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Passengers riding in the cars of smokers are exposed to nicotine levels nearly twice those found in restaurants and bars that permit smoking, a new study suggests.

The dangers of exposure to secondhand smoke are well known, including the risk for heart and respiratory disease, and have led to laws banning smoking in many public places. Many anti-smoking advocates believe the next frontier in the fight against secondhand smoke is in cars.

“These levels of exposure are unacceptable for nonsmoking passengers, particularly children, who are at increased risk for secondhand smoke-related health problems,” said study co-author Patrick Breysse, director of the Division of Environmental Health Engineering at the Johns Hopkins University Bloomberg School of Public Health.

Breysse and his co-author Dr. Ana Navas-Acien, an assistant professor of occupational and environmental health at Hopkins, believe that smoking should be banned in cars as it has been in other places.

“The high secondhand tobacco smoke levels measured in this study support the urgent need for smoke-free education campaigns and legislative measures banning smoking in motor vehicles when passengers, especially children, are present,” Navas-Acien said.

The report is published in the Aug. 25 online edition of Tobacco Control.

For the study, Breysse and Navas-Acien compared nicotine levels in the cars of 17 smokers and five nonsmokers whose commute to and from work took 30 minutes or longer. The researchers placed airborne nicotine samplers in the cars, one near the front passenger seat headrest and another in the back seat behind the driver.

The researchers then analyzed the samples and found a twofold increase in concentrations of nicotine for every cigarette smoked.

Navas-Acien and Breysse estimate that nicotine concentrations are twice as high in smokers’ cars as in other public and private places studied, and 40 percent to 50 percent higher than in restaurants and bars that allow smoking.

“While partially opening windows reduced exposure to secondhand smoke it did not eliminate exposure within motor vehicles,” Breysse said. “It is important to remember that there is no known safe level of exposure to secondhand smoke.”

People in the study also completed a questionnaire that included questions on their knowledge and attitudes about the health risks of secondhand smoke and relevant regulations and legislation. Both smokers and nonsmokers said smoking in a car posed a health risk to passengers. Among smokers, 53 percent said not being able to smoke in the car would help them to quit, and 93 percent said cars should be smoke-free voluntarily. Only 7 percent of smokers said there should be laws outlawing smoking in cars.

“Results of this research and other studies can be used to develop education campaigns aimed at eliminating secondhand smoke exposure in motor vehicles,” Breysse said. “In addition, these results can be used to support legislative efforts aimed at banning smoking in vehicles, particularly when children are present.”

Dr. Norman H. Edelman, chief medical officer of the American Lung Association, said “all those people who smoke in cars and think they are protecting the passengers by using AC [air conditioning] or opening the window are wrong and potentially impairing their passengers’ health.”

Matthew L. Myers, president of the Campaign for Tobacco-Free Kids, called the new study “a rude wake-up call — cars literally become toxic gas chambers.”

Myers also believes that laws banning smoking in cars are needed. “It is appropriate and necessary to ban smoking in cars where children are passengers,” he said. “Children are not volunteers in cars. This is a more intense, more dangerous exposure to kids than in any other location.”

Patients who take the diabetes drugs known as thiazolidinediones may be at higher risk of bone fracture, new research suggests.

In the study, Dr. Ian Douglas of the London School of Hygiene and Tropical Medicine and colleagues searched a database of more than 6 million patients in the United Kingdom and found 1,819 people aged 40 and older who had had a bone fracture and had been prescribed a type of thiazolidinedione. The drugs were introduced in the 1990s and are used to treat type 2 diabetes.

After adjusting their figures to account for the fact that older people are more likely to break bones, the researchers found that those taking thiazolidinediones had almost 1.5 times as many fractures while taking the drugs as they did when they weren’t taking the drugs. The risk grew the longer the people took the medications.

The findings support previous research that has suggested a link between these medications and bone fractures. But the researchers acknowledge that the study didn’t follow the gold standard of research, which is to randomly assign people to take the drug or not take it.

Still, Douglas and colleagues conclude that the findings “should be taken into consideration in the wider debate surrounding the possible risks and benefits of treatment with thiazolidinediones.”

Don’t discount a bump to the noggin that knocks you out during a soccer game: Researchers report poorer than average thinking skills and reaction times in young soccer players, and particularly female players, who had just one concussion.

Concussions – usually marked by a loss of consciousness — may result in memory loss, slower reaction times, poorer thinking skills, and symptoms such as headache, dizziness, trouble balancing, and nausea. There may be as many as four million sports-related concussions per year.

But questions remain on the severity of a first, versus repeated concussions in male and female athletes, mostly because prior studies were a mix of body sizes, contact sports, and helmet use, note Dr. Alexis Chiang Colvin, at Mount Sinai Medical Center in New York, New York, and colleagues.

The current study, in The American Journal of Sports Medicine, tested post-concussion memory, reaction times, and symptoms, in U.S. soccer players of similar body size.

Colvin’s team assessed 141 female and 93 male soccer players from 8 to 24 years old, within 2 weeks of their concussion diagnosis.

Overall, the 101 athletes with a history of prior concussion had poorer memory, ability to process visual images, and reaction times than did 133 athletes without a prior concussion.

Still, compared with male soccer players with concussion, females had significantly poorer – meaning slower – overall reaction time and a markedly higher number of symptoms.

Those findings remained true after adjusting for various factors such as age, grade level, and the number of days after the injury.

Colvin and colleagues call for more studies, particularly of the severity of concussion among female athletes.

People suffering from the flu may be at higher risk for having a heart attack, especially those with heart disease and diabetes, British researchers report.

Because both seasonal and the pandemic H1N1 swine flu are circulating this fall and winter, people at risk for heart attacks are urged to get a seasonal flu shot and an H1N1 flu shot, which may reduce the chance of getting the flu and thereby lower the risk for a heart attack, experts say.

“Influenza is most concerning because of its secondary complications,” said Dr. Marc Siegel, an associate professor of medicine at New York University School of Medicine in New York City.

“Most of the time with influenza, death or hospitalization isn’t because of the influenza, it’s because influenza puts you in a weakened state — it’s a stress on the system,” he said. “So, it is not surprising that you would have the increased risk of a myocardial infarction during or right after an influenza infection.”

In addition, the flu virus may have a negative effect directly on the heart, Siegel said. “Flu stresses and strains the system,” he added.

To determine the risk of heart attack among those with flu, a research team led by Andrew C. Hayward, a senior lecturer in infectious disease epidemiology at the UCL Centre for Infectious Disease Epidemiology in London, looked at 39 studies conducted between 1932 and 2008.

The studies showed an increase in deaths from heart disease and more heart attacks during flu season. In fact, excess deaths because of heart disease averaged 35 percent to 50 percent, according to the report in the October issue of The Lancet Infectious Diseases.

But the studies also showed that getting a flu shot reduced the risk of dying from heart disease or suffering a heart attack, Hayward’s group found.

“We believe influenza vaccination should be encouraged wherever indicated, especially in those people with existing cardiovascular disease. Further evidence is needed on the effectiveness of influenza vaccines to reduce the risk of cardiac events in people without established vascular disease,” Hayward’s team concluded.

Dr. Gregg C. Fonarow, a professor of cardiology at the University of California, Los Angeles, agreed that flu shots appear to reduce the risk of heart attacks.

“It has long been hypothesized that influenza infection results in an acute inflammatory response that can also trigger the onset of cardiovascular events such as heart attack and stroke in vulnerable individuals,” Fonarow said.

A number of observational studies have suggested more cardiovascular events occur in patients with influenza than otherwise expected and that individuals who receive annual flu shots are much less likely to have fatal or nonfatal cardiovascular events or be hospitalized for heart failure, he said.

“Guidelines from the American Heart Association and American College of Cardiology strongly recommend that all individuals with cardiovascular disease receive annual influenza vaccination,” Fonarow said.

However, Dr. Pascal James Imperato, dean and distinguished service professor at the School of Public Health at the State University of New York Downstate Medical Center in Brooklyn, said the role of flu shots in preventing heart attack has not been proven conclusively.

“The role of severe respiratory infections in precipitating myocardial infarctions in vulnerable individuals is well-established,” Imperato said. “However, the role of influenza vaccines in protecting such individuals is less clear from the limited scientific evidence available.”

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Eat right, exercise and hope that your genes don’t predispose you to dementia.

That’s the recipe for preserving cognitive function as you age, according to four new studies that were presented this week at the Alzheimer’s Association annual meeting, in Vienna.

The findings echo other research suggesting that clean living can safeguard mental sharpness. However, one of the studies did contain a surprise finding — that strenuous exercise actually impaired cognitive skills later in life.

That should be viewed, for now, with some skepticism, said William Thies, chief medical and scientific officer of the Alzheimer’s Association.

“That’s something I wouldn’t take on faith from a single study,” he stressed.

But the heart-healthy diet advice seemed sound, he said, and confirms other research. In that study, Heidi Wengreen, an assistant professor of nutrition at Utah State University, asked 3,831 adults, aged 65 and older, to complete a food survey. They then tested their cognitive skills over an 11-year period, beginning in 1995.

The researchers looked to see how well the participants followed the DASH diet, an eating regimen that protects against hypertension and heart trouble. Those who followed the DASH diet more closely had higher scores on the cognitive tests at the start of the study and over time, Wengreen found.

Although Wengreen said more study was needed, “I believe there is plenty of evidence to suggest that diet plays a role in delaying cognitive decline and perhaps preventing Alzheimer’s disease among the elderly.”

Two exercise studies found staying active can also help.

In one study, Deborah E. Barnes, of the University of California, San Francisco, followed more than 3,000 adults aged 70 to 79. Those who were sedentary had the lowest level of cognitive function at the start and higher rates of decline over the course of the seven-year study.

A third study found moderate long-term exercise helped cognitive skills later, but that strenuous long-term exercise might hamper them.

Mary Tierney, a professor of family and community medicine at the University of Toronto, evaluated 90 women, aged 50 to 63, taking into account their long-term activity, both moderate and strenuous. Each woman got a score for strenuous and moderate activity.

Strenuous activities included swimming laps, aerobics, calisthenics, jogging, running, basketball, biking on hills and racquetball. Moderate included brisk walking, golf, volleyball, cycling on level streets, tennis and softball.

“The average long-term strenuous activity was for 2.5 hours a week, and the average long-term moderate activity was 3.2 hours a week,” Tierney said.

“The worst groups [on cognitive function tests] were the ones highest in strenuous and lowest in moderate,” she said.

Exactly why the link showed up isn’t known, she said. But it may be that the strenuous exercise is lowering estrogen levels and lowered estrogen lowers cognitive skills. “Estrogen is bad for breast cancer, but good for the brain,” Tierney explained.

It’s impossible to say how much exercise is too much, Tierney added.

Yet another study in which researchers followed nearly 1,800 men and women aged 60 and older found that physical activity boosts cognitive function, except in those who carried the so-called Alzheimer’s gene, known as APOE-e4.

Thies said the study on the DASH diet may be especially valuable because the diet gives detailed information about what to eat and the plan is widely available.

The link found between strenuous exercise and lowered cognitive skills may be explained by something else in future research, he said. “You could propose that people who exercise perhaps are a little more tired when they take the test,” Thies noted.