevalent" ( 14). Studies of intermittent smokers in Finland and Denmark did not find a significant increase in lung cancer incidence ( 16, 17).

This study has at least 7 limitations: 1) types of smoking other than cigarette smoking are not included, 2) the use of self-reported data, 3) the limited number of years for consumption data, 4) the response rate of the survey, 5) the use of a cross-sectional survey design, 6) sample sizes, and 7) age of the data.

Information on cigar and pipe smoking were unavailable in the BRFSS and ATS, a potential gap in the assessment of tobacco exposure, particularly for men. The data do not indicate whether people are switching from cigarettes to a different type of smoking (ie, cigars, pipes, chewing tobacco, or e-cigarettes) or to dual usage to compensate for switching from smoking every day to smoking on some days.

Prevalence data are based on self-report, suggesting the possibility of recall or social desirability bias. However, a study of self-reported smoking status in Canada, which included measures of urinary cotinine, found a greater than 90% concordance between reported smoking status and urinary cotinine concentrations ( 18). The authors of the Canadian study caution, however, that 1) the response rate was only 52%, 2) both daily and occasional smokers were classified as smokers, and 3) the measurement of urinary cotinine may be inappropriate for occasional smokers. Similarly, in another study that included data from 3 countries, self-reported cigarette smoking prevalence was compared with either serum cotinine levels or salivary cotinine levels ( 19). Self-reported smoking prevalence underestimated true tobacco smoking prevalence by 0.6% in the United States, 2.8% in England, and 4.4% in Poland. Information on occasional smokers was not provided. However, using serum cotinine measurements, one of us detected numerous false negative reports of smoking in Kansas during 2006 through 2008 (S.M.L., unpublished data, 2006-2008).

Annual consumption information was based on 2 years of data. Additional cigarette consumption data for 1999-2001, 2003-2005, and 2007-2010 would have been helpful in evaluating trends, but these data were not available.

The BRFSS response rates in Kansas, ranging from 47.6% to 66.3%, are somewhat better than those for the nation as a whole. The median overall BRFSS response rate in 2004 across the 53 states and territories was 41.2% (range, 22.0%-63.4%) ( 20). Data on smoking prevalence and cigarette consumption represent all Kansans whether or not they answered the survey. Estimates were derived from the sampling design and weights were applied. We had no health or demographic information on people who refused to participate or did not answer the phone. Fifteen call attempts were made before designating a potential respondent as a nonrespondent. Although survey methodology for the ATS is stated to be similar to that for the BRFSS, details on ATS survey methodology are not published.

This was a cross-sectional survey, not a study over time of the same individuals. Thus, trends in smoking cessation might vary by individual age cohort, even if the overall trend is representative of the total population. A single longitudinal study would have been preferred but did not exist. Similarly, a single cross-sectional study with questions on both smoking prevalence and smoking consumption did not exist. Although the cigarette smoking questions were the same over time, the sample sizes varied. For 1999-2001 and 2003-2008, the Kansas BRFSS was conducted using disproportionate stratified sampling methodology, which considers the entire state as a single geographical stratum. In 2002, the sampling method used was only slightly modified from 2001. Beginning in 2009, the sampling method was modified by implementing disproportionate stratified sampling methodology that included selection of landline telephone numbers in 10 geographic strata consisting of county groupings instead of random selection of telephone numbers from the entire state as a single geographic stratum. However, the survey methods used were the same as those used in previous years, and the analysis included data weighting ( 3).

A relatively small number of people reported smoking on some days in 2002. Information was available from fewer than 40 men and 50 women, and these small numbers may have affected data stability and generalizability. However, the analysis was population weighted.

The data cover 1999 through 2010 for prevalence and 2002 through 2006 for consumption. New data are needed to determine recent changes.

Our study aimed to test the hypothesis that the mean annual number of cigarettes smoked decreased as smoking prevalence decreased. We found that while smoking prevalence declined, cigarette consumption among smokers did not. This could be a problem because exposure and risk are functions of both tobacco consumption and smoking prevalence. The trend in smoking on some days among women increased over time. Although some day smokers may have a reduced risk for lung cancer, their risk may depend on whether they previously accumulated many years of every day smoking or have other environmental or genetic risk factors for lung cancer.

Because of an approximate 20-year delay between smoking prevalence and lung cancer incidence rates ( 21), we cannot know how a change from smoking every day to smoking on some days will affect future lung cancer rates. No safe level is known for the impact of cigarette smoking on lung cancer, so the extent of sporadic or intermittent smoking on future lung cancer incidence needs further investigation. Follow-up reports of smoking prevalence should routinely include information on annual cigarette consumption for a better estimate of risk.

Analyses like this one can be useful to state policy makers and health departments because they can suggest additional tobacco prevention and control activities. For example, additional education is needed among the smoking population on the need to stop every day smoking. Particular emphasis could be placed on encouraging women never to start. Other activities in Kansas could include increasing excise taxes on tobacco products, strengthening the state's clean indoor air law, and fully funding the state's Tobacco Use Prevention Program. Our findings will be shared with the Kansas Department of Health and Environment, and we will work closely with them in developing BRFSS and ATS tobacco-related surveys and tobacco control programs.

Acknowledgments

This work was supported by the University of Kansas Medical Center, the Kansas Department of Health and Environment, and the Centers for Disease Control and Prevention. The Kansas Cancer Registry is funded by the Centers for Disease Control and Prevention and the Kansas Department of Health and Environment. The authors appreciate the cooperation of the Kansas Department of Health and Environment in providing cigarette smoking prevalence data from 1999 through 2010 from the BRFSS and from the ATS in 2002 and 2006. The authors have no competing interests to declare. Preliminary data were presented at the Annual Meeting of the National Conference on Smoking or Health on August 15, 2012, in Kansas City, Missouri.

Footnotes

The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions.

Suggested citation for this article: Neuberger JS, Lai SM. Cigarette Consumption and Cigarette Smoking Prevalence Among Adults in Kansas. Prev Chronic Dis 2015;12:150011. DOI: http://dx.doi.org/10.5888/pcd12.150011.

References

# data[].attributes.attachment_link.title
Peer Reviewed: Cigarette Consumption and Cigarette Smoking Prevalence Among Adults in Kansas

# data[].attributes.attachment_link.description
Peer Reviewed Overall adult smoking rates are decreasing in the United States for both men and women. This phenomenon has also been observed in Kansas. It is important to know whether recent tobacco prevention and cessation activities, which have focused on nonsmoking ordinances and behavioral changes, have resulted in reductions in cigarette consumption.