100 Years of Amnesia
Peace, war, WW1
Darryl Accone
It was meant to be the war to end all wars, another of those grandiose and foolish human notions. World War I, often dubbed the Great War, formally ended at 11am on 11 November 1918, though fighting on the far eastern front, in Russia, dragged on.
If there was greatness in the slaughter of 20 million soldiers and civilians, it lay in the sheer magnitude of the dead, and in countless acts of nobility, sacrifice and bravery, most unrecorded, if not unremembered. “Never again” was the cry that rang through Europe and the world after the guns grew silent, the troops returned home, and peace began scrabbling its way up from the bloodied earth of Europe.
Yet, here we are again, a scant 100 years later, faced with many of the same preconditions for continental and global conflict that saw the war of 1914 begin. Populist demagogues hold the reins of government in powerful nations with key strategic interests in Europe and the Middle East, from Erdogan in Ankara to Putin in Moscow. The United States is even more isolationist than it was in 1914, but with a vital difference: its leader is very keen to be numbered among those US presidents who have waged war and won.
Spoiling for a fight with new bogeyman China, Donald Trump embarks on a mutually destructive trade war, which is like the real thing without the shooting. Meanwhile, a series of skirmishes and little wars are waged by his administration against people who aren’t white Anglo-Saxon Protestants: migrants, non-capitalists, intellectuals, pacifists, conservationists, indeed anyone who lacks the radical reactionary beliefs of those enraptured by the so-called Rapture and the coming great war that will see Us (the Trumpites) beat Them (everyone else).
Bugles calling them from sad shires
“Was it for this the clay grew tall?” asks Wilfred Owen in Futility, one of the greatest of the poems written by the war poets, that small group who fought, and mostly died, between 1914 and 1918. Owen was killed in action on 4 November 1918, exactly a week before the war ended. He was 25.
In a ceremony this month to mark the centenary of Owen’s death, some of his poems were read at his graveside and the bugle that he had sent home, taken from a fallen enemy soldier, was played. It called to mind a line from his Anthem for Doomed Youth: “And bugles calling for them from sad shires”—“them” being the doomed and fallen youth.
That poem begins, viscerally:
What passing bells for those who die as cattle?
Only the monstrous anger of the guns.
Only the stuttering rifles’ rapid rattle
Can patter out their hasty orisons.
(Orisons being an archaic and literary word for “prayers”.)
Bugles are summoned again in 1914, Rupert Brooke’s set of five short poems.
Blow out, you bugles, over the rich Dead!
There’s none of these so lonely and poor of old,
But, dying, has made us rarer gifts than gold.
These laid the world away; poured out the red
Sweet wine of youth; gave up the years to be
Of work and joy, and that unhoped serene,
That men call age; and those who would have been,
Their sons, they gave, their immortality.
(The first stanza from III. The Dead.)
Is it all going to happen again?
Brooke died at 28 in 1915, a sub-lieutenant in the Royal Navy, during the campaign against Istanbul. He is buried on the Greek island of Skyros. In my first edition of his 1914 & Other Poems there is a poignant inscription, in pencil, by a previous owner of the book. It reads: “RBA / August 1915 / Ypres”. Ypres was one of the bloodiest chapters of the war, and one can reasonably surmise that RBA died there and was remembered by a loved one or a friend in that pencilled memoriam.
It was a survivor of the carnage, Siegfried Sassoon (1886–1967), who most conveyed the horror. In Aftermath, he writes:
Do you remember the rats; and the stench
Of corpses rotting in front of the front-line trench –
And dawn coming, dirty-white, and chill with a hopeless rain?
Do you ever stop and ask, ‘Is it all going to happen again?’
Three sections of the poem, italicised in the original, remind the hearer of what they dare not forget:
Have you forgotten yet? …
But the past is just the same, – and War’s a bloody game …
Look down, and swear by the slain of the War that you’ll never forget.
Look up, and swear by the green of the Spring that you’ll never forget.
And yet, we have forgotten, doomed to repeat the mistakes of the past.
Darryl Accone is books editor of the Mail & Guardian, a South African weekly newspaper, and director of the annual M&G Literary Festival.
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Home » Chapter 7: Cessation » 7.1 Health and other benefits of quitting
Suggested citation: Greenhalgh, EM, Stillman, S, & Ford, C. 7.1 Health and other benefits of quitting. In Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2016. Available from http://www.tobaccoinaustralia.org.au/chapter-7-cessation/7-1-health-and-other-benefits-of-quitting
A substantial body of research has established that quitting smoking has immediate as well as long-term health benefits for men and women of all ages, reducing risks for diseases caused by smoking and improving health in general.1-4
The strongest evidence for this comes from a landmark 50-year follow-up of 34,000 British male doctors first studied in 1951.5-7 Many participants quit as the evidence on smoking and health accumulated from the 1950s onwards, providing a natural experiment demonstrating the impact of number of years smoking on health and eventual mortality. The study showed just how hazardous tobacco is and estimated that almost two-thirds of persistent smokers were killed by their smoking. Among those who quit, the greatest benefit was seen in those who quit earliest in life.7 Quitting at age 50 halved the risk of smoking-related death, but cessation by age 30 avoided almost all of the excess risk. Stopping at age 60, 50, 40 or 30 resulted in gains, respectively, of about 3, 6, 9 or 10 years of life expectancy.7, 8 A number of more recent studies have supported these findings. A 2015 Australian study that explored tobacco smoking and all-cause mortality found that past smokers who quit prior to age 45 did not significantly differ in mortality from never-smokers. Mortality diminished gradually with increasing time since cessation. Current smokers lost an average decade of life compared with non-smokers.9 Similarly, Italian researchers found that the more cigarettes per day a person smokes, and the earlier the person quits, the more years of life gained. For men that smoked 10-19 cigarettes per day, cessation at age 30, 40, 50, or 60 led to a gain of about 7, 7, 6, or 5 years of life respectively, and for women, 5, 5, 4, or 3 years of life, respectively.10
Changes in disease risk following cessation can be measured in different ways. A common measure is relative risk, as in the studies cited above, where the likelihood of developing or dying of disease in a population of former smokers is compared to either current or never smokers. At a population level, relative risk represents the fraction of disease attributable to smoking. However this measure is influenced by the rates of disease in the reference population, which should be taken into account when examining the influence of cessation on disease risk. Another measure is absolute risk, where the actual rates of disease in former smokers are compared to those of current or never smokers. Rates can be directly compared, or the excess rate of disease caused by smoking in smokers can be calculated as can the excess disease rate in former smokers. Another measure is cumulative risk of disease, which enables the cumulative risk for those who quit at different ages to be compared to that of continuing smokers.
A more complete discussion of changes in risk following cessation can be found in a handbook published in 2007 by the International Agency for Research in Cancer.3 i In general, the risk of disease is lower in former smokers than in otherwise similar current smokers. Smoking results in both acute and chronic changes to the body and progression towards disease. Cessation results in reversal of acute changes and slowing of disease progression and provides the potential for damage reversal.3
Many harmful effects of smoking are arrested or begin to decline as soon as a person stops smoking.1, 2 Many disease risks in former smokers continue to decrease with prolonged abstinence, compared to continued smoking. The risk for some health effects decreases more rapidly than for others, and improvement may continue for years after quitting. Some disease risks return to the level of never smokers after a long period of abstinence, but others do not, even after 20 years of abstinence.3
The extent of damage to health and risk for smoking-related disease is related to how much the person has smoked and for how long.3 For some health effects, for example inflammation of the lung, the reversal process is not yet well understood.3
However, while some damage may be irreversible or less reversible, there are substantial benefits to be gained from quitting at any age, regardless of smoking history.1, 2 Benefits accrue to persons both with and without smoking-related disease.1
7.1.1 Health problems that may be temporarily exacerbated by quitting
While there is no question of the overall long-term benefits of cessation, quitting is associated with a number of bothersome short-term problems such as mouth ulcers and cold symptoms, weight gain and constipation.11
Mouth ulcers and colds
There is evidence that smokers and users of smokeless tobacco are less likely to develop aphthous stomatitis (common mouth ulcers). Individuals commonly report a short-term increase in mouth ulcers and cold symptoms on quitting smoking.12
Many smokers appear to have an increase in depressed mood and associated negative affect as part of nicotine withdrawal, but for the majority of people who quit this is temporary.13, 14 A common belief is that smoking cessation will exacerbate mental illness.15 However, recent evidence suggests that the reverse is true; quitting smoking for at least six weeks actually improves mental health, mood, and quality of life, both among the general population and among people with a psychiatric disorder.16 (See Section 7.12)
People with diabetes who quit smoking have a lower risk of death and cardiovascular events compared with those who continue to smoke.17 However, recent research has shown while quitting generally decreased the risk of diabetes overall, smoking cessation is associated with an increased risk and deterioration in blood glucose control in the first 2-3 years of abstinence.18, 19 A recent review similarly found that cessation can cause weight gain and can be associated with diabetes or obesity onset.20 Therefore, it is important that quit attempts are accompanied by preparation, extra care, and careful monitoring to keep the person's blood glucose well controlled during this time.18, 21
7.1.2 Quitting and weight gain
While smoking cessation usually results in some level of weight gain, there is disagreement about the extent and how long it lasts.
Smokers' average weight is about 3 to 4 kg less than that of non-smokers.14, 22 Smoking appears to attenuate weight gain over time, in part due to increasing metabolic rate.22, 23 The difference in weight between smokers and non-smokers is more marked in older long-term smokers while the average weight of younger smokers is similar.23-26 The weight difference, however, is further complicated by the finding that despite their lower weight and body mass index (BMI), smokers have a greater waist-to-hip ratio than non-smokers. Increased waist circumference is a stronger predictor of cardiovascular disease than BMI.27
When smokers quit, the majority experience some weight gain.1 Estimates of weight gain associated with cessation vary depending on the sample, study design and follow-up period.28 Most excess weight gain occurs in the first year after cessation, after which the rate of weight gain slows.22, 24, 29-33 One study found that increase in body weight may continue for longer.34 Estimates of the mean weight gain in people continuously abstinent for a year are about 5 to 6 kg.30-33 Results from a 2015 meta-analysis showed that on average, quitters gained 4.1 kg and continuing smokers gained 1.47 kg over an average of 5.15 years follow-up.35 Individual experience of weight change after quitting is quite broad, ranging from weight loss to a minority gaining over 10 kg.24, 31, 33, 36-39 Increase in waist circumference per kilogram gained is smaller in people who quit than in continuing smokers, indicating that recent ex-smokers gain less visceral fat.37, 40
Limited research suggests that some of the weight gained during the first few years after quitting may be lost with continued abstinence,41, 42 however more research is needed to resolve this issue.43 Large cross-sectional studies show that long-term former smokers have a mean waist-to-hip ratio and a mean BMI similar to or approaching that of people who have never smoked.27, 36, 39, 44 Research in New Zealand that followed a cohort of people from age 15 to 38 concluded that on average, quitters do not experience greater weight gain than never-smokers.45
Reasons for the association between smoking cessation and weight gain are not fully understood. Predictors of weight gain include younger age, lower socio-economic status and heavier smoking, with some influence of underlying genetic factors.29 Weight gain after smoking cessation is related to a transient increase in food intake,46 changes in metabolic rate,47 and minimal physical activity.48, 49 There is some evidence that smoking and obesity are independently associated with specific food cravings and mood states.50 Smokers who have a higher BMI also experience more weight gain after quitting.51, 52 A person's gender may also influence post-cessation weight gain. One study found that among light smokers, men gained more weight on average than women one year after quitting, while the opposite was observed among heavy smokers. Young women who were heavy smokers had the highest risk of weight gain after quitting.53
The health benefits of smoking cessation far outweigh the health risk from extra body weight, unless the weight gain is extraordinarily large.1 Even in cases of significant post-cessation weight gain and/or high prevalence of obesity, diabetes, and hypertension, sustained tobacco abstinence appears to substantially reduce cardiovascular risk.54, 55 The risk of death is smaller in overweight or obese ex-smokers than in normal-weight smokers.56 One study concluded that cessation related weight gain may actually be beneficial, as it is associated with increased muscle mass, muscle strength, and bone density.57 Nonetheless, fear of weight gain is a significant factor in discouraging quitting and provoking relapse in smokers.29, 58-66
(See Chapter 3, Section 3.29 for further information on the health effects of smoking in conjunction with and compared with those associated with obesity, and Section 7.8.3 for further information on managing weight gain.)
7.1.3 Immediate health effects of quitting
Upon cessation, the nicotine and carbon monoxide levels in the body decline rapidly. Nicotine levels drop to very low levels within a few hours, and the main metabolites of nicotine are largely eliminated within a week.1, 3, 67 After 24 hours the level of carbon monoxide in the blood has decreased substantially.1 After four weeks small airway function improves, with further improvements after six months.68 After two months, improvements can be seen in blood viscosity, blood flow to the limbs and blood levels of high-density cholesterol.1, 69, 70 Within six months the immune system improves greatly. Within a few months the cilia in the lungs and airways improve at sweeping mucus and debris from the lungs (as long as irreversible damage has not taken place).71 Lung function improves and the presence and severity of respiratory symptoms reduces.11 Symptoms of chronic bronchitis, such as chronic cough, mucus production and wheeze, decrease rapidly, and lung function in asthmatic patients improves within a few months after stopping smoking.3, 72, 73 Rates of respiratory infections such as bronchitis and pneumonia also decrease, compared to continued smoking.1
7.1.4 Short to medium-term reductions in health risks following quitting
7.1.4.1 Problems during pregnancy
It is extremely dangerous for a woman to smoke during pregnancy. (Refer to Chapter 3, Section 3.7 for a more detailed discussion of health effects, and Section 7.11 for a more detailed discussion of interventions aimed at pregnant women and their partners.) The US Surgeon General has stated that ‘smoking is probably the most important modifiable cause of poor pregnancy outcome among women in the United States'.1 Stopping smoking before or during pregnancy is important and has benefits for both the baby and the mother.74 Encouraging women to quit before they become pregnant or early in pregnancy is important because the critical period may be quite early.23
There is limited evidence that reducing consumption to fewer than eight cigarettes per day can improve birthweight75 and reduce preterm birth.76 However, complete abstinence is the only proven way to maximise health benefits. Women who stop smoking either before becoming pregnant or in the first three to four months of pregnancy have infants with a similar birthweight to those infants born to women who have never smoked.1, 77 Women who stop smoking any time up to the 30th week of pregnancy have infants with higher birthweights than those who smoke throughout pregnancy. Women who quit smoking before or during pregnancy reduce their risk of pregnancy complications, including preterm premature rupture of membranes and preterm delivery (birth at less than 37 weeks gestation).1, 23 Smoking cessation reduces the risk of infant death.78
7.1.4.2 Diseases for which the risk quickly declines
Smoking cessation reduces the risk of cardiovascular disease and death for male and female smokers of all ages with or without existing heart disease.4 One study found that smoking cessation is beneficial for people even after the age of 65 in reducing the excess risk of cardiovascular events and mortality.79 There are immediate and long-term benefits of cessation.80 After one year the increased risk halves and after about 151, 81 to 2082 years the rate is similar to that of a non-smoker for most former smokers. However, one study found that these cardiovascular benefits did not extend to former heavy smokers who smoked more than 3.2 packs per day, although they did have lower risk of death relative to current smokers.81 Quitting helps to improve peripheral vascular tone83 and to prevent atherosclerosis (the narrowing and hardening of the arteries due to build-up of plaque on the artery walls) advancing to heart disease and stroke.2, 3, 84 Smoking is a known risk factor for sudden cardiac death (SCD),2 and quitting smoking results in a significant reduction in SCD risk.85 Quitting is also associated with improved exercise tolerance among middle-aged men and women, with physical fitness being a protective factor against cardiovascular disease.86
There is a marked reduction in risk within two to five years of quitting.3 After 15 years the risk of stroke is the same as a non-smoker.1
Stopping smoking can reduce the risk of oral diseases associated with smoking including cancer, and improve the health of the mouth, gums and teeth.2, 87-89 Stopping smoking reduces the risk of leukoplakia, and after one to five years about half of leukoplakia disappears.90 Cessation reduces the risk of developing periodontitis, slows down the progress of existing disease, and quite quickly improves wound healing.2, 87, 91-93 Following cessation, gum colour gradually returns to normal88 and so-called ‘smoker's palate' can disappear.87, 88 Stopping smoking improves the success rate of dental implants.89 Smoking cessation may be associated with relatively rapid improvement in periodontal health in young adults.93
7.1.5 Medium to long-term health benefits of quitting
Successful cessation appears to stop the progressive increase in the use of health services associated with continued smoking within a few years.94
Specific long-term health benefits include:
Lung cancer. Quitting is beneficial for lung cancer risk.95 Quitting at age 30 reduces the risk of lung cancer by several times compared to a lifetime smoker. Even quitting at 50 more than halves the risk over the next 25 years compared to continued smoking.96 The absolute annual risk of developing or dying from lung cancer does not decrease, but by stopping smoking the much greater increase in risk that would result from continuing to smoke is avoided.3
Chronic obstructive pulmonary disease (COPD). Smoking cessation remains the only proven strategy for reducing the disease-causing processes leading to COPD.4 Cessation reduces decline in lung function.97 In smokers without COPD, stopping smoking improves lung function by about 5% within a few months of cessation. The accelerated decline in lung function in smokers stops within five years of smoking cessation, returning to the far slower rates of decline that naturally occur with ageing.1, 3 Existing emphysematous damage to lung tissue caused by smoking is permanent1 however cessation slows the progression of COPD.11 Symptoms of COPD will be less likely in the short and long term.1 However, even after many years of abstinence, COPD risk still remains elevated in comparison with never smokers.1 Statistical modelling has estimated that about 35% of the excess risk still exists after 20 years of quitting.98 In people diagnosed with COPD, stopping smoking reduces the rate of lung function decline, decreases the risk of hospitalisation for COPD,3, 71, 99 and results in fewer physician visits and less use of COPD medications.100
Other cancers. Smoking cessation is the only proven strategy for reducing the disease-causing processes leading to cancer.4 The risks of cancers of the mouth, throat, larynx, oesophagus, stomach, bladder, kidneys, pancreas and cervix are reduced after quitting compared to continued smoking, and continue to decrease over time.1, 3 The risk of pancreatic, oral and cervical cancers quite quickly become similar to people who have never smoked, but the risks for the other cancers remain higher than never-smokers even after 15 to 20 years.1, 3
Peripheral vascular disease. Quitting slows down the build-up of plaque on artery walls, so that the risk of the disease is substantially reduced. For those who already have the disease, amputations are less likely.1, 101
Blindness. Cataract development and macular degeneration risks and progression are reduced.2, 67
Male erectile dysfunction is reduced when smokers quit.2, 67
Female fertility. Missed and painful periods are reduced after quitting, as is the risk of delayed conception and early menopause.23, 102 The higher risk of heart disease and stroke among women smokers who use the contraceptive pill is reduced.103
Overall health and quality of life improve, with some evidence that heavier smokers report greater improvement in quality of life after quitting and report feeling happier compared with when they were smoking.1, 2, 104-107 Ex-smokers also appear to experience a meaningful increase in subjective well-being (i.e. satisfaction with life) from quitting.108 A 2014 meta-analysis reported that smoking cessation is associated with reduced depression, anxiety, and stress, and improved positive mood compared with continuing to smoke.16 Quitting has also been linked with less financial stress among women.109
7.1.6 Cutting down: are there health benefits?
Cutting down the number of cigarettes smoked each day is a common strategy used by smokers to reduce harm, to move towards quitting, or to save money.110-113 However, research shows no noticeable improvement in health outcomes or lifespan among smokers who are able to cut down on a long-term basis.4, 114-116 This is largely because smokers primarily seek a consistent level of nicotine. Those who cut down therefore tend to smoke the remaining cigarettes harder by taking more and larger puffs, and holding each puff longer. Thus they do not reduce their intake of toxins as much as the reduction in the number of cigarettes suggests.111, 117 For a detailed discussion on smoking reduction, see Chapter 18, Section 18.3.
7.1.7 Other benefits of quitting
There are other benefits of quitting smoking. Financial savings for a 20 cigarette pack-a-day smoker are about $7500 per year (2016 prices).118 Smokers who quit reduce their likelihood of financial stress and are likely to enhance their material wellbeing.119 As more public and private places become smokefree, ex-smokers avoid the inconvenience of having to find somewhere to smoke. Quitting avoids further smoking-related damage to skin, and slows the development of wrinkles.120 Life insurance is often cheaper,121 the risk of smoking-related fires is reduced122, 123 and people who quit have fewer sick days.2
Relevant news and research
For recent news items and research on this topic, click here.(Last updated May 2019)
1. US Department of Health and Human Services. The health benefits of smoking cessation. A report of the Surgeon General. Atlanta, GA: Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1990. Available from: http://www.cdc.gov/tobacco/data_statistics/sgr/pre_1994/index.htm.
2. US Department of Health and Human Services. The health consequences of smoking: A report of the Surgeon General. Atlanta, Georgia: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004. Available from: http://www.cdc.gov/tobacco/data_statistics/sgr/index.htm.
3. International Agency for Research on Cancer. Reversal of risk after quitting smoking. IARC handbooks of cancer prevention, Tobacco Control, 11 Lyon, France: IARC, 2007. Available from: http://apps.who.int/bookorders/anglais/detart1.jsp?sesslan=1&codlan=1&codcol=76&codcch=22.
4. US Department of Health and Human Services. How smoking causes diseases: A report of the Surgeon General. 2010. Available from: www.surgeongeneral.gov/library/tobaccosmoke/Cached .
5. Doll R and Hill AB. The mortality of doctors in relation to their smoking habits: A preliminary report. British Medical Journal, 1954; 1(4877):1451-5. Available from: www.ncbi.nlm.nih.gov/pubmed/13160495
6. Doll R, Peto R, Wheatly L, Gray R, and Sutherland I. Mortality in relation to smoking: 40 years' observations on male British doctors. British Medical Journal, 1994; 309(6959):901-11. Available from: http://www.bmj.com/cgi/content/full/309/6959/901
7. Doll R, Peto R, Boreham J, and Sutherland I. Mortality in relation to smoking: 50 years' observations on male British doctors. British Medical Journal, 2004; 328(7455):1519. Available from: http://www.bmj.com/cgi/content/abstract/328/7455/1519
8. Taylor DH, Hasselblad V, Henley SJ, Thun MJ, and Sloan FA. Benefits of smoking cessation for longevity. American Journal of Public Health, 2002; 92(6):990-6. Available from: http://www.ajph.org/cgi/content/full/92/6/990
9. Banks E, Joshy G, Weber MF, Liu B, Grenfell R, et al. Tobacco smoking and all-cause mortality in a large Australian cohort study: Findings from a mature epidemic with current low smoking prevalence. BMC Medicine, 2015; 13(1):38. Available from: http://www.ajph.org/cgi/content/full/92/6/990
10. Carrozzi L, Falcone F, Carreras G, Pistelli F, Gorini G, et al. Life gain in Italian smokers who quit. International Journal of Environmental Research and Public Health, 2014; 11(3):2395-406. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24577282
11. Gratziou C. Respiratory, cardiovascular and other physiological consequences of smoking cessation. Current Medical Research and Opinion, 2009; 25(2):535-45. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24577282
12. Ussher M, West R, Steptoe A, and McEwen A. Increase in common cold symptoms and mouth ulcers following smoking cessation. Tobacco Control, 2003; 12:86-8. Available from: http://tc.bmjjournals.com/cgi/content/abstract/12/1/86
13. Hughes J. Effects of abstinence from tobacco: Valid symptoms and time course. Nicotine & Tobacco Research, 2007; 9(3):315-27. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17365764
14. Royal College of Physicians of London. Nicotine addiction in Britain. A report of the tobacco advisory group of the royal college of physicians. London: Royal College of Physicians of London, 2000. Available from: http://bookshop.rcplondon.ac.uk/details.aspx?e=131 .
15. Mendelsohn CP, Kirby DP, and Castle DJ. Smoking and mental illness. An update for psychiatrists. Australas Psychiatry, 2015; 23(1):37-43. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25512967
16. Taylor G, McNeill A, Girling A, Farley A, Lindson-Hawley N, et al. Change in mental health after smoking cessation: Systematic review and meta-analysis. British Medical Journal, 2014; 348:g1151. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24524926
17. Qin R, Chen T, Lou Q, and Yu D. Excess risk of mortality and cardiovascular events associated with smoking among patients with diabetes: Meta-analysis of observational prospective studies. International Journal of Cardiology, 2013; 167(2):342-50. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24524926
18. Lycett D, Nichols L, Ryan R, Farley A, Roalfe A, et al. The association between smoking cessation and glycaemic control in patients with type 2 diabetes: A thin database cohort study. The Lancet. Diabetes and Endocrinology, 2015; 3(6):423-30. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24524926
19. Sung Y-T, Hsiao C-T, Chang I-J, Lin Y-C, and Yueh C-Y. Smoking cessation carries a short-term rising risk for newly diagnosed diabetes mellitus independently of weight gain: A 6-year retrospective cohort study. Journal of Diabetes Research, 2016; 2016:7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24524926
20. Bush T, Lovejoy JC, Deprey M, and Carpenter KM. The effect of tobacco cessation on weight gain, obesity, and diabetes risk. Obesity, 2016; 24(9):1834-41. Available from: http://dx.doi.org/10.1002/oby.21582
21. Kilpatrick ES. Risk factors: Smoking cessation in T2DM-not without issues but still worthwhile. Nature Reviews. Endocrinology, 2015. Available from: http://dx.doi.org/10.1002/oby.21582
22. Perkins K. Weight gain following smoking cessation. Journal of Consulting and Clinical Psychology, 1993; 61(5):768-77. Available from: www.ncbi.nlm.nih.gov/pubmed/8245274
23. US Department of Health and Human Services. Women and smoking. A report of the Surgeon General. Atlanta, Georgia: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2001. Available from: http://www.cdc.gov/tobacco/data_statistics/sgr/index.htm .
24. Klesges RC, Ward KD, Ray JW, Cutter G, Jacobs DR, Jr., et al. The prospective relationships between smoking and weight in a young, biracial cohort: The coronary artery risk development in young adults study. Journal of Consulting and Clinical Psychology, 1998; 66(6):987-93. Available from: www.ncbi.nlm.nih.gov/pubmed/9874912
25. Akbartabartoori M, Lean ME, and Hankey CR. Relationships between cigarette smoking, body size and body shape. International Journal of Obesity, 2005; 29(2):236-43. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15505632
26. O'Loughlin J, Karp I, Henderson M, and Gray-Donald K. Does cigarette use influence adiposity or height in adolescence? Annals of Epidemiology, 2008; 18(5):395-402. Available from: www.ncbi.nlm.nih.gov/pubmed/18346909
27. Canoy D, Wareham N, Luben R, Welch A, Bingham S, et al. Cigarette smoking and fat distribution in 21,828 British men and women: A population-based study. Obesity Research, 2005; 13(8):1466-75. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16129730
28. Eisenberg D and Quinn B. Estimating the effect of smoking cessation on weight gain: An instrumental variable approach. Health Services Research, 2006; 41(6):2255-66. Available from: www.ncbi.nlm.nih.gov/pubmed/17116119
29. Filozof C, Fernandez Pinilla MC, and Fernandez-Cruz A. Smoking cessation and weight gain. Obesity Reviews, 2004; 5(2):95-103. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15086863
30. Nides M, Rand C, Dolce J, Murray R, O'Hara P, et al. Weight gain as a function of smoking cessation and 2-mg nicotine gum use among middle-aged smokers with mild lung impairment in the first 2 years of the lung health study. Health Psychology, 1994; 13(4):354-61. Available from: www.ncbi.nlm.nih.gov/pubmed/7957014
31. O'Hara P, Connett JE, Lee WW, Nides M, Murray R, et al. Early and late weight gain following smoking cessation in the lung health study. American Journal of Epidemiology, 1998; 148(9):821-30. Available from: http://www.ncbi.nlm.nih.gov/pubmed/7957014
32. Pirie PL, McBride CM, Hellerstedt W, Jeffery RW, Hatsukami D, et al. Smoking cessation in women concerned about weight. American Journal of Public Health, 1992; 82(9):1238-43. Available from: www.ncbi.nlm.nih.gov/pubmed/1503165
33. Klesges RC, Winders SE, Meyers AW, Eck LH, Ward KD, et al. How much weight gain occurs following smoking cessation? A comparison of weight gain using both continuous and point prevalence abstinence. Journal of Consulting and Clinical Psychology, 1997; 65(2):286-91. Available from: http://psycnet.apa.org/index.cfm?fa=main.landing
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Richard III cortege through Leicester on Sunday
Saturday, March 21st, 2015
The week of events leading to the reinterment of King Richard III on Thursday, March 26th, begins this Sunday with a cortege bearing his coffin from the University of Leicester to the Leicester Cathedral. After emerging from the university’s Fielding Johnson Building, the coffin holding Richard III’s remains will depart in a hearse at 11:40 AM and begin a slow procession stopping at historical sites from Richard’s last days.
The first stop is Fenn Lane Farm, the spot where archaeologists believe Richard III died at the Battle of Bosworth on August 22, 1485. There the Reverend Hilary Surridge will lead a private ceremony bringing together soil from three locations of significance in the king’s life: Fotheringhay (where he was born), Middleham (where he spent his early teens learning the knightly arts), and Fenn Lane (where he died).
Further stops include the Sutton Cheney church, the nearby Bosworth Heritage Centre and Bow Bridge, the medieval boundary of Leicester where the City Mayor, Lord Mayor and Gild of Freemen will welcome the remains. The cortege will then follow on foot to St. Nicholas Church where after a brief service the coffin will be transferred to a horse-drawn hearth to process through the city center.
The final stop at 5:45 PM is Leicester Cathedral where the king’s remains will be formally handed over from the University, holder of the Ministry of Justice exhumation license, to the Cathedral Church of St Martin, Leicester. The congregation will hold a service of Compline with a sermon preached by Cardinal Vincent Nichols, the Roman Catholic Archbishop of Westminster. On Monday the Cathedral will open to members of the public who wish to view the coffin and pay their respects. It will remain open during the week.
I haven’t been able to find any live video feeds of the entire cortege, but BBC Radio Leicester will be covering it. Listen live here. Channel 4 television will be covering the reinterment live on Thursday but is only scheduled to broadcast the arrival of Richard’s coffin at Leicester Cathedral on Sunday at 5:10 PM GMT.
Leicester has a website dedicated to reinterment week with lots of information and details about the events. The BBC has interactive maps of the cortege’s stops outside and inside the city. I’m hoping the University of Leicester’s YouTube channel, which has been replete with Ricardian goodness in anticipation of the reinternment, will have complete video of all the ceremonies.
Posted in Medieval, Modern(ish) | 2 Comments »


The Cliffsofmoher dies after suffering injury in Melbourne Cup
By Adam Pengilly & Chloe Booker
Updated November 6, 2018 — 6.51pm first published at 3.51pm
Irish visitor The Cliffsofmoher has been put down after a mishap passing the winning post the first time in the Melbourne Cup.
The Caulfield Cup placegetter, trained by Aidan O'Brien, fractured a shoulder as he was approaching the turn out of the straight for the first time.
Stablemate Yucatan was favourite and ran 11th in the race, which was won by Cross Counter, with Marmelo second and A Prince of Arran third.
Jamie Stier, Racing Victoria's manager of integrity services, confirmed the news on Tuesday afternoon.
“It is with sadness that we confirm that The Cliffsofmoher had to be humanely euthanised after sustaining a fractured right shoulder during the running of the Melbourne Cup at Flemington,” Stier said.
“The horse received immediate veterinary care, however it was unable to be saved due to the nature of the injury sustained.
“This was an unfortunate incident that happens infrequently, with Victoria having one of the best safety records in world racing.
The Cliffsofmoher is attended to on the track after suffering an injury. Credit:Eddie Jim
“Our sympathies are extended to Coolmore and the Williams family, the owners of The Cliffsofmoher, jockey Ryan Moore, trainer Aidan O’Brien and his staff who cared for the horse and are greatly saddened by their loss.”
Ryan Moore was uninjured in the incident.
The chairman and the directors of the Victoria Racing Club released a statement extending their sympathies to the Williams family and Coolmore connections of The Cliffsofmoher.
Jockey Ryan Moore is assisted by a race steward after The Cliffsofmoher was injured. Credit:AAP
It is the fourth time in the past six years that the Melbourne Cup has been shrouded by the death of horses.
In 2014 pre-race favourite Admire Ratki died after collapsing from heart failure in the stalls minutes after the race.
In the same race, import Araldo had to be euthanised because of an injury suffered when he was returning to scale.
Araldo placed seventh but was spooked by a flag in the crowd on the way back to weigh in, kicking out and breaking a rear leg on a fence.
In 2015 crowd favourite and three-time Cup runner up Red Cadeaux had to be euthanised two and a half weeks after the Cup as a result of complications from an injury suffered in that year's race.
The RSPCA has called the death of Cliffsofmoher a tragedy.
"Today's tragedy is a stark reminder of the risks these horses face every time they run, and highlights that behind the gloss and glamour of Cup celebrations there is a dark reality," spokeswoman Jane Speechley said.
"The racing industry has much work to do."
Anti-racehorsing protesters have condemned Cliffsofmoher's death, calling for major reforms to the industry.
"We are calling on the racing industry to phase out two-year-old racing and ban the whip so that horses are not pushed beyond their limits," said Elio Celotto from the Coalition for the Protection of Racehorses.
People for the Ethical Treatment of Animals said it wanted an investigation into the horse’s death.
"Cliffsofmoher [is] the most recent victim of the cruel annual spectacle known as the Melbourne Cup,’’ the PETA spokesman said.
"Considering Australians hate cruelty to animals, commemorating a day on which horses routinely die in the Melbourne Cup is fundamentally un-Australian."
"Horrific to see celebrations continue while this horse may be dying," one of many tweets about the horse's death said.
With AAP
Spring Racing Carnival
Adam Pengilly
Adam Pengilly is a Sports reporter for The Sydney Morning Herald.
Chloe Booker
Chloe Booker is a reporter at The Age.


Special Coverage Civic Election 2010
Parting shot maligns quality of councillors
'I think the average IQ has been less with every council'
Posted: 09/20/2010 1:00 AM	| Comments:
One of the longest-serving politicians in the City of Winnipeg's history says the quality of city councillors has declined during his decades in office because salaries have become too low to attract gifted candidates.
This Wednesday's city council meeting will be the final legislative hurrah for Old Kildonan Coun. Mike O'Shaughnessy, who has sat on city council for 30 out of the past 36 years.
Only Mynarski Coun. Harry Lazarenko, who remains hospitalized following a May aneurysm and who is also expected to retire, has served the city as long as O'Shaughnessy.
An often outspoken conservative with federal Liberal affiliations, O'Shaughnessy served as council speaker, finance chairman, and other roles during a career that saw him work with six different mayors during two stints on council, from 1974 to 1980, and then from 1986 until next month. Prior to entering politics, he covered city hall for the Winnipeg Free Press.
MIKE APORIUS / WINNIPEG FREE PRESS ARCHIVES
Coun. Mike O'Shaughnessy served 30 years on council under six different mayors.
He also witnessed council contract from 50 members to 29 and then finally 16. But he does not believe Winnipeg has better representation now than it did when he was first elected.
"I think the average IQ has been less with every council," O'Shaughnessy said last week in an interview inside the office he'll soon vacate.
The salaries offered to councillors are part of the problem, he said, as they're better suited for low-level managers than politicians responsible for $1.4 billion worth of annual city budgets. Meanwhile, unelected managers are compensated far more handsomely. "You have department heads making up to $200,000 and EPC (executive policy committee members) making $75,000. It's kind of silly," he said.
O'Shaughnessy also contends some of today's full-time councillors have entered politics for the wrong reasons. "There are too many people who want to be a city councillor and not enough who want to do the work of a city councillor," he said, citing modest works such as the construction of community centres, arenas and basketball courts in Old Kildonan as his proudest achievements.
City-wide, he's proud of helping create The Forks and thankful he was off council when Portage Place was approved. He concedes he made a mistake when he voted against Esplanade Riel, the pedestrian bridge he now calls "the stamp of Winnipeg."
He wants this city to continue to promote business, complete an inner ring road, and help create more affordable apartments in the Exchange District for singles, young couples and seniors.
But he fears council will remain divided between ideological factions. "Let's not argue over what to do," he says, imploring council's left-leaning opposition to be less negative and more constructive in its dealings with the centre-right majority. "Let's not argue 'this is bad.' Argue 'I've got something better,' " he said.
Winnipeg Mayor Sam Katz said O'Shaughnessy will be remembered as a very creative but no-nonsense public servant who knew the rules of council better than anyone else and never shied away from speaking his mind.
"He was extremely outspoken," Katz said.
The heated atmosphere of public life is partly what's leading O'Shaughnessy to retire. He has diabetes, must lose 45 kilograms, and has suffered two heart attacks over the past seven years.
"With my last one, my heart stopped. They had to put the pedals on me twice," he said. "After property committee (on Sept. 14), my chest was so heavy because I was so pissed off and so into it.
"I can't afford to care that much any more. It isn't worth dying for."
O'Shaughnessy refuses to formally endorse a successor, although he makes no secret of his affection for Old Kildonan candidate Devi Sharma, a former executive assistant.
"Who I help privately on the side is my business," he said. "Devi's son calls me grampa, so you can figure out."
O'Shaughnessy said he won't miss anything about public life. He said he expects the same sorts of people who stopped calling him when he was away from council from 1980 to 1986 to follow suit this time.
He said he "found out who my friends were in a hurry" during his darkest days on council, when he was accused of taking an envelope of money from a developer but was fully exonerated by the RCMP. A six-month investigation took place toward the end of the Bill Norrie administration.
O'Shaughnessy is not sentimental about leaving office. He said he would have skipped Wednesday's council meeting if he didn't have to introduce a minor item on the public works agenda he took over following the death of Charleswood Coun. Bill Clement in May.
"Council was my least favourite of all my meetings," he said, dismissing it as theatre. "When I spoke on things on occasion, it was quite often since I heard so much B.S. from other people.
"I wanted to make sure something was on the record that was factual."
Trio of veterans leaving
At least two veteran city politicians will make their final appearance in the council chamber this Wednesday -- a third may have already said goobye.
Mike O'Shaughnessy (Old Kildonan): Will retire next month after serving on council for 30 years, from 1974 to 1980, and then from 1986 until the present.
Lillian Thomas (Elmwood-East Kildonan): Will retire next month after serving on council for 21 years, beginning in 1989.
Harry Lazarenko (Mynarski): Expected to retire next month after serving on council for 30 years, from 1974 to 1977, and then from 1983 until the present.