Should Nicotine Content of Cigarettes Be Reduced Gradually or Suddenly?

MedicalResearch.com Interview with:

Dorothy K. Hatsukami, Ph.D. Forster Family Professor in Cancer Prevention Professor of Psychiatry Associate, Director Masonic Cancer Center University of Minnesota

Dr. Hatsukami

Dorothy K. Hatsukami, Ph.D.
Forster Family Professor in Cancer Prevention
Professor of Psychiatry
Associate, Director Masonic Cancer Center
University of Minnesota 

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

Response: The U.S. Food and Drug Administration is considering a rule that would reduce nicotine in all cigarettes and possibly other burned tobacco products sold in the U.S. to minimally addictive levels.   Reducing nicotine in cigarettes does not make the cigarette safer, but because nicotine is the addictive chemical in tobacco, nicotine reduction would reduce the progression towards tobacco dependence and make it easier for smokers to quit smoking.  We recently published a study in JAMA that adds to the accumulating evidence to support reducing nicotine in cigarettes and addresses if a gradual reduction or a targeted immediate reduction in nicotine in cigarettes is the best approach.

In a large clinical trial involving 1,250 smokers across 10 academic institutions, immediate reduction of nicotine was compared to a gradual nicotine reduction approach. These two groups were also compared to smokers who continued to smoke usual nicotine content cigarettes.

Key findings showed that immediate nicotine reduction is likely to result in more rapid positive public health effects.  That is, smokers in the immediate reduction group experienced significantly less exposure to toxic cigarette smoke chemicals and reported smoking fewer cigarettes per day, less dependence on cigarettes and greater number of days that they were smoke-free compared to the other two groups. On the other hand, smokers in the immediate nicotine reduction group experienced more severe but transient withdrawal symptoms and greater drop-outs.  Continue reading

Which Group Is at Highest Risk for Tobacco Use Onset? Youth or Young Adults?

MedicalResearch.com Interview with:
“hookah” by Ksenia M is licensed under CC BY 2.0Cheryl L. Perry, Ph.D.
Professor of Health Promotion and Behavioral Sciences
The Rockwell Distinguished Chair in Society and Health
University of Texas Health Science Center at Houston (UTHealth)
School of Public Health, Austin, Texas

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

Response: There have been large changes in the social environment over the past 10 years that have affected tobacco use among youth and young adults. These include social media, e-cigarettes, and new regulations aimed at preventing use among youth.

Historically, nearly all onset of tobacco use, particularly cigarettes, occurred prior to high school graduation by age 18. Some recent national cross-sectional data suggested that onset might be occurring among young adults.

We decided to explore, with national and Texas data, whether onset of tobacco use was more likely to occur among young adults.

We did this by analyzing data from 3 studies over one year. Continue reading

Could Restricting Nicotine in E-Cigarettes Do More Harm Than Good?

MedicalResearch.com Interview with:
e-cigarette CDC imageDr Lynne Dawkins, PhD

Associate Professor
London South Bank University

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

Response: Many people think that it’s the nicotine that’s harmful so they opt for using a low strength in their e-liquid. We know from tobacco smoking that when people switch to using a lower nicotine yield cigarette, they compensate in order to maintain a steady blood nicotine level by taking longer, harder drags and this can increase exposure to toxins in the smoke. We also know from some of our other work with vapers (e-cigarette users) that they tend to reduce the nicotine strength of their e-liquid over time. We therefore wanted to explore whether vapers also engage in this compensatory puffing and whether this has any effect on exposure to potentially harmful chemicals.

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Does Preloading With a Nicotine Patch Help Smokers Quit?

MedicalResearch.com Interview with:
“Day 1 of nicotine patch, just stuffed my face with lunch at work and do NOT even want a cigarette” by David Bruce Jr. is licensed under CC BY 2.0Paul Aveyard
Professor of Behavioural Medicine
Nuffield Department of Primary Care Health Sciences
University of Oxford
Radcliffe Primary Care Building
Radcliffe Observatory Quarter
Oxford

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

Response: Tobacco addiction occurs because of repeated pairings of the act and sensation of smoking with binding of nicotine in the midbrain leading to release of dopamine in the nucleus accumbens. These repeated pairings create associative learning and, when brain nicotine concentrations fall, this produces a compulsion to keep using tobacco. In theory, blocking the actions of nicotine released while smoking ought to reverse this learning. One way to do this is to use a nicotine patch which provides a steady state high concentration of nicotine that desensitises the nicotinic receptors in the midbrain, making them unresponsive to nicotine from a smoked cigarette. This is the theory behind nicotine preloading.

The clinical trial evidence that preloading works is equivocal, with some trials suggesting a very large therapeutic effect and others no benefit at all. In the light of both the promise and the uncertainty, we aimed to complete the largest trial to date of nicotine preloading to examine its effectiveness, safety, and tolerability.

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Tobacco Flavorings On Their Own May Cause Heart Disease

MedicalResearch.com Interview with:
“fathers day” by James Simkins is licensed under CC BY 2.0Jessica L. Fetterman, PhD

Assistant Professor of Medicine
Boston University School of Medicine

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

Response: In our study, we studied endothelial cells, the cells that line the inside of the blood vessels. We collected endothelial cells from smokers both who use menthol and non-menthol cigarettes are impaired compared to non-smokers and we could make the non-smoker cells look like the endothelial cells of smokers by treating with menthol or eugenol (provides a clove spice-flavoring).

To test a wider variety of commonly used flavoring additives, we treated cultured (outside of the body in a dish) endothelial cells with some of the most commonly used flavoring additives in tobacco products and at different concentrations/doses. We then evaluated the effects of flavoring additives by looking at measures of cell death, oxidative stress, inflammation, and the ability of the cells to produce nitric oxide, a cardio-protective chemical made by endothelial cells that is lost when the cells become damaged.

We found that the flavoring additives used in tobacco products like e-cigarettes are toxic to the cells that line the blood vessels (endothelial cells). Our works suggests that the flavoring additives used in tobacco products may be harmful to the cardiovascular system.

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Cigarette Taxes Associated With Increased Smokeless Tobacco Use Among Adolescents

MedicalResearch.com Interview with:
Summer Sherburne Hawkins, PhD, MS Associate Professor School of Social Work Boston College Summer Sherburne Hawkins, PhD, MS
Associate Professor School of Social Work
Boston College 

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

Response: Increasing cigarette taxes has been a major policy driver to decrease smoking, including adolescent smoking, while taxes on other tobacco products have received less attention. Taxes on cigarettes, smokeless tobacco, and cigars are all fiscal policies, but they are not all equal. While state taxes on cigarettes have increased substantially over the past decade, there has been little change in policies governing alternative tobacco products.

The aim of our study was to evaluate the impact of chewing tobacco and cigar taxes, cigarette taxes, and the enactment of smoke-free legislation on adolescent male and female use of smokeless tobacco and cigars.

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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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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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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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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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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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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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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.

Continue reading

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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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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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

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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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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Hookah Smoking and Bars Flourishing

Michael L. Weitzman MD Professor, Departments of Pediatrics and Environmental Medicine NYU Langone Medical Center

Dr. Weitzman

MedicalResearch.com Interview with:
Michael L. Weitzman MD
Professor, Departments of Pediatrics and Environmental Medicine
NYU Langone Medical Center.

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

Dr. Weitzman: While the prevalence of cigarette smoking in the United States has recently seen a steady decline, more and more individuals report hookah (water pipe) usage. Researchers have shown that web queries for ‘hookah’ and ‘hookah bars’ have increased dramatically, but it is unclear whether this interest has led to an increase in the number of hookah bars in a given area.  We first tested the website Yelp.com to see whether it could reliably provide us with information – such as the date of establishment of a hookah bar – by comparing the date of the first review written on Yelp.com with the actual opening date. We found that, for 2014 onwards, the first review posting on Yelp.com, on average, occurred within the first month of a hookah bar’s opening date. Additionally, we found a dramatic increase in the number of hookah bars in New York City over the past 5 years. These hookah bars tend to be not randomly distributed, but instead clustered near universities and specific ethnic neighborhoods.

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Depression and Smoking Linked To Worse Prognosis in Oral Cancer

Dr. Eileen H. Shinn PhD Assistant Professor, Department of Behavioral Science Cancer Prevention and Population Sciences MD Anderson Cancer Center The University of Texas Houston, TX

Dr. Eileen Shinn

MedicalResearch.com Interview with:
Dr. Eileen H. Shinn PhD
Assistant Professor, Department of Behavioral Science
Cancer Prevention and Population Sciences
MD Anderson Cancer Center
The University of Texas
Houston, TX 

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

Dr. Shinn: Recent studies with leukemia, breast, lung, renal and liver cancer patients have shown that patients with depression have worsened survival.  These effect sizes are small, but independent of any of the traditional factors that are known to impact survival, such as extent of cancer, types of treatment administered and baseline health and age of the patient.  The current thinking is that cancer patients who are depressed have chronically heightened responses to stress; the constant release of stress hormones trigger changes in the tumor itself (such as noradrenergically-driven tumor angiogenesis) or may weakens the body’s immune function and ability to resist tumor growth.

When we measured depression in newly diagnosed patients with oropharyngeal cancer (cancer of the base of tongue and tonsil), we found that those patients who scored as depressed were 3.5 times more likely to have died within the five year period after their diagnosis, compared to nondepressed patients.  We also found that patients who were depressed were also 3.8 times more likely to have their cancer recur within the first five years after diagnosis.  We also found that patients who continued to smoke after diagnosis were more likely to recur within the first five years. These effect sizes were larger than those typically found in recent studies.  We believe that the larger effect size may be due to the tight eligibility criteria ( e.g., we did not include patients who already had recurrent disease, we only included patients with one specific type of head and neck cancer, oropharyngeal) and also due to controlling other known factors (all patients completed individualized treatment regimens of radiation/ chemoradiation at a comprehensive cancer center and patients with more advanced disease stage were more likely to have received treatment intensification compared to patients with early stage disease).  In all, we had 130 patients, one of the largest prospective studies with oropharyngeal cancer to examine the effect of depression on cancer outcome.

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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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Smokers’ Homes Have High Air Pollution Levels

Dr. John Cherrie PhD Honorary Professor in Occupational Hygiene Institute of Applied Health Sciences Aberdeen, UKMedicalResearch.com Interview with:
Dr. John Cherrie PhD
Honorary Professor in Occupational Hygiene
Institute of Applied Health Sciences
Aberdeen, UK


Medical Research: What are the main findings of the study?

Dr. Cherrie: We set out to bring together measurements of fine particle levels in homes where smoking takes place, to compare these with smoke-free homes and then to estimate how much of these fine particles are inhaled by people at different stages in their life. We also wanted to look at the exposure to particles of non-smokers living with smokers and compare this with the exposure of people living in heavily polluted major cities around the world.
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Smoking Continues To Be Major Source Of Preventable Disease In US

Dr. Brian Rostron PhD, MPH Center for Tobacco Products US Food and Drug Administration Silver Spring, MarylandMedicalResearch.com Interview with:
Dr. Brian Rostron PhD, MPH
Center for Tobacco Products
US Food and Drug Administration
Silver Spring, Maryland


Medical Research: What are the main findings of the study?

Dr. Rostron: We estimated that Americans in 2009 had had 14 million major medical conditions such as heart attack, stroke, lung cancer, and COPD that were attributable to smoking.  COPD was the leading cause of smoking-attributable morbidity, with over 7.5 million cases of COPD attributable to smoking.
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