title: Tobacco smoking contributes little to facial wrinkling.
abstract: BACKGROUND
  The potential detrimental effects of tobacco smoking have been widely cited. Tobacco smoking has been linked with facial wrinkling, but some previous studies have failed to take into account a number of potential confounders or were unblinded and thus subjective to bias.
  
  
  OBJECTIVE
  This study was designed to determine if there was increased facial wrinkling in smokers directly associated with tobacco usage after controlling for solar risk behavior.
  
  
  METHODS
  Eighty-two smokers (> 10 cigarettes per day) and 118 non-smokers (< 100 lifetime cigarettes) were recruited. Caucasian participants completed a questionnaire designed to assess demographic variables and other suspected factors related to wrinkling.
  
  
  METHODS
  Three dermatologists, blinded to demographic information, reviewed three photographs of each subject and rated the wrinkling on a 100 mm visual analog scale. Stepwise linear regression was performed on all variables which attained a P < 0.1 level of independent significance.
  
  
  RESULTS
  Overall the model accounted for 75.4% (P = 0.0001) of the variance in wrinkling, and predictive variables (P < or = 0.02) included age (partial R2 = 0.69), smoking pack years (R2 = 0.04), hours of outdoor work (R2 = 0.008), freckling (R2 = 0.007), and eye color (R2 = 0.004). A second model was created excluding age which accounted for 37.8% of the variance. The predictive variables in the second model (P < 0.08) included education (partial R2 = 0.08), smoking pack years (R2 = 0.05), hours of outdoor work (R2 = 0.03), weight change (R2 = 0.02), female sex (R2 = 0.02), hours of lifetime sun (R2 = 0.03), tanning bed use (R2 = 0.01), and sunscreen use (R2 = 0.02).
  
  
  CONCLUSIONS
  Smoking may significantly contribute to facial wrinkling, but accounts for only 6% of the explained variance. If there is a role for tobacco smoking in causing wrinkling, this role is a minor one.
authors.affiliation: Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1071, USA.
authors.forename: P M
authors.initials: PM
authors.lastname: O'Hare
authors.forename: A B
authors.initials: AB
authors.lastname: Fleischer
authors.forename: R B
authors.initials: RB
authors.lastname: D'Agostino
authors.forename: S R
authors.initials: SR
authors.lastname: Feldman
authors.forename: M A
authors.initials: MA
authors.lastname: Hinds
authors.forename: S A
authors.initials: SA
authors.lastname: Rassette
authors.forename: A J
authors.initials: AJ
authors.lastname: McMichael
authors.forename: P M
authors.initials: PM
authors.lastname: Williford
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015982:Bias; D001835:Body Weight; D015986:Confounding Factors, Epidemiologic; D004522:Educational Status; D005127:Eye Color; D005145:Face; D005260:Female; D005544:Forecasting; D006801:Humans; D016014:Linear Models; D008297:Male; D008548:Melanosis / Q000150:complications; D008875:Middle Aged; D012309:Risk-Taking; D012737:Sex Factors; D016037:Single-Blind Method; D015595:Skin Aging / Q000473:pathology*; D012907:Smoking / Q000009:adverse effects*; D013472:Sunlight / Q000009:adverse effects; D013473:Sunscreening Agents / Q000627:therapeutic use; D011795:Surveys and Questionnaires
chemical_list: D013473:Sunscreening Agents