Non-Cigarette Tobacco Products Double Chances of Youth Smoking Within a Year

MedicalResearch.com Interview with:
“hookah” by Ksenia M is licensed under CC BY 2.0Benjamin Chaffee, DDS MPH PhD

UCSF School of Dentistry
San Francisco, CA 94118

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Non-cigarette tobacco products, which include electronic cigarettes, hookah (tobacco waterpipe), smokeless tobacco, and non-cigarette combustibles, like cigars, are increasingly popular among young people. Considerable debate surrounds whether use of these non-cigarette products encourages youth to begin smoking conventional cigarettes.

Several previous studies have shown associations between non-cigarette tobacco use and youth smoking. These studies had largely looked at only one type of tobacco product at a time. This study included more than 10,000 adolescents from all over the United States, surveyed at two time points one year apart. Therefore, this study featured enough participants and detailed information about tobacco behaviors to consider all types of tobacco products in a comprehensive way.

We found that each type of non-cigarette tobacco product (i.e., e-cigarettes, hookah, combustibles, or smokeless tobacco) added to smoking risk. Among youth who had never smoked a cigarette at the start of the survey, use of any of the non-cigarette products approximately doubled the odds of cigarette smoking within a year, after adjusting for multiple smoking-related risk factors. Each product independently increased risk. The adolescents most susceptible to future smoking to were those who had tried two or more types of non-cigarette tobacco.

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Fewer Cigarettes But More Vaping Among Today’s Adolescents

MedicalResearch.com Interview with:
“Checking your phone and vaping as you do” by Alper Çuğun is licensed under CC BY 2.0
Richard Allen Miech, PhD
Research Professor, Survey Research Center
Institute for Social Research
University of Michigan 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Monitoring the Future conducts annual, nationally-representative surveys of ~45,000 adolescents every year to assess trends in substance use.  We track which drugs are gaining traction among adolescents and which are falling out of favor.  The survey draws separate, nationally-representative samples of 8th, 10th, and 12th grade students from about 400 total schools every year.  Once a recruited school agrees to participate, a field interviewer travels to the school to administer the paper-and-pencil survey, typically in classrooms.  The project is funded by the National Institute of Drug Abuse and is carried out by the University of Michigan.  More details on the project’s survey design and survey procedures can be found in chapter 3 here: http://monitoringthefutu re.org/pubs/monographs/mtf- vol1_2016.pdf

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Married Head/Neck Cancer Patients Less Likely To Smoke, More Likely To Live Longer

MedicalResearch.com Interview with:

Nosayaba Osazuwa-Peters, BDS, MPH, CHES Instructor, Department of Otolaryngology-Head and Neck Surgery Saint Louis University School of Medicine Member, Saint Louis University Cancer Center St Louis, Missouri

Nosayaba Osazuwa-Peters

Nosayaba Osazuwa-Peters, BDS, MPH, CHES
Instructor, Department of Otolaryngology-Head and Neck Surgery
Saint Louis University School of Medicine
Member, Saint Louis University Cancer Center
St Louis, Missouri 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Several studies have shown that there is an adverse effect of smoking on head and neck cancer survival; however, there are studies that show no effect between smoking and head and neck cancer. We wanted to investigate this problem using a single institution’s cancer dataset. Additionally, we wanted to understand the role of marital status in the smoking behavior of head and neck cancer patients, and to understand if smoking played any role in head and neck cancer survival.

Our study confirmed that head and neck cancer patients who were smokers at the time of diagnosis had lower survival rates than nonsmokers. We also found that married head and neck cancer patients were less likely to be smokers and more likely to survive longer than those unmarried.

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Trained Volunteers Can Deliver Effective Brief Smoking Cessation Advice

MedicalResearch.com Interview with:
“Stop smoking!” by Emil_95 is licensed under CC BY 2.0
Dr. Man Ping Wang, PhD
School of Nursing
University of Hong Kong
Hong Kong

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Smoking cessation (SC) services can effectively increase the chance of abstinence, but few smokers proactively seek help from these services worldwide. Smoking cessation guidelines recommend referring smokers to SC services, but such referrals were usually conducted in a passive way (e.g. providing contacts of these services and asking smokers to use them). Actively referring smokers may increase use of smoking cessation services and abstinence rates.

Previous studies were mostly conducted in clinical settings. We investigated the efficacy of using trained volunteers to actively refer smokers recruited in the community to smoking cessation services in this cluster randomized control trial. We found that smokers who received a brief cessation advice and active referral had significantly higher abstinence rate and smoking cessation service use rate at 6-month follow-up, compared with smokers who received a minimal advice and a self-help booklet.

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Can Cigarette Butts Be Recycled Into Bricks and Concrete?

MedicalResearch.com Interview with:

Abbas Mohajerani BsEng, MsEng, PhD, FIEAust, MAGS. MACI Senior Lecturer School of Engineering, Civil and Infrastructure Engineering RMIT University Melbourne Victoria  Australia

Dr. Mohajerani

Abbas Mohajerani BsEng, MsEng, PhD, FIEAust, MAGS. MACI
Senior Lecturer
School of Engineering, Civil and Infrastructure Engineering
RMIT University
Melbourne Victoria  Australia

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: I knew about the harmful chemicals in cigarette butts and was not happy to see them everywhere in the environment, in our footpath, parks, and rivers. Cigarette butts (CBs) contain a large number of toxic to highly toxic chemicals and stay in the environment for a long time. Decomposition of CBs can take from a couple of months to many years depending on the environmental factors.

Cigarette butts are one of the most common types of waste found around the world. Currently about 6 trillion cigarette butts per year are deposited somewhere in the environment. This is equivalent to an estimated mass of over 1.2 million tonnes of Cigarette butts each year. And this is expected to increase significantly by 2025, mainly due to an increase in the world population.

In 2005, I started to think about different ways to recycle CBs in construction materials, and the first idea which struck me was to recycle them in fired clay bricks.

After several years of research, we came up with a proposal, that if every brick manufacturer were to produce 2.5% of their bricks with 1% Cigarette butts incorporated, all CBs produced worldwide could be recycled. A 1% CB content would have very little effect on the physical and mechanical properties of the brick. And the estimated firing energy saved by incorporating 1% CBs into clay bricks is about 10%. That is a very significant reduction in the firing energy.

This proposal was published in the journal of Waste Management in May 2016.

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Cheap Cigarettes in Europe Associated With Increased Infant Mortality

MedicalResearch.com Interview with:

Filippos Filippidis MD MPH PhD Lecturer in Public Health School of Public Health Imperial College London London

Dr. Filippidis

Filippos Filippidis MD MPH PhD
Lecturer in Public Health
School of Public Health
Imperial College London
London

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Smoking kills millions of people every year. It is well established that increasing tobacco prices is the most effective way to reduce tobacco consumption and hence mitigate the devastating effects of tobacco on health. Taxation on tobacco products is high in the European Union, which makes cigarettes less affordable. However, transnational tobacco companies are known to manipulate prices, ensuring that cheap or ‘budget’ cigarettes are still available. This is particularly important for younger smokers and those of low socioeconomic status who are more sensitive in price increases.

Smoking during pregnancy, as well as exposure of pregnant women and babies to cigarette smoke increase infant mortality. There is also evidence that increasing tobacco prices is associated with lower infant mortality. However, researchers typically use average or premium cigarette prices. We analysed 54 million births from 23 European Union countries to see if the differential between average priced and budget cigarettes (i.e. the availability of cigarettes much cheaper than average priced ones) is associated with infant mortality.

We found that increasing average cigarette prices by 1 Euro per pack was associated with 0.23 fewer deaths per 1,000 live births in the same year and an additional 0.16 fewer deaths per 1,000 live births in the following year. A 10% increase in the price differential between budget and average priced cigarettes was associated with 0.07 more deaths per 1,000 live births the following year. This means that 3,195 infant deaths could potentially have been avoided in these 23 countries if there was no price difference between cigarette products over the 10-year study period.

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Smoking Cessation Meds Underprescribed To Hospitalized Cardiac Patients

MedicalResearch.com Interview with:

Dr Quinn Pack

Dr. Quinn Pack

Dr.  Quinn R Pack MD
Assistant Professor of Medicine at Tufts University School of Medicine
Baystate Northern Region Cardiology
Baystate Health
Springfield, MA  

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Smoking is the leading cause of preventable death and is very common among patients with heart disease.  Several smoking cessation medications are available and recommended in clinical guidelines to help smokers quite. However, it was unknown how often these were used and what factors make the use of pharmacotherapy more common.

The main finding is that, across of broad range of hospitals, smoking cessation medications are infrequently used and the hospital where the patient was treated was the most important factor in determining if the patient was treated.

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Holes in Cigarette Filters Linked To Increase in Lung Adenocarcinomas

MedicalResearch.com Interview with:
Peter G. Shields, M.D.
Deputy Director, Comprehensive Cancer Center
James Cancer Hospital
Professor, College of Medicine
Julius F. Stone Chair in Cancer Research
The Ohio State University Columbus, OH

MedicalResearch.com: What do we know about the health effects of cigarette filters? 
Response:  The issue is that the design of the filters makes a cigarette even more dangerous, which can be regulated by the FDA. The issue is not about having a filter, but how they are made. And now we are changing the dialogue to the design of virtually all cigarettes. The holes on the filter are likely one reason the cigarettes of today are more dangerous.

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“Heat-Not-Burn” Cigarettes Release Heart Attack and Cancer-Causing Chemicals

MedicalResearch.com Interview with:

Reto-Auer.jpg

Prof. Reto Auer

Reto Auer, MD, MAS
Institute of Primary Health Care (BIHAM), University of Bern, Bern,
Department of Ambulatory Care and Community Medicine
University of Lausanne, Lausanne, Switzerland

MedicalResearch.com: What is the background for this study?

Response: When the tobacco industry began to promote new “heat-not-burn” (HNB) tobacco cigarettes as a “safer” alternative to traditional cigarettes, we wanted to find out if their claims were true. Philip Morris International (PMI) created an HBN called IQOS® (I-Quit-Ordinary-Smoking). IQOS® uses tobacco sticks soaked in propylene glycol, which are inserted into a holder and heated to a maximum of 350°C. PMI claims that because its HNBs don’t combust, they emit far fewer harmful chemicals than conventional cigarettes. We decided to test their claims.

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E-cigarette Smoke Increases Bladder Cancer Risk

MedicalResearch.com Interview with:

Moon-shong Tang, Ph</strong>D Professor of Environmental Medicine, Pathology and Medicine New York University School of Medicine Tuxedo Park, New York 10987

Dr. Moon-shong Tang

Moon-shong Tang, PhD
Professor of Environmental Medicine, Pathology and Medicine
New York University Langone School of Medicine
Tuxedo Park, New York 10987

MedicalResearch.com: What is the background for this study?

Response: E-cigarettes (E-cigs) are designed to deliver the stimulant nicotine through aerosols, commonly referred as vapors. Nicotine is dissolved in organic solvents such as glycerin and propylene glycol. The nicotine is then aerosolized by controlled electric heating. E-cigs do not use tobacco leaves and E-cig smoke does not involve the burning process. Hence, E-cig smoke (ECS) contains only nicotine and the gas phase of the solvent. Because ECS contains neither carcinogens nor allergens or odors from the tobacco burning process, E-cigs have been promoted as an invention that can deliver a TS ‘high’ without TS negative effects. The population of E-cig users is rapidly rising, particularly in young adults. It has been estimated that 16% of high school students are E-cig smokers. Therefore, the health effects of E-cig smoke, particularly its carcinogenicity, deserve careful scrutiny.

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Smoking Associated With Comorbidities in Atopic Dermatitis

MedicalResearch.com Interview with:

Jacob P. Thyssen MD, PhD, DmSci Department of Dermatology and Allergy Herlev and Gentofte Hospital University of Copenhagen Hellerup, Denmark

Dr. Thyssen

Jacob P. Thyssen MD, PhD, DmSci
Department of Dermatology and Allergy
Herlev and Gentofte Hospital
University of Copenhagen
Hellerup, Denmark

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Atopic dermatitis has been associated with various comorbidities. With the emergence of biologics for the treatment of atopic dermatitis, the hypothesis has been raised that atopic dermatitis is a systemic immune disease affecting more than just the skin.

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Cigarettes Continue To Vastly Outweigh Sales Of E-Cigarettes

MedicalResearch.com Interview with:

Kristy Marynak Master of Public Health Public Health Analyst at Centers for Disease Control and Prevention Centers for Disease Control and Prevention Duke University

Kristy Marynak

Kristy Marynak, Master of Public Health
Public Health Analyst at Centers for Disease Control and Prevention
Centers for Disease Control and Prevention
Duke University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The background for our study is that in recent years, self-reported cigarette smoking has declined among youth and adults, while electronic cigarette (e-cigarette) use has increased. However, sales trends for these products are less certain. Our study assessed national and state patterns of U.S. cigarette and e-cigarette unit sales using retail scanner data from convenience and grocery stores; mass merchandisers like Walmart; drug, dollar, and club stores; and military commissaries.

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Patients Who Quit Smoking Had Fewer Adverse Events After Knee Replacement

MedicalResearch.com Interview with:
Amy Wasterlain, MD

Fourth-year orthopaedic surgery resident
NYU Langone Medical Center who led the study with Dr. Richard Iorio 

MedicalResearch.com: What is the background for this study?

Response:  We looked at smoking habits and outcomes for 539 smokers undergoing primary total hip or knee arthroplasty, 73 of whom participated in a pre-operative smoking cessation program. Patients who participated in program were 4.3 times more likely to quit than smokers who tried to quit on their own. Program participants also reduced their tobacco intake dramatically (10.6 fewer cigarettes/day) compared to smokers who didn’t participate (2.3 fewer cigarettes/day), even if they weren’t able to quit completely. Patients who completed the program before undergoing total knee arthroplasty had about 24% fewer adverse events (readmission, venous thromboembolism, stroke, urinary tract infection, pneumonia, and surgical site infection) than smokers who didn’t participate in the program.

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Prenatal Tobacco Smoke Raises Risk of Atopic Dermatitis in Offspring

MedicalResearch.com Interview with:

Dr. Saskia Trump PhD Helmholtz-Centre for Environmental Research – UFZ Department of Environmental Immunology Leipzig, Germany

Dr. Saskia Trump

Dr. Saskia Trump PhD
Helmholtz-Centre for Environmental Research – UFZ
Department of Environmental Immunology
Leipzig, Germany

MedicalResearch.com: What is the background for this study?

Response: Environmental chemicals have long been discussed to contribute to the exacerbation or even the development of allergic diseases. In our study we were particularly interested in the effect of tobacco smoke exposure, which is the main source for indoor benzene exposure, on regulatory T cell (Treg) function and its relation to the development of childhood atopic dermatitis (AD). Tregs play a critical in controlling T effector cell activity by avoiding overexpression. A deficiency in this T cell subset increases the risk for allergic inflammation.

We have previously described that exposure to tobacco smoke during pregnancy can decrease the number of regulatory T cells (Treg) in the cord blood and predispose the child to the development of AD (1). In this subsequent study we were interested in the underlying mechanism involved.

Benzene itself is not considered to be toxic, however its metabolization leads to the formation of highly reactive molecules. In humans for example the metabolite 1,4-benzochinone (1,4-BQ) can be found in the blood as a consequence of benzene exposure.

To further assess the effect of benzene on Treg and the development of AD we combined in vitro studies, evaluating the impact of 1,4-BQ on human expanded Treg, with data from our prospective mother-child cohort LINA. The LINA study, recruited in Leipzig, Germany, is a longitudinal evaluation of mother-child pairs with respect to lifestyle and environmental factors that might contribute to disease development in the child. Based on this deeply phenotyped cohort we were able to translate our in vitro findings to the in vivo scenario.

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CVS Pharmacy’s Discontinuance of Tobacco Sales Led To Big Drop In Cigarette Purchases

MedicalResearch.com Interview with:

Jennifer M. Polinski PhD Senior Director, Enterprise Evaluation and Population Health Analytics, CVS Health CVS Caremark Corporation Harvard School of Public Health

Dr. Jennifer Polinski

Jennifer M. Polinski PhD
Senior Director, Enterprise Evaluation and Population Health Analytics, CVS Health
CVS Caremark Corporation
Harvard School of Public Health

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Nearly three years ago, we removed tobacco products from all CVS Pharmacy locations to help our customers on their path to better health. While there is a growing body of evidence that suggests that restricting access to tobacco helps reduce its use, we wanted to understand if our decision to remove tobacco had a nationwide impact on our customers’ purchasing behavior and presumed smoking habits.

In fact, our research findings, published in the American Journal of Public Health, show that CVS Health’s decision to remove tobacco from all CVS Pharmacy stores reduced the number of cigarette purchases across all other retail settings, including gas stations, convenience stores, and other outlets. In addition, customers who exclusively purchased cigarettes at CVS Pharmacy were 38 percent more likely to stop buying cigarettes, and those who purchased three or more packs of cigarettes per month at a CVS Pharmacy were more than twice as likely to stop buying cigarettes altogether.

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High Achieving Adolescents Less Likely To Smoke, But More Likely to Drink, Use Pot

MedicalResearch.com Interview with:
Dr. James Williams
UCL Medical School
UCL
, London, UK

MedicalResearch.com: What is the background for this study?

Response: Despite a downward trend over the last decade in the usage of particular substances amongst adolescents in the UK, smoking cigarettes, drinking alcohol and smoking cannabis remain prevalent behaviours in this demographic. These risky health behaviours present a large problem in terms of public health due to the immediate and long-term health problems they cause, as well as negative non-health outcomes such as poor educational attainment and reduced employment.

The role of academic ability in determining patterns of substance use is not clear and no study has evaluated academic ability at age 11 in relation to the onset and persistence of all three substances from early to late adolescence and into young adulthood. Our study sought to determine the association between academic ability and the onset and persistence of substance use in adolescence in a representative sample of English school pupils. This would answer for the first time whether ability was associated with ‘experimentation’ in early adolescence or if the association persists into late adolescence.

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Smokers Who Switch Completely To E-Cigs Reduce Their Exposure to Toxins

MedicalResearch.com Interview with:
Dr Lion Shahab
MA (Oxon) MSc MSc PhD CPsychol AFBPsS PGCLTHE
Senior Lecturer in Health Psychology
Department of Behavioural Science and Health
University College London
London 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: To date most studies on e-cigs have either looked at the product itself, i.e. analysed vapour/aerosol or e-liquid, or investigated its effects on animal and cell models. Only very few studies have looked at actual body-level exposure in users of e-cigarettes to evaluate their safety, and this study is the first to explore this in long-term real-life users of e-cigs.

We find that compared with people who continue to smoke conventional cigarettes, those who switch over completely to using e-cigarettes long-term (1.5 years) dramatically reduce their exposure to cancer-causing chemicals to levels observed in users of nicotine replacement products like nicotine patch or gum (which are known to be safe when used long-term).

Our results also suggest that while e-cigarettes are not only safer, the amount of nicotine they provide is not noticeably different to conventional cigarettes. This can help people to stop smoking altogether by dealing with their cravings in a safer way.

MedicalResearch.com: What should readers take away from your report?

Response: The public has been receiving very mixed signals about the safety of e-cigarettes, with some reports claiming to show that they are as harmful as smoking. These reports have been based on studies that bear little relationship to exposure of e-cigarette users in the real world.

We report the first study that has actually measured the intake of potentially harmful chemicals in e-cigarette users, and compared this with people using licensed nicotine products (e.g. nicotine patches), and cigarettes. This study should reassure smokers who are thinking of switching to an e-cigarette that if they manage to cut out cigarettes altogether, they should see a large benefit in terms of their health.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: The next step would be would be to follow smokers over a longer period of time who switch over to using e-cigarettes and measure potential harm and risks not only in relation to cancer but also lung function and cardiovascular health.

MedicalResearch.com: Is there anything else you would like to add?

Response: None of the other authors have received funding from an e-cigarette company or any organisation acting for one.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Shahab L, Goniewicz ML, Blount BC, Brown J, McNeill A, Alwis KU, et al. Nicotine, Carcinogen, and Toxin Exposure in Long-Term E-Cigarette and Nicotine Replacement Therapy Users: A Cross-sectional Study. Ann Intern Med. [Epub ahead of print 7 February 2017] doi: 10.7326/M16-1107

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Teen Vaping is a Risk Factor for Future Smoking

MedicalResearch.com Interview with:

Professor Richard Miech Institute for Social Research University of Michigan

Prof. Richard Miech

Professor Richard Miech
Institute for Social Research
University of Michigan

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The main finding of this study is that teen vaping predicts future smoking.  We surveyed a nationally-representative sample of 12th graders in 2014 and then re-surveyed them a year later.  We found:

  • Among teens who had never smoked at baseline, those who vaped were more than four times more likely to have smoked a year later than those who didn’t vape
  • Among teens who were former smokers at baseline, those who vaped were more than twice as likely to have smoked a year later than those who didn’t vape
  • Among teens who were current smokers at baseline, smoking levels a the one-year followup were the same for vapers and non-vapers.

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E-Cigs Linked To Adverse Cardiac Effects

MedicalResearch.com Interview with:

Holly R. Middlekauff, MD Professor UCLA Division of Cardiology David Geffen School of Medicine UCLA

Dr. Holly Middlekauff

Holly R. Middlekauff, MD
Professor
UCLA Division of Cardiology
David Geffen School of Medicine
UCLA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: E-cigarettes are the fastest rising tobacco product in the US today, but almost nothing is known about their cardiovascular effects. Rather than wait decades for epidemiological data in e-cigarette users to become available, we reasoned that investigations into the known mechanisms by which tobacco cigarettes increase heart disease would provide insights into the health risks of e-cigarettes.

We focused on 2 critical mechanisms:
1) cardiac adrenaline activity, and
2) oxidative stress, measured in chronic e-cigarrete users compared to matched, healthy controls.

The major findings were that, compared to healthy controls, e-cig users had increased cardiac adrenaline activity (measured by a technique called “heart rate variability”). Furthermore, compared to healthy controls, the e-cig users had increased susceptibility to oxidative stress.

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Cigarette Smoking Remains A Huge Public Health Problem

MedicalResearch.com Interview with:
Andrew Hyland, PhD

Chair of the Department of Health Behavior at Roswell Park Cancer Institute and
Karin Kasza, MA
Senior Research Specialist in the Department of Health Behavior
Roswell Park Cancer Institute

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The PATH Study is unique because it is a large, nationally representative study of more than 45,000 youth and adults who are interviewed at multiple points over time and asked about their use of a wide array of tobacco products. The data reported in this study are from the baseline wave, and we find that while cigarettes are by far the most commonly used product for both youth and adults, we see a lot of use of non-cigarette products. E-cigarettes trailed only cigarettes in popularity for youth and water pipe smoking was high among 18-24 year olds. However, we see different patterns of use for different products with cigarettes being used much more frequently that other products like e-cigarettes. Another surprising finding was that about 4 in 10 youth and adult tobacco users were currently using two or more tobacco products.

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Young Smokers Have Drastic Increase in Heart Attack Risk

MedicalResearch.com Interview with:

Dr. Kevin Campbell MD FACC Wake Heart and Vascular Assistant Professor of Medicine,  UNC School of Medicine Cardiology and Cardiac Electrophysiology in Raleigh, Smithfield and Wilson North Carolina.

Dr. Kevin Campbell

Dr. Kevin Campbell MD FACC
Wake Heart and Vascular
Assistant Professor of Medicine,  UNC School of Medicine
Cardiology and Cardiac Electrophysiology in Raleigh, Smithfield and Wilson
North Carolina 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In this study, data was analyzed from nearly 1800 patients who had ST elevation MI.  Findings were published in Heart.  They found that younger  smokers (age under the age of 50)  had an 8-fold increased risk of acute STEMI , when compared to ex- and never smokers.

In addition, researchers found that current smokers of all ages were 3.26 times more likely to have STEMI than ex- and never-smokers—suggesting that if you stop smoking, you can reduce your risk for heart attack.

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Smoking Deaths Disproportionately Affect Poor and Black Americans

MedicalResearch.com Interview with:
Jane Henley MSPH

Epidemiologist
Division of Cancer Prevention and Control

MedicalResearch.com: What is the background for this study? 

Response: The Surgeon General concluded that cigarette smoking causes at least 12 types of cancer: oral cavity and pharynx, esophagus, stomach, colon and rectum, liver, pancreas, larynx, lung, bronchus and trachea, bladder, kidney and renal pelvis, cervix, and acute myeloid leukemia. Other tobacco products — cigars, chewing tobacco and snuff — and secondhand smoke are also linked to some of these cancers.

MedicalResearch.com: What are the main findings?

Response: We examined rates and trends of new cases and deaths from these cancers using U.S. registry and mortality data from 2004 to 2013. We broke the data down by characteristics that might display disparities — sex, age, race, ethnicity, state, county-level poverty and education, rural/urban continuum, and cancer site.

We found that about 660,000 people were diagnosed with and 343,000 people died each year from these cancers. Rates were higher among men, black men and women, and people in counties with low education or high poverty. Rates ranged by state from a low of 130 cases in Utah (126 in Puerto Rico) to a high of 248 cases in Kentucky. Incidence decreased 1.3 percent per year and mortality decreased faster, at about 1.6 percent per year; decreases were observed across most groups, but not at the same rate. Disparities persist among certain groups with higher rates or slower declines in rates.

We also looked at changes in cancer death rates from 1970 to 2014 and estimated that 1.3 million tobacco-related cancer deaths were averted since 1990, in part because of comprehensive cancer and tobacco control efforts to reduce tobacco use and other cancer risk factors, early detection of cancer, and improvements in cancer treatment.

MedicalResearch.com: What should readers take away from your report?

Response: Further reducing tobacco use can save thousands more people from getting and dying from cancer. Based on current estimates, about 36.5 million people smoke, and about half will die from a smoking related disease, unless programs are implemented to help them quit smoking. Comprehensive cancer and tobacco control programs actions can be done at the state and local level, such as:

• Promoting healthy, tobacco-free environments
• Increasing access to early detection and care for tobacco-related cancers
• Helping cancer survivors who use tobacco quit
• Better assisting communities disproportionately impacted by cancer

And of course, increasing the price of tobacco products and ongoing media campaigns, like Tips from Former Smokers, have a huge impact.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Ongoing surveillance efforts are needed to monitor changes in the number of new cases and deaths from tobacco-related cancers and whether there are differences among communities or groups of people. This work will provide insight into the impact of comprehensive cancer and tobacco control efforts and how to target these efforts in the areas where they’re needed most.

MedicalResearch.com: Is there anything else you would like to add?

Response: You can find more information at https://www.cdc.gov/cancer/tobacco/

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Henley SJ, Thomas CC, Sharapova SR, et al. Vital Signs: Disparities in Tobacco-Related Cancer Incidence and Mortality — United States, 2004–2013. MMWR Morb Mortal Wkly Rep 2016;65:1212–1218. DOI: http://dx.doi.org/10.15585/mmwr.mm6544a3.

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Smoking Reduces Surgical Improvement for Cervical Myelopathy

MedicalResearch.com Interview with:

Dr. David Kusin MD University of Nebraska Medical Center Omaha

Dr. David Kusin

Dr. David Kusin MD
University of Nebraska Medical Center
Omaha

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There is a wealth of research showing that cigarette smoking impairs healing through various mechanisms, including microvascular injury. Some evidence also suggests that tobacco use results in direct neurological injury to the peripheral and central nervous systems. Many studies have also shown that smoking reduces fusion rates and time to fusion in orthopedic surgery, including cervical surgery. Prior to our work, only a few high quality studies had been conducted to investigate prognostic factors in patients undergoing surgery for cervical myelopathy, and these identified smoking as a risk factor for a poorer outcome. The purpose of our study was to investigate this relationship further.

We conducted a retrospective cohort study of 87 nonsmokers and 47 smokers and correlated postoperative change in Nurick score (a measure of severity of cervical myelopathy from 0-5 with 5 being the worst) with smoking status. After controlling for age, sex, diabetes, duration of preoperative symptoms, severity of preoperative symptoms, signal change on MRI, surgical approach, number of spinal levels operated on, and alcohol use, we found that smokers had a significantly decreased improvement in Nurick score. Nonsmokers improved by 1.5 points whereas smokers only improved by 0.6 points. We also found that this was a dose response relationship, such that those with a history of greater tobacco use by pack years or packs per day had a greater decrease in improvement postoperatively. Interestingly, we found no correlation between tobacco use and preoperative severity of symptoms.

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Over 25% Of All US Cancer Deaths Due to Smoking

MedicalResearch.com Interview with:

Joannie Lortet-Tieulent MSc Senior Epidemiologist American Cancer Society, Inc.

Joannie Lortet-Tieulent

Joannie Lortet-Tieulent MSc
Senior Epidemiologist
American Cancer Society, Inc.
Atlanta, GA 30303

MedicalResearch.com: What is the background for this study?

Response: Many tobacco control policies are decided at state level. We have known for some times that some states have pioneered tobacco control, or have implemented strong tobacco control or programs. Meanwhile, in other states, tobacco control and programs can be weaker. Also, some states have large populations with low socioeconomic status, among which smoking prevalence is higher. We were interested in how those state-level differences impact people’s health.
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Children Who Experience Early Parental Absence More Likely To Smoke or Drink Before Age 11

MedicalResearch.com Interview with:

Dr Rebecca Lacey, PhD Research Associate Epidemiology & Public Health Institute of Epidemiology & Health Faculty of Pop Health Sciences University College London

Dr. Rebecca Lacey

Dr Rebecca Lacey, PhD
Research Associate
Epidemiology & Public Health
Institute of Epidemiology & Health
Faculty of Pop Health Sciences
University College London

MedicalResearch.com: What is the background for this study?

Response: We know from previous research that children who experience parental absence, whether due to death, divorce or some other reason, are more likely, on average, to have poorer health in later life. This includes being more likely to smoke and drink as an adult. However, what we didn’t know before we conducted our study was whether children who experienced parental absence were more likely to engage in the early uptake of risky health behaviours in childhood. This is what we looked at in our study.

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Hookah Smoking in the US: Potential Threat to Young Adults

MedicalResearch.com Interview with:

Professor Michael Weitzman MD  New York University's College of Global Public Health and  The Departments of Pediatrics and Population Health New York University School of Medicine NYU Langone Medical Center

Dr. Michael Weitzman

Professor Michael Weitzman MD
New York University’s College of Global Public Health and
The Departments of Pediatrics and Population Health
New York University School of Medicine
NYU Langone Medical Center

MedicalResearch.com: What is the background for this study?

Response: There is a marked and rapidly increasing epidemic of hookah (waterpipe) use in the US. Hookah use appears to be as, or even more, dangerous than cigarette use. There are data suggesting that one hookah session is comparable to smoking 5 packs of cigarettes in terms of exposure to toxins. The CDC and WHO both have issued warnings that hookah pipe use may eradicate much or all of the progress of the past 50 years of tobacco control efforts.

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Electronic cigarettes increase endothelial progenitor cells in the blood of healthy volunteers

MedicalResearch.com Interview with:

Lukasz Antoniewicz MD PhD candidate Karolinska Institutet Department of Clinical Sciences Danderyd University Hospital Stockholm, Sweden

Dr. Lukasz Antoniewicz

Lukasz Antoniewicz MD, PhD candidate
Karolinska Institutet
Department of Clinical Sciences
Danderyd University Hospital
Stockholm, Sweden

MedicalResearch.com: What is the background for this study?

Response: Electronic cigarette sales increase exponentially on a global scale without knowledge about possible negative effects on human health. We performed an exposure study in young healthy volunteers and analyzed blood samples for endothelial progenitor cells and microvesicles. Increase in those markers may reflect vascular injury, inflammation and platelet activation.

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Voltage and Flavoring Contribute To Overall Toxicity of Aerosols from E-Cigarettes

MedicalResearch.com Interview with:

Maciej L. Goniewicz, PhD Assistant Professor of Oncology Department of Health Behavior Division of Cancer Prevention and Population Sciences Roswell Park Cancer Institute Elm & Carlton Streets / Carlton House A320 Buffalo, New York 14263, USA

Dr. Maciej L. Goniewicz

Maciej L. Goniewicz, PhD PharmD
Assistant Professor of Oncology
Department of Health Behavior
Division of Cancer Prevention and Population Sciences
Roswell Park Cancer Institute
Elm & Carlton Streets / Carlton House A320
Buffalo, New York 14263, USA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We have previously identified several ingredients in e-cigarettes that may be potentially dangerous to users. The long-health effects of inhaling aerosol from e-cigarettes is currently unknown and we are looking for alternative ways to test the products safety. We have noticed previously that various brands and types of e-cigarettes differ in the toxicant levels and their potential toxic effects. So we systematically evaluated various product features and we were able to identify device power and flavoring additives as key components that significantly affect the potential toxicity of e-cigarettes. Interestingly, it was not nicotine or nicotine solvents but other additives in e-cigarettes that affected respiratory cells used in our study.

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Most Childhood Atopic Dermatitis Lasts About Three Years

MedicalResearch.com Interview with:

Dr. Jonathan L. Silverberg MD PhD MPH Assistant Professor in Dermatology Medical Social Sciences and Preventive Medicine Northwestern University, Chicago, Illinois

Dr. Jonathan Silverberg

Dr. Jonathan L. Silverberg MD PhD MPH
Assistant Professor in Dermatology
Medical Social Sciences and Preventive Medicine
Northwestern University, Chicago, Illinois

MedicalResearch.com: What is the background for this study?

Response: Some children with atopic dermatitis may have disease activity persist into adolescence and adulthood, although most children are thought to “grow out of it.” There have been a number of studies with varied results about how commonly atopic dermatitis actually persists later in life. Moreover, the risk factors for persistence of atopic dermatitis are unclear. We sought to systematically analyze the extant literature of research studies to determine the rates and predictors of atopic dermatitis persistence over time.
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Increased Odds of Quitting Smoking When Distance To Store Increased

MedicalResearch.com Interview with:

Anna Pulakka PhD, Postdoctoral Researcher Department of Public Health University of Turku, Finland

Dr. Anna Pulakka

Anna Pulakka PhD, Postdoctoral Researcher
Department of Public Health
University of Turku, Finland

MedicalResearch.com: What is the background for this study?

Response: Smoking is the one of the leading health risks globally. Finland, among some other countries, has set a target for a tobacco-free society by 2040. However, with the current rate of decline in smoking prevalence, the target will not be met. It is therefore important to explore new avenues for helping people to quit smoking.

Recently, researchers have become more interested in availability of tobacco as one determinant for smoking habit. We have learned from cross-sectional studies that people who live in neighborhoods with many stores that sell tobacco, smoke more than those who have less tobacco stores in their neighborhood. What has been lacking is more robust evidence from longitudinal studies on the association between availability of tobacco in neighborhoods and smoking behaviours. We sought to determine whether change in the location of tobacco stores nearby people’s place of residence was associated with the odds of quitting smoking or smoking relapse in a longitudinal setting.

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NYU Researcher Discusses Nanoparticles in Sunscreens and E-Cigs

MedicalResearch.com Interview with:

Judith T. Zelikoff, PhD, Professor Department of Environmental Medicine NYU Langone Medical Center.

Dr. Judith Zelikoff

Judith T. Zelikoff, PhD, Professor
Department of Environmental Medicine
NYU Langone Medical Center.

MedicalResearch.com: Would you tell us a little about yourself?

Response: I am a tenured full professor in the Department of Environmental Medicine at the NYU School of Medicine with >25 years of experience studying the toxicology of inhaled single contaminants and complex mixtures including metals, nanoparticles, gaseous and particulate (PM) air pollutants, e-cigarettes and combustible products from cigarettes, biomass burning, and diesel exhaust. Over the last decade, studies in my laboratory has focused on the effects of maternal inhalation of environmental toxicants, including fine-sized ambient particulate matter during pregnancy (and/or during neonatal development) on fetal cardiovascular structure, obstetric consequences, and later life disorders including obesity, immune dysfunction, and decreased sociability and reproductive success in adult male and female offspring. Other early life studies associated with inhaled nicotine/tobacco products have demonstrated that maternal and neonatal exposure of mice to aerosols from e-cigarettes (with and without nicotine) alters neurodevelopment and produces hyperactivity in adult male offspring.

Our studies with smokeless tobacco products demonstrate dyslipidemia and non-alcoholic steatohepatitis in prenatally exposed adult offspring. One of my major scientific accomplishments are my early life inhalation exposure studies demonstrating, for the first time in some cases, that prenatal/neonatal exposure to environmental agents can produce effects persistent into adulthood that can increase susceptibility to a variety of disorders, including cardiovascular disease. In addition, I serve as the Community Outreach and Engagement Core (COEC)Director for our NYU NIEHS Core Center. In this regard, our COEC team partners with environmentally-impacted communities in the NY/NJ area to assess community concerns associated with environmental pollution and provide educational information that can help build community infrastructure. I am also extremely active as a leader in the Society of Toxicology having served as Secretary of the Society for 3 years and President of the Metals and Immunotoxicology SOT Specialty Sections where i received an Immunotoxicology Lifetime Achievement Award.

I currently serve as Chairperson of the SOT Committee for Diversity Initiatives and President of the Ethical, Legal and Social Specialty Section. I am currently a full member of a National Institute of Health Study and have also served on several other Federal/State Advisory Panels including the Institute of Medicine and National Research Council, EPA, NASA, NTP, and NJ Department of Environmental Protection. In addition to serving as an Associate Editor and Editorial Board member for numerous toxicology/environmental health journals, I currently serve as vice-President for the NYU School of Medicine Faculty Council.

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Even Light Smoking Elevates Risk of Brain Bleeding From Intracranial Aneurysm

MedicalResearch.com Interview with:
Joni Valdemar Lindbohm, MD
Department of Public Health
University of Helsinki, Finland

MedicalResearch.com: What is the background for this study?

Response: Approximately 1-6% percent of people carry an unruptured intracranial aneurysm but most of these never rupture during lifetime and cause subarachnoid hemorrhage (SAH). In SAH, the rupture of an aneurysm causes bleeding into the lining between the brain’s surface and underlying tissue. Despite advances in operative techniques, SAH can lead to death in up to 45% of the cases. Because life style risk factors are critical in development of subarachnoid hemorrhage, it is important to characterize the risk factor profile of those with an elevated risk.

Widely accepted risk factors for SAH are increasing age, smoking, hypertension and female sex. However, the reasons for an elevated risk in women have remained uncovered and the effect of smoking habits are not well understood.

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Large Proportion of Pregnant Women Use Alcohol and Tobacco in First Trimester

MedicalResearch.com Interview with:

Dr. Qiana L. Brown, PhD, MPH, LCSW Postdoctoral Research Fellow Columbia University Mailman School of Public Health Department of Epidemiology Substance Abuse Epidemiology Training Progra

Dr. Qiana Brown

Dr. Qiana L. Brown, PhD, MPH, LCSW
Postdoctoral Research Fellow
Columbia University
Mailman School of Public Health
Department of Epidemiology
Substance Abuse Epidemiology Training Program

MedicalResearch.com: What is the background for this study?

Dr. Brown: Prenatal substance use is a major public health concern, and poses significant threats to maternal and child health. Tobacco and alcohol are the most commonly used substances among pregnant women and non-pregnant women of reproductive age, and are leading causes of preventable adverse health outcomes for both mother and baby. Women with health insurance have more prenatal visits, and present for prenatal care earlier than uninsured women, which may increase their exposure to health messaging around substance abuse prevention at prenatal visits. Additionally, treatment for substance use disorders and maternal and child health care are part of the Essential Health Benefits covered by the Affordable Care Act, which may encourage patients and providers to engage in discussions around alcohol and tobacco use prevention during pregnancy.

Given these factors, we examined the relationship between health insurance coverage and both past month tobacco use and past month alcohol use among a nationally representative sample of reproductive age women in the United States. We sampled 97,788 women ages 12 to 44 years old who participated in the U.S. National Survey of Drug Use and Health in 2010 to 2014. Among these women, 3.28% (n=3,267) were pregnant. We specifically investigated whether the relationship between health insurance and alcohol or tobacco use differed between pregnant and non-pregnant women.
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Smoking Warnings in Pictures Worth a Thousand Words?

MedicalResearch.com Interview with:

Marissa G. Hall, MSPH Doctoral Candidate, Department of Health Behavior Gillings School of Global Public Health University of North Carolina at Chapel Hill

Marissa Hall

Marissa G. Hall, MSPH
Doctoral Candidate, Department of Health Behavior
Gillings School of Global Public Health
University of North Carolina at Chapel Hill

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The US Food and Drug Administration (FDA) requires pictorial warnings on cigarette packs, but implementation was stalled by a 2012 lawsuit by the tobacco industry. The US Court of Appeals for the DC Circuit ruled against pictorial warnings, saying that FDA had “not provided a shred of evidence” that the pictorial warnings reduce smoking. To address this critique, our randomized trial examined the impact on smoking behavior of adding pictorial warnings to the front and back of cigarette packs. We found that smokers with pictorial warnings on their packs were more likely to attempt to quit and to successfully quit than those whose packs had text-only warnings.

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Smoking During Pregnancy Raises Risk of Schizophrenia in Offspring

MedicalResearch.com Interview with:

Alan S. Brown, M.D., M.P.H. Professor of Psychiatry and Epidemiology Columbia University Medical Center Director, Program in Birth Cohort Studies, Division of Epidemiology New York State Psychiatric Institute

Dr. Alan Brown

Alan S. Brown, M.D., M.P.H.
Professor of Psychiatry and Epidemiology
Columbia University Medical Center
Director, Program in Birth Cohort Studies, Division of Epidemiology
New York State Psychiatric Institute

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Brown: Smoking during pregnancy is a risk factor for several pregnancy-related outcomes including low birthweight and preterm birth. Evidence for a link with schizophrenia is scant. We analyzed a maternal biomarker of smoking called cotinine, a nicotine metabolite, in mothers of nearly 1,000 schizophrenia cases and 1,000 controls in a national birth cohort in Finland. We found that heavy smoking in pregnancy was related to a 38% increase in schizophrenia risk in offspring and that as cotinine levels increased even in the more moderate smokers risk of schizophrenia also increased.

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Is Smokers’ Paradox in STEMI Patients Treated With PCI Real?

MedicalResearch.com Interview with:

Tanush Gupta, MD Chief Resident & Instructor of Medicine Department of Medicine New York Medical College & Westchester Medical Center Valhalla, NY

Dr. Tanush Gupta

Tanush Gupta, MD
Chief Resident & Instructor of Medicine
Department of Medicine
New York Medical College & Westchester Medical Center
Valhalla, NY 

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Gupta: Cigarette smoking is the leading preventable cause of premature death in the United States (U.S.). Approximately one-third of all coronary artery disease related deaths in the U.S. annually can be attributed to cigarette smoking. However, studies from the pre-thrombolytic and thrombolytic eras have shown that mortality in smokers with ST-segment elevation myocardial infarction (STEMI) may be lower than in nonsmokers, a phenomenon called the “smoker’s paradox.”

The majority of STEMI patients in contemporary practice are treated with primary percutaneous coronary intervention (pPCI). Data on the association of smoking with outcomes in STEMI patients undergoing pPCI are limited and also conflicting as to whether the smoker’s paradox exists in this population. Hence, the purpose of our study was to examine the association of smoking status with in-hospital outcomes in a nationwide cohort of STEMI patients undergoing pPCI, included in the U.S. National Inpatient Sample, over a 10-year time period from 2003 to 2012. Our primary outcome of interest was in-hospital mortality and secondary outcomes were post-procedure hemorrhage, in-hospital cardiac arrest, and average length of stay.

Of 985,174 STEMI patients who underwent pPCI in the U.S. over this time period, 438,954 (44.6%) were smokers. Smokers were on an average 8 years younger than nonsmokers and had lower prevalence of most cardiovascular comorbidities. Smoking status was associated with lower risk-adjusted in-hospital mortality (2.0% vs. 5.9%, adjusted OR 0.60, p<0.001), lower incidence of post-procedure hemorrhage (4.2% vs. 6.1%, adjusted OR 0.81, p<0.001) and in-hospital cardiac arrest (1.3% vs. 2.1%, adjusted OR 0.78, p<0.001), and shorter average length of stay (3.5 days vs. 4.5 days, p<0.001). To assess whether younger age of smokers was influencing the association with in-hospital mortality, we also performed an age-stratified analyses in different age groups. The smoker’s paradox largely persisted in age-stratified analyses suggesting that younger age of smokers was not the sole explanation for this paradox.

We performed additional assessment for confounding to explore whether the paradoxically lower risk-adjusted in-hospital mortality in smokers with STEMI was driven by differences in baseline demographics and comorbidities between hospitalized smokers and nonsmokers in general. To test for such confounding, we examined the association of smoking with in-hospital mortality in 2 conditions in which this association has not been previously studied – hip fractures and severe sepsis – using similar statistical regression models. In both these study populations, smokers were on average younger than nonsmokers and had lower risk-adjusted in-hospital mortality, but, the paradoxical association in both these conditions was weaker in magnitude than in STEMI patients. Since there is no cogent biological hypothesis to explain the lower mortality in smokers with sepsis or hip fractures, it is likely that the smoker’s paradox in STEMI is also at least partly driven by residual confounding due to inadequate adjustment for the biological effects of age. However, as this paradox was stronger in STEMI patients than in patients with hip fractures or severe sepsis, we believe that additional true biological differences between smokers and nonsmokers with STEMI also contribute to the paradoxically lower in-hospital mortality.

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No Apparent Increase in Neuropsychiatric Side Effects From Smoking Cessation Mediations

MedicalResearch.com Interview with:

Robert M. Anthenelli, M.D. Professor and Executive Vice Chair Director, Pacific Treatment and Research Center Department of Psychiatry University of California, San Diego, Health Sciences

Dr. Robert Anthenelli

Robert M. Anthenelli, M.D.
Professor and Executive Vice Chair
Director, Pacific Treatment and Research Center
Department of Psychiatry
University of California, San Diego, Health Sciences 

MedicalResearch.com: What is the background for this study?

Dr. Anthenelli: Despite growing evidence to the contrary, significant concerns have been raised about the neuropsychiatric safety risk of the smoking cessation medications, varenicline and bupropion. What has been lacking until now among individuals with and without psychiatric disorders is a large, randomized controlled trial that directly compares these medications with placebo and an active comparator (nicotine patch) and that systematically probes for neuropsychiatric adverse events while smokers are trying to quit.

MedicalResearch.com: What are the main findings?

Dr. Anthenelli:

1) Neither varenicline nor bupropion significantly increased incidence of moderate-to-severe neuropsychiatric adverse events relative to placebo or nicotine patch in smokers without or with stable psychiatric disorders.

2) Regardless of treatment condition, smokers with a history of or a current stable psychiatric disorder reported more neuropsychiatric adverse events than their counterparts without such conditions.

3) Varenicline was more effective than placebo, nicotine patch, and bupropion in helping smokers achieve abstinence; bupropion and nicotine patch were more effective than placebo.

4) While quit rates overall were slightly lower in smokers with psychiatric disorders compared with cessation rates in individuals without these conditions, all three medications were more effective than placebo, and their relative efficacy (varenicline > bupropion = nicotine patch > placebo) was the same in this special population of smokers as it was for smokers without mental health disorders.

EAGLES is the first trial to have compared the smoking cessation efficacy of the three, first-line smoking cessation medications in smokers with current or past psychiatric disorders. These results are important because individuals with mental health conditions are disproportionately affected by smoking-related diseases and death.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Anthenelli:

1) In the context of a growing body of studies finding no evidence of a greater incidence of serious neuropsychiatric adverse events in users of varenicline and bupropion compared with nicotine replacement therapy or placebo, it appears these non-nicotine medications can be used safely by psychiatrically stable smokers.

2) Smokers with a history of or current stable psychiatric disorder are more prone to exhibit such events regardless of the medication used and should be monitored during a quit attempt.

3) Varenicline demonstrates superior efficacy to bupropion and nicotine patch, but all three medications are more effective than placebo in smokers with and without stable psychiatric disorders.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Anthenelli: We are looking forward to conducting secondary analyses of the large EAGLES dataset to examine, in finer detail, the safety and efficacy of the three first-line medications in sub-cohorts (e.g., smokers with major depressive disorder, bipolar disorder, and schizophrenia) of the psychiatric cohort. We will also be examining predictors of treatment response to determine whether these vary as a function of a smoker’s psychiatric history.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Neuropsychiatric safety and efficacy of varenicline, bupropion, and nicotine patch in smokers with and without psychiatric disorders (EAGLES): a double-blind, randomised, placebo-controlled clinical trial

Anthenelli, Robert M et al.

The Lancet , Volume 0 , Issue 0 , Published Online: 22 April 2016

DOI: http://dx.doi.org/10.1016/S0140-6736(16)30272-0

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

More Medical Research Interviews on MedicalResearch.com

 

 

 

Brain Reward System May Underlie Tobacco Cravings in Schizophrenia

MedicalResearch.com Interview with:
Stéphane Potvin, PhD
Associate professor, Department of Psychiatry
Eli Lilly Chair in Schizophrenia Research
University of Montreal

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Potvin:  Life expectancy is substantially reduced in schizophrenia, and one of the main factors contributing to this is the high prevalence of cigarette smoking in these patients. The leading hypothesis for cigarette smoking in schizophrenia is the self-medication hypothesis. Although some empirical results show that nicotine improves cognitive performance in schizophrenia, some authors have criticized the self-medication hypothesis for its implied (and unintented) justification of cigarette smoking in schizophrenia. About a decade ago, it has been hypothesized that cigarette smoking may be more reinforcing in schizophrenia patients, due to biological dysfunctions common to schizophrenia and tobacco use disorder. However, that model had not been formally tested.

Based on recent findings showing that cigarette cravings are increased in schizophrenia smokers, compared to smokers with no comorbid psychiatric disorder, we performed a neuroimaging study on cigarette cravings in schizophrenia. Unless we are wrong, this was most probably the first study to do so. We found that relative to control smokers, smokers with schizophrenia had increased activations of the ventro-medial prefrontal cortex in response to pleasant images of cigarette. What is is interesting is that the ventro-medial prefrontal cortex is one of the core regions of the brain reward system, which mediated the reinforcing effects of several psycho-active substances, including tobacco. As such, our results tend to confirm the assumption that cigarette might be more reinforcing in schizophrenia smokers.

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Task Force Recommends Against Routine COPD Screening in Asymptomatic Adults

MedicalResearch.com Interview with:

Dr. William Phillips MD MPH USPSTF Task Force member and Theodore J. Phillips Endowed Professor in Family Medicine University of Washington, Seattle. Dr. Phillips is also a founder and senior associate editor of the Annals of Family Medicine

Dr. William Phillips

Dr. William Phillips MD MPH
USPSTF  Task Force member and
Theodore J. Phillips Endowed Professor in Family Medicine
University of Washington, Seattle. Dr. Phillips is also a founder and senior associate editor of the Annals of Family Medicine

MedicalResearch.com: What is the background for this study? What are the main findings? 

Dr. Phillips: Chronic obstructive respiratory disease, or COPD, is a serious, chronic condition that affects a person’s ability to breathe. It is the third leading cause of death in the United States. When the Task Force reviewed the research on screening adults for COPD in a primary care setting, we concluded with moderate certainty that screening has no net benefit, which is why we do not recommend screening for COPD in people who do not have symptoms.

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Quitting Smoking Can Restore Normal Bacteria To Oral Microbiome

MedicalResearch.com Interview with:
Jiyoung Ahn, PhD, RD, MS
Associate Professor of Population Health
Associate Director of Population Sciences,
NYU Perlmutter Cancer Center  and
Brandilyn Peters (post-doctoral fellow, lead author)
NYU Langone School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Oral bacteria play important roles in oral health, and can influence the health of other body systems as well. We were interested in studying how cigarette smoking affects oral bacteria. To do this, we examined the oral bacteria in mouthwash samples from 112 current smokers, 571 former smokers, and 521 people who never smoked. We found that the mouth bacterial composition of current smokers differed dramatically from those who never smoked. However, the mouth bacterial composition of former smokers was similar to that of never smokers, suggesting that quitting can restore the oral bacteria back to a healthy state.

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Quitting Smoking Cold Turkey Leads To More Success

MedicalResearch.com Interview with:

Dr Nicola Lindson-Hawley PhD Cochrane Tobacco Addiction Group (TAG) Managing Editor

Dr. Lindson-Hawley

Dr Nicola Lindson-Hawley PhD
Cochrane Tobacco Addiction Group (TAG) Managing Editor

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Lindson-Hawley: For many people, the obvious way to quit smoking is to cut down gradually until they stop.  After all, that’s how we accomplish most other goals that are hard.  With addictions other than smoking, we aim to get people to cut down gradually rather than stop abruptly.  But with smoking, the norm is to advise people to stop all at once.  Around the world, physicians and others who support smoking cessation help people to quit abruptly and not to cut down first.  However, if physicians are not providing support to people who want to quit by reduction, then they will have less chance of success as we know that people who receive support to quit are more likely to succeed.  On the other hand, if cutting down is a bad way to quit, then we need to persuade people to abandon their common sense idea and quit abruptly instead. Therefore, this study investigated this by comparing a group of smokers advised to quit gradually by cutting down with a group who quit all at once. What we found was that cutting down first, was a less successful way to quit than smoking as normal and then stopping. Smokers who quit abruptly were 25% more likely to have quit after 4 weeks than those who quit gradually.

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Being Born in Winter, or To A Smoker, Worsens Children’s Lung Health

MedicalResearch.com Interview with:

Dr. med. Julia Dratva, MD MPH Medical Specialist Prevention and Public Health - FMH Scientific project leader MAS Versicherungsmedizin/Studienkoordinationleitung

Dr. Julia Dratva

Dr. med. Julia Dratva, MD MPH         
Medical Specialist Prevention and Public Health
FMH  Scientific project
leader
MAS Versicherungsmedizin/Studienkoordinationleitung
Dept. Epidemiology and Public Health
Swiss Tropical and Public Health Institute
Socinstrasse 57, P.O. Box, 4002 Basel,
Switzerland

Medical Research: What is the background for this study? What are the main findings?

Dr. Dratva: Early childhood is a critical time window for subsequent health. Early life environment is known to be important for lung development and respiratory health. Little is known on the potential impact on lung ageing and the potential mechanisms responsible for the long-term impact. We investigated early childhood factors and their association with lung function decline, a common marker of lung aging, in two long-standing adult cohorts, SAPALDIA and ECRHS. As recently published in scientific journal PlosONE, maternal smoking, early respiratory infections or season of birth are associated with a faster decline in lung function decline, while less rapid decline was found in persons who had attended daycare. The early exposures may not only have an independent adverse effect on lung aging but also increase the respiratory vulnerability to other adult risk factors. Stronger effects were observed in in smokers exposed to the aforementioned adverse factors.

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There is No Safe Level of Passive Smoking Exposure

MedicalResearch.com Interview with:

Dr. Kate Frazer University College Dublin School of Nursing, Midwifery & Health Systems Dublin , Ireland

Dr. Kate Frazer

Dr. Kate Frazer
University College Dublin
School of Nursing, Midwifery & Health Systems
Dublin , Ireland

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Frazer: The review is an update of a 2010 Cochrane systematic review publication ‘Legislative smoking bans for reducing secondhand smoke exposure, smoking prevalence and tobacco consumption’.

The 2010 review identified

  • Evidence of secondhand smoke exposure and reduced cotinine levels after the implementation of legislative smoking bans.
  • Evidence of reduced admissions for acute coronary syndrome.
  • Limited evidence of an impact on active smoking rates.

The update was undertaken because more countries have since implemented legislative smoking bans since the review was published in 2010 and the body of research was growing in the intervening period.

The new review, published 4th February 2016, presents evidence from 77 observational studies in 21 countries.

MedicalResearch: What are the main findings?

Dr. Frazer: There is consistent evidence identifying reduced admissions in the post ban period for acute coronary syndrome/ acute myocardial infarction in 33 of 43 studies.

There is evidence of reduced mortality from smoking related illnesses in 8 out of 11 studies.

There is evidence of reduced admissions for asthma and chronic obstructive pulmonary disease, but the evidence of reduced admissions was not consistent in all studies.

There is evidence of an impact on perinatal health outcomes including low birth weight and risk of pre term birth, but the evidence was not consistent in all studies.

The evidence of an impact of legislative smoking bans on active smoking and tobacco consumption is not consistent. There have been reductions in smoking rates.

The impact of the ban on reducing admissions was observed in smokers and in non-smokers.

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Cherry Flavored E-Cigarette Smokers Inhaling Benzaldehyde

Maciej Goniewicz

Dr. Maciej Goniewicz

MedicalRearch.com Interview with:
Maciej Goniewicz, PhD, PharmD

Assistant Professor of Oncology, Department of Health Behavior
Roswell Park Cancer Institute (RPCI

Medical Research: What is the background for this study? What are the main findings?

Dr.
Goniewicz: In addition to nicotine and its solvents (like propylene glycol and vegetable glycerin), a majority of e-cigarettes contain flavorings. Users of e-cigarettes can choose their favorite flavor among hundreds of various options, including fruit, coffee, menthol, vanilla, chocolate, candy flavors, and tobacco.  Although many flavorings used in e-cigarettes are recognized as safe when used in food products, little is known about their potential toxicity when inhaled.

In this study we measured one such flavoring, benzaldehyde. This flavoring is commonly used in food and cosmetics. We know that there is little to no toxicity if we eat this compound or if we apply it on our skin. However, workers who regularly inhale a high concentration of benzaldehyde often report irritation of their eyes and throat. In this study, we tested 145 e-cigarette products, and we found benzaldehyde in 108 products. Interestingly, the highest levels of benzaldehyde were detected in cherry-flavored products.  Continue reading

Free Nicotine Patches Helped Smokers Quit

MedicalResearch.com Interview with:

John Cunningham, PhD Senior Scientist, Social & Epidemiological Research  Centre for Addiction and Mental Health Toronto, Ontario

Dr. John Cunningham

John Cunningham, PhD
Senior Scientist, Social & Epidemiological Research
Centre for Addiction and Mental Health
Toronto, Ontario

 Medical Research: What is the background for this study? What are the main findings?

Dr. Cunningham: Nicotine Replacement Therapy (NRT) has been found to improve tobacco cessation success rates in clinical trials where there is accompanying behavioral support. However, population survey data has indicated that people who purchase NRT as part of a quit attempt are no more successful at quitting smoking than people who don’t use NRT as part of their quit attempt. While causal statements about the effectiveness of NRT cannot be made based on the population survey findings, it does raise concerns about the effectiveness of NRT when there is no accompanying behavioral support.

Our trial used an interesting design where participants were recruited for a longitudinal survey about their patterns of smoking. As part of this survey, participants were asked if they would be interested in nicotine patches to help them quit smoking, if they were offered for free. Of those participants who said they were interested, a randomized half were actually sent a five-week supply of nicotine patches. The other half of participants were not sent the nicotine patches and were, in fact, unaware that nicotine patches were sent to others in the trial. Participants were followed-up at 8 weeks and 6 months, with those participants receiving free-of-charge nicotine patches being more likely to report current abstinence compared to those participants not sent the free nicotine patches (30-day self-reported abstinence at 6-months was 7.6% versus 3.0% respectively; odds ratio (OR), 2.65; 95% CI, 1.44 – 4.89, p = .002).

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Smokers Should Not Be Discouraged By Quit Attempts That Don’t Work

Dr-Timothy-B-Baker.jpg

Dr. Timothy B. Baker

MedicalResearch.com Interview with:
Timothy Baker, PhD
Professor of Medicine
University of Wisconsin-Madison School of Medicine and Public Health 

Medical Research: What is the background for this study? What are the main findings?

Dr. Baker: Previous research showed that combination nicotine replacement (the nicotine patch plus the nicotine lozenge or gum) and varenicline are the most effective smoking cessation treatments available, yet they had never been directly compared with one another. This study set out to do that, and compare them with the nicotine patch.

The present study shows that three medications which were combined with coaching to quit smoking—a pill called varenicline (Chantix), the nicotine patch alone, and a combination of nicotine-replacement medications—all produced about the same abstinence rates among participants at 6- and 12-months after the quit attempt. We were surprised that the patch by itself produced about the same level of success as the other two more intensive medications.

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Hookah Bars Raise Secondhand Smoke Risks For Employees

MedicalResearch.com Interview with:

Terry Gordon, PhD Professor, Department of Environmental Medicine at NYU Langone Medical Center and at New York University's College of Global Public Health

Dr. Terry Gordon

Terry Gordon, PhD
Professor, Department of Environmental Medicine
at NYU Langone Medical Center and at
New York University’s College of Global Public Health 

Medical Research: What is the background for this study? What are the main findings?

Dr. Gordon:I t is well established that the intentional inhalation of tobacco combustion products causes severe respiratory and cardiovascular health effects and, in fact, active smoking is the leading preventable cause of death in the US and worldwide.  Importantly, secondhand smoke exposure also causes a range of serious health problems in adults, adolescents, and children exposed in the home or at work. Secondhand smoke exposure can be as harmful as active smoking and is a major cause of both cancer and cardiovascular disease itself, as well as having countless other harmful effects. It was the scientific findings of these effects that led to many clean air regulations across the nation and enabled the FDA to regulate a number of tobacco products.  A growing number of studies in the U.S. and abroad have demonstrated poor indoor air quality in hookah bars, but none have looked at the effect of this on those who work in such establishments.

We, therefore, studied whether workplace exposure to secondhand hookah smoke affects the pulmonary and cardiovascular systems.  One of our main findings was that occupational exposure to secondhand hookah smoke produces systemic effects as seen by increases in inflammatory cytokines in the blood after a 10 to 12 hour work shift. This is very worrisome as more and more diseases are being linked to chronic inflammation.  Changes in heart rate suggested that the cardiovascular system was also altered during a single work shift.  The most dramatic effect, however, appeared to be an increase in exhaled carbon monoxide after the work shift.  The low temperature burning of charcoal used to heat the shisha in a water pipe produces large amounts of carbon monoxide, and we observed exhaled carbon monoxide levels as high as 90 ppm, which suggests significant exposure of workers to secondhand hookah smoke and the potential for impairment of hemoglobin to efficiently carry oxygen to the tissues.

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Beyoncé, Pitbull, Feature Alcohol in Music Videos Aimed at Young People

Dr Joanne Cranwell PhD, CPsychol The UK Centre for Tobacco and Alcohol Studies (UKCTAS) School of Medicine Division of Epidemiology & Public Health Clinical Sciences Building University of Nottingham City Hospital Nottingham

Dr. Joanne Cranwell

More on Alcohol on MedicalResearch.com

MedicalResearch.com Interview with:
Dr Joanne Cranwell PhD, CPsychol
The UK Centre for Tobacco and Alcohol Studies 
School of Medicine
Division of Epidemiology & Public Health
Clinical Sciences Building
University of Nottingham

MedicalResearch: What is the background for this study?

Dr. Cranwell: We conducted this particular study because it is well established that adolescent exposure to alcohol and tobacco in the media, such as film, television, and paid for advertising are determinants of subsequent alcohol and tobacco use in young people. The extent of potential exposure has been transformed over the past decade by the emergence of social media, in which exposure to pro-tobacco content has also been linked to favourable attitudes towards tobacco, including intention to smoke, in young non-smokers.

Our previous published research highlighted that popular YouTube music videos contain tobacco and substantial alcohol content, including branding. Alcohol advertising is largely self-regulated by the alcohol industry and the Portman Group who speaks on behalf of the UK drinks industry.   The Advertising Standards Authority also provides guidance on marketing of alcohol products in the UK. Broadly speaking the guidelines from these three regulators state that “Marketing communications for alcoholic drinks should not be targeted at people under 18 and should not imply, condone or encourage immoderate, irresponsible or anti-social drinking”. However the extent to which adults and adolescents are exposed to tobacco or alcohol content from YouTube at a population level has not been quantified. In this new study we have therefore estimated population exposure to tobacco and alcohol impressions, defined as appearances in 10-second intervals in a sample of popular videos, in the British adolescent and adult population.

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Periodontal Disease Linked to Breast Cancer Risk in Postmenopausal Women

Jo Freudenheim, PhD UB Distinguished Professor and Interim Chair Department of Epidemiology and Environmental Health School of Public Health and Health Professions University at Buffalo Buffalo, NY

Dr. Jo Freudenheim

MedicalResearch.com Interview with:
Jo Freudenheim, PhD
UB Distinguished Professor and Interim Chair
Department of Epidemiology and Environmental Health
School of Public Health and Health Professions
University at Buffalo
Buffalo, NY

Medical Research: What is the background for this study? What are the main findings?

Dr. Freudenheim: There have been a number of studies that have shown an association between periodontal disease and chronic diseases, particularly stroke and heart attacks. There is also some newer evidence that periodontal disease is associated with cancer, particularly cancers of the gastrointestinal tract. Ours is the first large prospective study of periodontal disease and breast cancer.

This was part of a study of more than 70,000 postmenopausal women from throughout the United States, the Women’s Health Initiative. Women provided information about their health and other related factors and then those women were followed to see who developed certain diseases.

We found that women who had been told that they had periodontal disease were more likely to develop breast cancer. In particular, women who were former smokers (quit within the last 20 years) and who had periodontal disease were at increased breast cancer risk. There was a similar increase in risk for current smokers with periodontal disease but it was not statistically significant. (There was a relatively small number of current smokers in the WHI study.)

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Electronic Nicotine Use Rises, Especially Among Smokers

Ralph S. Caraballo, PhD MPH Branch Chief, Epidemiology Branch Office on Smoking and Health National Center for Chronic Disease Prevention and Health Promotion CDC Atlanta GA

Dr. Ralph Caraballo

MedicalResearch.com Interview with:
Ralph S. Caraballo, PhD MPH
Branch Chief, Epidemiology Branch
Office on Smoking and Health
National Center for Chronic Disease Prevention and Health Promotion
CDC Atlanta GA

Medical Research: What is the background for this study? What are the main findings?
Dr. Caraballo: Electronic nicotine delivery system (ENDS) use has increased rapidly in the U.S. in recent years. The availability and use of ENDS raise new issues for public health practice and tobacco regulation, as it is unknown whether patterns of ENDS use enhance, deter, or have no impact on combustible tobacco product use. This study assessed past-month, lifetime, and frequency of ENDS use among current, former, and never adult cigarette smokers.

In 2014, overall lifetime and past-month ENDS use was 14.1% and 4.8%, respectively. By smoking status, 49.5% of current, 14.7% of former, and 4.1% of never cigarette smokers had used ENDS in their lifetime, whereas 20.6% of current, 4.0% of former, and 0.8% of never smokers used ENDS in the past month. Among current and former cigarette smokers who ever used ENDS, 44.1% and 44.7% reported using ENDS >10 days in their lifetime, respectively.

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