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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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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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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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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Memory Retrieval and Extinction Reduces Craving For Cigarettes

MedicalResearch.com Interview with:

Michael E. Saladin, Ph.D. Professor, Department of Health Sciences and Research College of Health Professions Medical University of South Carolina Charleston, SC

Dr. Michael Saladin

Michael E. Saladin, Ph.D.
Professor, Department of Health Sciences and Research
College of Health Professions
Medical University of South Carolina
Charleston, SC

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

Response: To the extent that learning and memory processes govern all aspects of behavior, they also govern dysregulated or maladaptive behaviors such as addiction and anxiety states. In the former case, stimuli associated with drug administration can acquire the ability to control drug-related motivational states (urges and craving) as well as drug seeking behavior. To illustrate the point, the simple act of observing a person light up a cigarette will cause the typical smoker to desire a cigarette and engage in smoking. A nonsmoker, by contrast, would not be similarly affected because they have no history where stimuli associated with smoking (e.g., sight of a lighter, cigarettes, plumes of smoke) are reliably paired with, or followed by, the rewarding effects of nicotine.

The research we conducted recently was based on neuroscience research showing that retrieved drug-associated memories (prompted with drug-paired cues) can be updated with information that decreases drug craving and/or administration. One such study showed that heroin craving in heroin addicts can be decreased by retrieving memories for heroin use via a brief heroin cue presentation (video of people using heroin) and then, a short time later, presenting an extensive variety of heroin cues (video, pictures and heroin use paraphernalia) over a 1-hour period. The logic of this intervention was that once the heroin memories were prompted into a labile state by the brief video presentation, the extensive heroin cue exposure would serve to update the content of the original memories with new information (i.e., cues are not followed by heroin reward) that is inconsistent with the original cue-drug contingency (i.e., cues are followed with heroin reward). Remarkably, just two sessions of this type of training, which we call retrieval-extinction training, resulted in significant reductions in heroin craving that persisted for six months. This study was done with heroin addicts who were inpatients so there was no way to assess the effects of this treatment on actual heroin use.

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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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Can Propranolol Reduce Nicotine Cravings?

MedicalResearch.com Interview with:

Lin Lu, M.D. Ph.D. Director/Professor, Institute of Mental Health and Peking University Sixth Hospital Director/Professor, National Institute on Drug Dependence, Peking University Beijing China

Dr. Lin Lu

Lin Lu, M.D. Ph.D.
Director/Professor, Institute of Mental Health and Peking University Sixth Hospital
Director/Professor, National Institute on Drug Dependence, Peking University
Beijing China

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

Response: Nicotine addiction is the leading preventable cause of mortality, and causes over 6 million deaths each year. One fundamental mechanism that maintain smoking relapse in smokers is the persistence of memories of both nicotine reward and nicotine-associated conditioned stimulus (CS, e.g. ashtray,cigarette lighters, etc.).Preclinical studies suggest that the drug reward memories can be reactivated by nicotine-associated CS undergo an unstable stage, named memory reconsolidation, and that pharmacological or behavioral manipulations that interfere with reconsolidation inhibit subsequent drug relapse.

However, most of the translational studies targeting reconsolidation stages of the drug reward memory have not been successful.One important reason is that when participants were exposed to nicotine-associated CS to induce memory reconsolidation, the pharmacological or behavioral manipulations only interfere with the reconsolidation of memories selectively associated with the reactivated CS, without affecting other CSs.

However, in real life, smoking is associated with multiple CSs that vary across individuals. Thus, a key question is how to interfere with reconsolidation of multiple nicotine-associated memories . In the present study, we introduce a novel memory reconsolidation interference procedure in which we reactivated multiple nicotine reward memories in rats and human smokers by acute exposure to nicotine (the UCS) and then interfered with memory reconsolidation using the noradrenergic blocker propranolol, an FDA-approved drug.

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Cigarette Smoking Remains A Huge Public Health Problem

MedicalResearch.com Interview with:
Andrew Hyland, PhD

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

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

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

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Young Smokers Have Drastic Increase in Heart Attack Risk

MedicalResearch.com Interview with:

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

Dr. Kevin Campbell

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

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

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

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

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Smoking Deaths Disproportionately Affect Poor and Black Americans

MedicalResearch.com Interview with:
Jane Henley MSPH

Epidemiologist
Division of Cancer Prevention and Control

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

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

MedicalResearch.com: What are the main findings?

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

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

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

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

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

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

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

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

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

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

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

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

Citation:

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

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

More Medical Research Interviews on MedicalResearch.com

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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Children Who Experience Early Parental Absence More Likely To Smoke or Drink Before Age 11

MedicalResearch.com Interview with:

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

Dr. Rebecca Lacey

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

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

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

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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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Even Light Smoking Elevates Risk of Brain Bleeding From Intracranial Aneurysm

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

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

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

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

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Smoking Warnings in Pictures Worth a Thousand Words?

MedicalResearch.com Interview with:

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

Marissa Hall

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

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

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

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Smoking During Pregnancy Raises Risk of Schizophrenia in Offspring

MedicalResearch.com Interview with:

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

Dr. Alan Brown

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

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

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

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

MedicalResearch.com Interview with:

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

Dr. Tanush Gupta

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

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

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

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

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

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

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No Apparent Increase in Neuropsychiatric Side Effects From Smoking Cessation Mediations

MedicalResearch.com Interview with:

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

Dr. Robert Anthenelli

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

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

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

MedicalResearch.com: What are the main findings?

Dr. Anthenelli:

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

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

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

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

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

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

Dr. Anthenelli:

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

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

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

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

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

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

Citation:

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

Anthenelli, Robert M et al.

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

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

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

More Medical Research Interviews on MedicalResearch.com

 

 

 

Brain Reward System May Underlie Tobacco Cravings in Schizophrenia

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

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

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

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

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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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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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Adolscents Who Try E-Cigs More Likely To Become Smokers

Brian A. Primack, MD, PhD Associate Professor of Medicine, Pediatrics, and Clinical and Translational Science Director, Center for Research on Media, Technology, and Health Assistant Vice Chancellor for Research on Health and Society University of Pittsburgh School of Medicine Pittsburgh, PA 15213MedicalResearch.com Interview with:
Brian A. Primack, MD, PhD

Associate Professor of Medicine, Pediatrics, and Clinical and Translational Science
Director, Center for Research on Media, Technology, and Health
Assistant Vice Chancellor for Research on Health and Society
University of Pittsburgh School of Medicine
Pittsburgh, PA 15213

Medical Research: What is the background for this study?

Dr. Primack: Adolescents and young adults who have never smoked traditional cigarettes are now using e-cigarettes. It is unclear whether these people are at risk for progression to traditional cigarette smoking. Therefore, we followed 694 non-smokers ages 16-26 who did not intend on taking up smoking for 1 year.

Medical Research: What are the main findings?

Dr. Primack: At baseline, only 16 of the 694 participants had used e-cigarettes. However, those individuals were significantly more likely to start smoking traditional cigarettes by the 1-year follow-up. In fully adjusted models, baseline e-cigarette use was independently associated with both progression to smoking (AOR = 8.3, 95% CI  = 1.2-58.6) and to susceptibility (AOR = 8.5, 95% CI = 1.3-57.2).

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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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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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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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Smoking Cessation: Less Expensive Cytisine May Be As Effective As Nicotine Replacements

natalie_walkerMedicalResearch.com Interview with:
Natalie Walker, Ph.D.
National Institute for Health Innovation
School of Population Health, University of Auckland
Auckland, New Zealand

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

Dr. Walker: Cytisine is a plant-based alkaloid and is structurally similar to nicotine.  It is found in various plants from the Legume Family (Fabaceae), the third largest plant family on earth.  Cytisine is currently manufactured by Sopharma Ltd, Bulgaria (Tabex®) and Aflofarm Pharma, Poland (Desmoxan®) as a smoking cessation treatment, with the cytisine used in the tablets taken from a plant called Golden Rain (Laburnum anagyroides).  Cytisine has been available with and without prescription for smoking cessation since the 1960s, largely in Eastern Europe.   Cytisine is not currently registered for use in any Western countries (although regulatory approval is currently been sought for the USA , UK and Japan).

            We know from trial evidence that cytisine is better than a placebo for helping people quit smoking.  Cytisine is also one of the most affordable smoking cessation medicines available. It is much cheaper than nicotine patches, gum and/or lozenges and other smoking cessation medicine such as varenicline. This means smokers and governments are more likely to afford cytisine, especially those from low and middle income countries. However, we don’t know if cytisine is as good as nicotine patches and/or gum or lozenges, one of the most commonly used smoking cessation treatments in many western countries. We therefore undertook a pragmatic non-inferiority trial to answer this question, with recruitment of 1310 adult daily smokers who were motivated to quit, undertaken using the New Zealand national Quitline. Smokers were randomised to receive the standard 25 days of cytisine treatment or 8 weeks of nicotine patches and/or gum or lozenges.  Both groups received standard Quitline behavioural support.  Follow-up occurred at one week and one, two, and six months.

At all time points, cytisine was found to be better at helping people quit smoking than nicotine patches and/or gum or lozenges.  This finding was consistent irrespective of ethnicity, age, alcohol consumption, degree of cigarette dependence or whether participants smoked factory-made cigarettes or roll-your-owns. For reasons unknown, cytisine helped more women quit smoking than nicotine patches, gum and/or lozenges.  For men the effectiveness of the two products was similar.  Cytisine use made people less likely to relapse back to smoking. Those who did smoke when using cytisine didn’t enjoy smoking as much, and reduced the number of cigarettes they smoked.  Self-reported, non-medically verified adverse events were more common in those that used cytisine. Three out of every 10 people who used cytisine reported an adverse event, compared to 2 out of every 10 that used nicotine patches, gum and/or lozenges.  However the majority of reported side effects were mild and self-limiting. More people in the cytisine group experienced nausea, vomiting and sleep disturbances (e.g. bad dreams).

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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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42 Million US Adults Still Smoke

MedicalResearch.com Interview with:
Darryl Konter
Health Communications Specialist, Office on Smoking and Health at Centers for Disease Control and Prevention

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

Response: Tobacco use is the leading cause of preventable disease and death in the United States, resulting in more than 480,000 premature deaths and $289 billion in direct health care expenditures and productivity losses each year. Despite progress over the past several decades, millions of adults still smoke cigarettes, the most commonly used tobacco product in the United States. Cigarette smoking among U.S. adults declined from 20.9% in 2005 to 17.8% in 2013. Among cigarette smokers who smoke daily, the average number of cigarettes smoked per day declined from 16.7 in 2005 to 14.2 in 2013, and the proportions of daily smokers who smoked 20–29 or ≥30 cigarettes per day also declined. However, an estimated 42.1 million adults still smoked cigarettes in 2013. Moreover, cigarette smoking remains particularly high among certain groups, including adults who are male, younger, multiracial or American Indian/Alaska Native, have less education, live below the federal poverty level, live in the South or Midwest, have a disability/limitation, or who are lesbian, gay, or bisexual. Continue reading

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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Cigarette Smoking Prevalence Varies By Gender and Occupation

MedicalResearch.com: Interview with:
Girija Syamlal MBBS, MPH , Epidemiologist
Division of Respiratory Disease Studies
National Institute for Occupational Safety and Health
CDC, Morgantown, West Virginia
CDC/NIOSH/DRDS
Morgantown,WV 26505

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

Dr. Syamlal: During 2004–2011, of the 141 million U.S. adults, 20.7% were current cigarette smokers. Smoking prevalences were higher among men (22.8%) than women (18.3%). In both men and women, cigarette smoking prevalence varied widely by occupational group. In certain occupations, the prevalence of smoking was three times greater than the Healthy People 2020 goal that aims to reduce cigarette smoking prevalence to 12%.

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Smokers With Low Educational Level Have Greater Stroke Risk

MedicalResearch.com Interview with:
Helene Nordahl, MS, PhD
Department of Public Health, University of Copenhagen
Copenhagen, Denmark.

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

Dr. Nordahl: The combined effect of low educational level and smoking on the risk of stroke is the most surprising finding of our paper. In other words, we found that smokers with low educational level had a greater risk of stroke than smokers with high education. Suggesting that people, particularly men, with lower educational level were more vulnerable to the effect of current smoking than those with higher educational level.

The overall implications of this study is that reducing smoking in those with low educational level could potentially yield a greater reduction in stroke than targeting the same behaviors in the higher educated.

Since the most disadvantaged groups are often exposed to a wide number of stroke risk factors, it seems plausible that these people are at increased risk of stroke not only in Denmark but also in the US. However, the distributions of stroke risk factors may vary across various contexts and study populations. Thus, further cross-country comparative research with in this field is needed.

Citation:

Combined Effects of Socioeconomic Position, Smoking, and Hypertension on Risk of Ischemic and Hemorrhagic Stroke
Helene Nordahl,Merete Osler,Birgitte Lidegaard Frederiksen,Ingelise Andersen,Eva Prescott,Kim Overvad,Finn Diderichsen,and Naja Hulvej Rod

Stroke. 2014;STROKEAHA.114.005252published online before print August 14 2014, doi:10.1161/STROKEAHA.114.005252

 

Psoriatic Arthritis: Smoking Decreases Treatment Response

Dr. Bente Glintborg: Copenhagen Centre for Arthritis Research Centre for Rheumatology and Spine Diseases Copenhagen University Hospital Glostrup Copenhagen, DenmarkMedicalResearch.com: Interview Invitation
Dr. Bente Glintborg:
Copenhagen Centre for Arthritis Research
Centre for Rheumatology and Spine Diseases
Copenhagen University Hospital Glostrup
Copenhagen, Denmark

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

Dr. Glintborg: Current smoking had a negative impact among patients with psoriatic arthritis treated with TNFi. This was especially observed among male patients and among patients treated with infliximab and etanercept. Current smokers had a shorter treatment duration (=poorer treatment adherence rate) compared to non-smokers. And current smokers had poorer treatment response (measured as ACR20, ACR50 and ACR70 responses and EULAR good response) compared to non smokers. Especially among male smokers the EULAR good response and ACR20 response rates were nearly half of the rates among male non-smokers. The response rates among women did not seem to be affcted by smoking status. Current smokers had poorer self reported outcome measures (HAQ and VAS global and VAS fatigue) when they started treatment with TNFi.
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Smoking Plus Mental Illness Leads To Substantial Economic Burden

Ms Qi Wu: Mental Health and Addiction Research Group, Department of Health Sciences University of York, Heslington York  UKMedicalResearch.com Interview with:
Ms Qi Wu:
Mental Health and Addiction Research Group, Department of Health Sciences
University of York, Heslington
York  UK

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

Ms Qi Wu: At any time in the UK about one in six adults has a mental health problem, the prevalence of smoking in this group is over 33%, which is around 50% higher than in the general population. It is estimated that 3 million adults with mental disorders were smokers in 2009-10. Meanwhile, people with mental health disorders are also more likely to smoke heavily, this group accounts for as much as 42% of the total national tobacco consumption.  In this study, we calculated the avoidable economic burden of smoking in people with mental disorders.

The main finding was that people with mental disorders who smoke cost the UK economy £2.34 billion a year. The total costs are more or less equally divided among losses sustained from premature death, lost productivity, and healthcare costs to treat smoking related diseases such as lung cancer, cardiovascular disease and chronic obstructive pulmonary disease (COPD) in this group.  An estimated £719 million (31% of the total cost) was spent on treating diseases caused by smoking. Productivity losses due to smoking-related diseases were about £823 million (35%) for work- related absenteeism and £797 million (34%) was associated with premature mortality.
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