Tobacco and Public Health - TCSC Indonesia

652
TOBACCO AND ALCOHOL INTERACTION
be heavy smokers, so it can be difficult to separate the effects of these two agents on the
pancreas. However, several studies have now reported that smoking in addition to
alcohol is a separate risk factor for pancreatitis. (Lowenfels et al. 1987; Talamini et al.
1996; Hartwig et al. 2000; Lin et al. 2000). Chronic pancreatitis is an example of a
digestive tract disorder where exposure to both addictive substances leads to the onset
of a debilitating, painful disease.
Dupuytren’s contracture
Dupuytren’s contracture (William Dupuytren, French surgeon 1777–1835), has long
been known to be associated with moderate to heavy alcohol consumption. The lesion,
which occurs in the palmar or plantar fascia, is characterized by the development of
strong fibrous bands, which restrict digital mobility. Recent studies have demonstrated
that smoking, in addition to alcohol, is a risk factor for this disease. One case-control
study based on 222 operated patients, revealed that smoking nearly tripled the risk of
developing this Dupuytren’s contracture: adjusted odd ratio 2.8, 95% CI = 1.5–5.2.)
Alcohol was an additional risk factor, resulting a twofold increased risk (Burge et al.
1997). In another study, the findings were nearly identical (An et al. 1988). The mechanism
might be related to microvascular occlusion with subsequent development of
fibrosis, leading to disabling contractures.
Other conditions
Trauma
The combination of drinking and smoking can cause serious injury—particularly
burns. A frequent scenario is as follows: after two or three drinks, a person smokes
a final cigarette in bed, falls asleep with the cigarette still burning, wakes up only after
sustaining a major burn. Both smoking and drinking are modifiable risk factors that
can significantly reduce the frequency of domestic fires (Warda et al. 1999).
Pregnancy
Despite the well-known adverse effects of smoking and drinking during pregnancy,
many women continue to smoke and drink even though they are pregnant. Estimated
exposure figures, based on actual interviews, are 34% for tobacco and 25% for alcohol
(Jones-Webb et al. 1999).
The main effect of smoking exposure and moderate alcohol intake seems to be
a reduction in fetal birth weight (Olsen et al. 1983), whereas heavy alcohol exposure
causes fetal alcohol syndrome, characterized by distinct facial abnormalities, hyperirritability,
and persistent cognitive impairment (Streissguth et al. 1994). Both smoking
and drinking may interact with specific genetic alterations to cause cleft lip and/or cleft
palate (Romitti et al. 1999). Clearly, both smoking and drinking have adverse effects on
the fetus; efforts at intervention should be included as an integral part of pre-conception
planning (Barrison and Wright 1984).