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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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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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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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 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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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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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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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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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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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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Ads Increase Curiosity and Trial of E-Cigarettes Among Young Adults

Dr. Andrea C. Villanti PhD, MPH Director, Regulatory Science and Policy Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative Washington, DC 20001

Dr. Villanti

MedicalResearch.com Interview with:
Dr. Andrea C. Villanti PhD, MPH
Director, Regulatory Science and Policy Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative
Washington, DC 20001

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

Dr. Villanti: Awareness, interest, and use of electronic cigarettes (e-cigarettes) have increased since the products were introduced in the U.S. in 2006. Between 2012 and 2013, 8.3% of young adults reported current e-cigarette use compared to 4.2% of adults overall. One factor likely driving e-cigarette use as well as the use of other tobacco products is advertising, which has been demonstrated to promote the initiation and continued use of cigarettes. Advertising is critical for raising awareness about newly introduced products, and has been shown to influence initiation, experimentation, and progression to regular combustible cigarette smoking in youth.

This study used a randomized control trial to assess the impact of brief exposure to four e-cigarette print advertisements (ads) on perceptions, intention, and subsequent use of e-cigarettes and cigarettes among young adults (age 18-34). It found that exposure to e-cigarette ads may enhance curiosity and limited trial of e-cigarettes in never users. Other findings include:

  • Compared to the control group, ad exposure was associated with greater curiosity to try an e-cigarette among never e-cigarette users (18.3% exposed vs. 11.3% unexposed), and greater likelihood of e-cigarette trial at follow-up among never users of cigarettes and e-cigarettes (3.6% exposed vs. 1.2% unexposed).
  • Exploratory analyses did not find an association between ad exposure and cigarette trial or past 30-day use among never users at follow-up, nor cigarette use among smokers over time.
  • Curiosity to try an e-cigarette mediated the relationship between ad exposure and e-cigarette trial among e-cigarette never users.

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Former Smokers Biggest User of E-Cigarettes

Cristine D. Delnevo, PhD, MPH Chair, Professor, and Director, Center for Tobacco Studies Rutgers School of Public Health

Dr. Delnevo

MedicalResearch.com Interview with:
Cristine D. Delnevo, PhD, MPH
Chair, Professor, and Director, Center for Tobacco Studies
Rutgers School of Public Health

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

Dr. Delnevo: We analyzed data from the 2014 National Health Interview Survey (NHIS) to examine how e-cigarette use differs by demographic subgroups and smoking status. We found that daily e-cigarette use is highest among former smokers who have quit in the past year. These recent quitters were four times more likely than current smokers to be daily e-cigarette users. Furthermore, regular use of e-cigarettes is rare among those who have never smoked and former smokers who have quit more than a year ago. This suggests that many smokers may be using e-cigarettes to quit, and that the devices are neither attracting nonsmokers nor leading to smoking relapse among long term former smokers. If e-cigarettes continue to be used as a smoking cessation tool and uptake among nonsmokers remains low, they may generate public health benefits.

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Smoking Increases Complications After Hip or Knee Arthroplasty

Jasvinder Singh MD MPH Professor of Medicine UAB Division of Clinical Immunology and Rheumatology MedicalResearch.com Interview with:
Jasvinder Singh MD MPH
Professor of Medicine
UAB Division of Clinical Immunology and Rheumatology 

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

Dr. Singh: A systematic review of the effect of smoking on outcomes after total joint replacement showed that current smoking increased the risk of overall post-operative complications but that there were scarce data for smoking and specific surgical outcomes of arthroplasty. We performed a study using data from an institutional Total Joint Registry to answer this question.   In a study of for 7,926 patients who underwent hip or knee arthroplasty, 7% were current tobacco users. We found that compared to current non-users, current tobacco users had higher hazard ratios (95% CI) for deep infection, 2.37 (1.19, 4.72; p=0.01) and implant revision, 1.78 (1.01, 3.13; p=0.04) after total hip or knee arthroplasty. No significant differences were noted for periprosthetic fractures or superficial infections.

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Why do “Smokers Drink and Drinkers Smoke” ?

Mahesh Thakkar, Ph.D. Associate professor and director of research School of Medicine's Department of Neurology Missouri University

Dr. Thakkar

MedicalResearch.com Interview with:
Mahesh Thakkar, Ph.D.
Associate professor and director of research
School of Medicine’s Department of Neurology
Missouri University

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

Dr. Thakkar: It is well known that “smokers drink and drinkers smoke.” The question is why. In our previous research, we had observed that alcohol promotes sleepiness by inhibiting the brain region known as the basal forebrain. So we asked, “Does nicotine override alcohol-induced inhibition and activate the basal forebrain?” This study was performed to address these questions. The main finding of this study is that nicotine, when co-used with alcohol, attenuates alcohol-induced sleepiness by overriding alcohol-induced inhibition of the basal forebrain region.

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Secondhand Smoke Exposure Doubles Risk of Cavities in Children

Dental Cavity Wikipedia

Dental Cavity
Wikipedia

MedicalResearch.com Interview with:
Koji Kawakami, MD, PhD
Professor and Chair, Department of Pharmacoepidemiology and Clinical Research Management
Graduate School of Medicine and Public Health
Director, Science for Innovation Policy Unit, Center for Promotion of Interdisciplinary Education and Research
Kyoto University Kyoto city
Kyoto Japan

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

Dr. Kawakami: The prevalence of caries in deciduous teeth in developed countries remains high, while established measures for caries prevention in young children is limited to sugar restriction, oral fluoride supplementation and fluoride varnish. In this study of 76920 children in Japan, exposure to tobacco smoke at 4 months of age, which was experienced by half of all children of that age, was associated with an increased risk of caries in deciduous teeth by approximately 2-fold.

Medical Research: What should clinicians and patients take away from your report?

Dr. Kawakami: Our findings would support extending public health and clinical interventions to reduce secondhand smoke. For example, the chance of education on the harm of secondhand smoke would increase if dentists become aware of the caries risk due to secondhand smoke as well as tobacco smoking of their patients.

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Obesity Paradox Tied To Smoking and Illness-Induced Weight Loss

Dr. Samuel H. Preston Ph.D Professor, Department of Sociology and Population Studies Center University of Pennsylvania Philadelphia, Pennsylvania

Dr. Samuel Preston

MedicalResearch.com Interview with:
Dr. Samuel H. Preston Ph.D
Professor, Department of Sociology and Population Studies Center
University of Pennsylvania
Philadelphia, Pennsylvania 

Medical Research: What is meant by the Obesity Paradox? Is it reported more in some groups?

Dr. Preston: The obesity paradox is a term that is used when a study finds that obese people have lower mortality than non-obese people. The finding is considered paradoxical because the obese do not have lower mortality in cross-sections of the general population. The paradox is, however, commonly observed among people who suffer from a particular illness such as heart disease or diabetes

Medical Research: What are the main findings of your study? What is reverse causation and how does it affect obesity studies?

Dr. Preston: We find in a nationally representative sample that, among people suffering from cardiovascular disease, mortality is indeed lower for people who are overweight or obese than for people of normal weight. So the paradox appears among this group. However, when we study people’s mortality according to their maximum lifetime weight, the paradox disappears. We attribute its disappearance primarily to the fact that many  people who have lost weight from their maximum are doing so because they are ill. This phenomenon is referred to as “reverse causation” because illness is affecting weight rather than weight affecting illness and mortality.
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What Can We Learn From Small Group of Smokers Who Survive To Old Age?

Dr. Morgan Elyse Levine PhD Postdoctoral Fellow Department of Human Genetics University of California, Los Angeles
MedicalResearch.com Interview with:
Dr. Morgan Elyse Levine PhD
Postdoctoral Fellow
Department of Human Genetics
University of California, Los Angeles

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

Dr. Levine: Studies using mice, worms, and flies have suggested that longevity may be linked to stress resistance. All of us are constantly encountering things that damage our cells and tissue and disrupt physiological functioning. Therefore, people who are genetically predisposed to better prevent or repair this damage may age slower. Smoking is one of the most damaging things someone can do to their health, yet some smokers are able to survive to extreme ages. This study looked at long-lived smokers to see if we could identify a “genetic signature”. We generated a genetic risk score that was found to be associated with longevity both in smokers and non-smokers, and also appeared to be associated with cancer risk.

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Up to 70% of Marijuana Users Also Use Tobacco With Complex Results

Francesca M. Filbey PhD School of Behavioral and Brain Sciences Center for Brain Health University of Texas at Dallas Dallas, TXMedicalResearch.com Interview with:
Francesca M. Filbey PhD
School of Behavioral and Brain Sciences
Center for Brain Health University of Texas at Dallas
Dallas, TX

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

Dr. Filbey: Most studies exclude tobacco users from participating, but 70% of marijuana users also use tobacco. We were interested in investigating the combined effects of marijuana and tobacco. Our research targeted the hippocampus because smaller hippocampal size is associated with marijuana use. We chose to study short term memory because the hippocampus is an area of the brain associated with memory and learning. The main finding was surprising. The smaller the hippocampus in the marijuana plus nicotine user, the greater the memory performance. We expected the opposite, which was true of the non-using control group. Continue reading

Toxins In Vapor From Electronic Cigarettes Can Travel Far

MedicalResearch.com Interview with:
Uploaded by Merak MareyJonathan Thornburg, PhD
Director, Exposure and Aerosol Technology
RTI International
Research Triangle Park, NC

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

Dr. Thornburg: RTI wants to improve the human condition by protecting public health from exposure to contaminants. That includes secondhand exposure to electronic cigarette vapors. RTI realized that most research has focused on the electronic cigarette user, not on secondhand exposure. Our research created a simulated lung in our laboratory to produce representative electronic cigarette aerosol that a user would exhale so we could measure the aerosol size distribution and chemical composition. Those two parameters are critical characteristics for understanding the physical and chemical properties of the aerosol as it disperses in the environment to produce the airborne concentrations that determine someone’s secondhand exposure. Our main findings were:

  1. The aerosol particles exhaled by a user are smaller than 1000 nm, with median size between 100 and 200 nm. The aerosol size distribution varies with the type of e-liquid used.
  2. The aerosol is made of water, glycerin/propylene glycol, nicotine, artificial flavors, and preservatives
  3. Artificial flavors identified were ethyl maltol, 2-methyl naphthalene and 2-tert-butyl-p-cresol present.
  4. BHA and BHT preservatives were present.
  5. Dosimetry modeling determined that more than 50% of the electronic cigarette emissions were exhaled by the user, potentially leading to secondhand exposure.

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Very Easy For Minors To Purchase E-Cigarettes Online

Rebecca S. Williams, MHS, PhD University of North Carolina at Chapel Hill Chapel Hill, NCMedicalResearch.com Interview with:
Rebecca S. Williams, MHS, PhD

University of North Carolina at Chapel Hill
Chapel Hill, NC

MedicalResearch: What is the background for this study? 

Dr. Williams: In recent years, the e-cigarette industry has ballooned into a multi-billion dollar market, with at least 466 brands and 7764 unique flavors of e-cigarettes sold online. With both smokers and people who never smoked turning to e-cigarettes, there are concerns about their safety, lack of regulation and accessibility to teens. The CDC reported that 17% of high school seniors use e-cigarettes, more than twice as many as use traditional cigarettes; furthermore, that hundreds of thousands of youth annually are using e-cigarettes who never smoked cigarettes.

Our previous studies of Internet cigarette sales indicated that Internet Tobacco Vendors did a poor job of preventing sales to minors, which helped inform development of state and federal regulations to regulate such sales.  In 2013, North Carolina passed a law requiring age verification for online e-cigarette sales. This study was the first study to examine age verification used by Internet e-cigarette vendors and the first to assess compliance with North Carolina’s e-cigarette age verification law.

MedicalResearch: What are the main findings?

Dr. Williams: It was very easy for minors to buy e-cigarettes online. It took little effort for them to bypass the age verification practices of the vendors because there was very little use of rigorous age verification.  With only 5 orders rejected by vendors due to age verification, there was a youth e-cigarette purchase success rate of 94.7%.  No vendors used age verification at delivery, and few used rigorous methods of age verification that could potentially block youth access. While 7 vendors claimed to use age verification techniques that could potentially comply with North Carolina’s law, only one actually did.

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Drug May Reverse Childhood Asthma Caused By Maternal Smoking

Virender K. Rehan, MD LA BioMed Lead ResearcherMedicalResearch.com Interview with:
Virender K. Rehan, MD

LA BioMed Lead Researcher

 

Medical Research: What are the main findings?

Dr. Rehan: A new study holds hope for reversing asthma caused by smoking during
pregnancy. The study, published online by the American Journal of Physiology
– Lung Cellular and Molecular Physiology, reported that a medication that
stimulates certain proteins in the body reversed airway damage in disease
models of asthma caused by prenatal exposure to nicotine.

This is the first study to indicate that the damage caused by exposure to
nicotine during pregnancy could actually be reversed. Earlier studies found
this medication could prevent nicotine-induced asthma when given during
pregnancy. Researchers at Los Angeles Biomedical Research Institute (LA
BioMed) conducted the study to determine if the lung and airway damage
caused by nicotine could be reversed and found it could be.

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Varenicline – Chantix – Helped More Smokers Quit Gradually

Jon Ebbert, M.D. Associate director for research Mayo Clinic Nicotine Dependence CenterMedicalResearch.com Interview with:
Jon Ebbert, M.D.

Associate director for research
Mayo Clinic Nicotine Dependence Center

 

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

Dr. Ebbert: Some cigarette smokers prefer to reduce the number cigarettes that they smoke before quitting smoking completely. Previous studies have evaluated the use of nicotine replacement therapy and one smaller study looked at varenicline to help smokers quit through smoking reduction. We wanted to conduct a larger study with varenicline using a longer duration of treatment.

We enrolled cigarette smokers who had no intention of quitting in the next month but who were willing to reduce the number of cigarettes they smoked while working toward a quit attempt in the next 3 months.

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Combination Services Have Higher Smoking Cessation Rates

dr-mary-puckettMedicalResearch.com Interview with:
Mary Puckett, PhD

CDC
Division of Cancer Prevention and Control.

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

Dr. Puckett: Smoking causes 480,000 deaths per year in the United States. Quitline services are offered by all 50 states. In addition to telephone quitlines, 96% of states also offer some form of web-based cessation service. Seven months after enrollment in the study, participants from four state quitlines were asked if they had smoked in the past 30 days as a measure of their smoking cessation success. Participants who used quitlines and web-based services in combination had higher rates of smoking cessation than participants who used only one of these services. Continue reading

Increasing Chantix Dose Did Not Increase Smoking Quit Rate

Dr Hayden McRobbie MB ChB PhD Reader in Public Health Interventions Wolfson Institute of Preventive Medicine Barts and The London School of Medicine and Dentistry Queen Mary University of LondonMedicalResearch.com Interview with:
Dr Hayden McRobbie MB ChB PhD

Reader in Public Health Interventions
Wolfson Institute of Preventive Medicine
Barts and The London School of Medicine and Dentistry
Queen Mary University of London

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

Dr. McRobbi: Varenicline is an effective smoking cessation aid that acts primarily to alleviate the symptoms of tobacco withdrawal discomfort, thereby making quitting easier. It also reduces the rewarding effects of cigarettes smoked which may enhance the drugs smoking cessation effect by reducing the enjoyment of smoking prior to quitting and preventing a lapse, after quitting, progressing to relapse.

In some people the standard dose of varenicline (2mg/day) results in a decrease in the enjoyment of smoking prior to quitting and that these people appear to have higher quit rates that those that don’t experience this reaction to smoking.

The randomised placebo controlled trial was designed to investigate whether increasing the varenicline dose (up to 5mg/day) in smokers who show no reaction to the standard dose improves treatment outcomes compared to remain on the standard dose.

Medical Research: What are the main findings?

Dr. McRobbi: Whilst the increased dose, compared with the standard dose, reduced the enjoyment of smoking prior to quitting it had no additional effect on alleviating tobacco withdrawal symptoms or smoking cessation rates at 12 weeks post quit date (26% vs. 23%).

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Premature Hair Graying Linked to Smoking and Obesity

MedicalResearch.com Interview with:
Seong Jin Jo, MD, PhD
Department of Dermatology
Seoul National University College of Medicine
Seoul Korea.

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

Response: Hair graying is a natural aging process, but some people develop hair graying in their youth.

In this study of young Korean males, we found that obesity, smoking, and family history were significantly associated with premature hair graying.

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CDC ‘Tips From Former Smokers Campaign’ Proves Cost Effective

MedicalResearch.com Interview with:
Xin Xu, Ph.D.
Senior Economist Office on Smoking and Health and

Darryl Konter
Health Communications Specialist
McNeal Professional Services
Centers for Disease Control and Prevention
Office on Smoking and Health
Atlanta, GA 30341

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

Response: Tips From Former Smokers (Tips), the first federally funded national mass media antismoking campaign, launched by the CDC, provides a unique opportunity to assess the cost effectiveness of a nationwide public health intervention that meets the ad exposure recommendation in CDC’s 2014 Best Practices for Comprehensive Tobacco Control Programs.  The 2012 campaign spent $393 per year of life saved—far less than the $50,000 per year of life saved figure used as a common threshold for cost-effectiveness. The campaign  added about 179,000 healthy life years, at $268 per healthy year gained. The campaign spent about $480 per smoker who quit. The campaign averted more than 17,000 premature deaths, at a cost of about $2,200 per premature death averted.
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Billions of Smoking Health Care Costs Paid By Taxpayers

MedicalResearch.com Interview with:
Darryl Konter

Health Communications Specialist
McNeal Professional Services
Centers for Disease Control and Prevention
Office on Smoking and Health Atlanta, GA 30341

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

Darryl Konter:

        Fifty years after the first Surgeon General’s report, tobacco use remains the nation’s leading preventable cause of death and disease, despite declines in adult cigarette smoking prevalence. Smoking-attributable healthcare spending is an important part of overall smoking attributable costs in the U.S.

        Data came from the 2006–2010 Medical Expenditure Panel Survey (MEPS) linked to the 2004–2009 National Health Interview Survey (NHIS). The MEPS is a nationally representative survey of civilian non-institutionalized families and individuals, their medical providers, and employers that collects information on individual healthcare utilization and medical expenditures.

        By 2010, 8.7% of annual healthcare spending in the U.S. could be attributed to cigarette smoking, amounting to as much as $170 billion per year.  More than 60% of the attributable spending was paid by public programs, including Medicare, other federally-sponsored programs, or Medicaid.

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Genes Influence Body Weight in Smokers and Never-Smokers

Marcus Munafò PhD Professor of Biological Psychology MRC Integrative Epidemiology Unit UK Centre for Tobacco and Alcohol Studies School of Experimental Psychology University of Bristol United KingdomMedicalResearch.com Interview with:
Marcus Munafò PhD
Professor of Biological Psychology
MRC Integrative Epidemiology Unit
UK Centre for Tobacco and Alcohol Studies
School of Experimental Psychology
University of Bristol United Kingdom

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

Dr. Munafo: We were conducting an analysis of data on smoking behaviour and body mass index (BMI), in order to better understand the potential causal effects of smoking on different measures of adiposity. Mendelian randomisation uses genetic variants associated with the exposure of interest (in this case smoking) as proxies for the exposure, in order to reduce the risk of spurious associations arising from confounding or reverse causality. As expected, we found that, among current smokers, a genetic variant associated with heavier smoking was associated with lower BMI, providing good evidence that smoking reduces BMI. However, we also unexpectedly found that the same variant was associated with higher BMI in never smokers. This suggests that this variant might be influencing BMI via pathways other than smoking.
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