Smoking Highlights Health Disparities Among US Cities

MedicalResearch.com Interview with:

Eric Leas PhD, MPH Stanford Prevention Research Center University of California, San Diego

Dr. Leas

Eric Leas PhD, MPH
Stanford Prevention Research Center
University of California, San Diego

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

Response: Recent research has demonstrated the importance that neighborhood context has on life opportunity, health and well-being that can perpetuate across generations. A strongly defining factor that leads to differences in health outcomes across neighborhoods, such as differences in chronic disease, is the concurrent-uneven distribution of modifiable risk factors for chronic disease.

The main goal of our study was to characterize inequities in smoking, the leading risk factor for chronic disease, between neighborhoods in America’s 500 largest cities. To accomplish this aim we used first-of-its-kind data generated from the 500 Cities Project—a collaboration between Robert Wood Johnson Foundation and the US Centers for Disease Control and Prevention—representing the largest effort to provide small-area estimates of modifiable risk factors for chronic disease.

We found that inequities in smoking prevalence are greater within cities than between cities, are highest in the nation’s capital, and are linked to inequities in chronic disease outcomes. We also found that inequities in smoking were associated to inequities in neighborhood characteristics, including race, median household income and the number of tobacco retailers. 

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Teen E-Cigarette Use Drives Flavored Tobacco Sales

MedicalResearch.com Interview with:

Dr. Hongying Dai, PhD Associate Professor at the College of Public Health University of Nebraska Medical Center.

Dr. Dai

Dr. Hongying Dai, PhD
Associate Professor at the College of Public Health
University of Nebraska Medical Center.

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

Response: The 2009 Family Smoking Prevention and Tobacco Control Act (FSPTCA) banned cigarettes with characterizing flavors (e.g., candy, fruit, clove) except menthol. However, there are no restrictions on the marketing and sales of flavored non-cigarette tobacco products. This has led to a proliferation of flavored tobacco products in the marketplace. Flavoring has become one of the leading reasons for current tobacco use among youth. It is reported that 81% of e-cigarette users, 79% of hookah users, 74% of cigar users, 69% of smokeless tobacco users, and 67% of snus users attributed the availability of appealing flavors for their tobacco use in 2013–2014 among teenagers aged 12 to 17 years. In November 2018, the FDA proposed new restrictions on flavored tobacco products.

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Parents: Vaping is Drawing Adolescents into Nicotine Use

MedicalResearch.com Interview with:

Richard Miech Ph.D Professor Principal Investigator, Monitoring the Future Institute for Social Research University of Michigan

Dr. Miech

Richard Miech Ph.D
Professor
Principal Investigator, Monitoring the Future
Institute for Social Research
University of Michigan

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

 Response: Every year Monitoring the Future conducts a survey to examine trends in adolescent substance use.  We draw a random sample of schools from a list of all schools in the United States and conduct our survey in ~400 schools.  Our survey is representative of U.S. 8th, 10th, and 12th grade students.  In other words, our results are what you would find if you surveyed every single 8th, 10th, and 12th graders in the United States, within the bounds of a small sampling error of a few percentage points.

An increase in vaping is the big news for 2018.  In 10th and 12th grade the increase in nicotine vaping was the largest we’ve ever seen for any substance in the past 43 years.  As a result of this increase in nicotine vaping, overall use of nicotine increased as well, which suggests that vaping is drawing youth into nicotine use.  We also saw a significant increase in marijuana vaping. Continue reading

Cutting Back on Alcohol May Help You Quit Smoking

MedicalResearch.com Interview with:

Dr. Sarah Dermody, PhD Assistant Professor School of Psychological Science Oregon State University Corvallis Oregon

Dr. Dermody

Dr. Sarah Dermody, PhD
Assistant Professor
School of Psychological Science
Oregon State University
Corvallis Oregon 

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

Response: Drinking alcohol is a risk factor for sustained smoking. In a sample of daily cigarette smokers receiving treatment for alcohol use disorder, we examined if reductions in drinking corresponded with reductions in nicotine metabolism as indexed by the nicotine metabolite ratio. The nicotine metabolite ratio is important because it is associated with smoking level and lapses. We found that for men, alcohol use and the nicotine metabolite ratio reduced significantly; however, for women, neither drinking nor nicotine metabolite ratio changed.

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Maternal Smoking Linked to Early Puberty in Offspring

MedicalResearch.com Interview with:

Nis Brix M.D., PhD Student Department of Public Health Department of Epidemiology Aarhus University Hospital Nis Brix M.D., PhD Student
Department of Public Health
Department of Epidemiology
Aarhus University Hospital 

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

Response: Several studies have indicated a secular trend towards earlier puberty. This is a potential concern as early puberty has been linked to an increased risk of a number of diseases, such as obesity, diabetes, cardiovascular diseases and certain types of cancer. For this reason, our research team are interested in identifying potential modifiable causes of early puberty.

Smoking during pregnancy may be such a modifiable cause of early puberty in the children. Former studies have already linked smoking during pregnancy to earlier age at the daughters’ first menstrual period, a relatively late marker of pubertal development, but other markers of puberty are less studied, especially in the sons.

We studied 15,819 sons and daughters. The mothers gave detailed information on smoking during their pregnancies, and the children gave information on a number of pubertal milestones half-yearly from the age of 11 years. The milestones for the sons were age at voice break, first ejaculation of semen, pubic hair and testicular growth, armpit hair growth and onset of acne. For the daughters the milestones were age at their first menstrual period, pubic hair growth, breast development, armpit hair growth and onset of acne.

Our results suggested that the more cigarettes the mother smoked during her pregnancy the earlier her children, both sons and daughters, went through puberty. If the mother smoked more than ten cigarettes a day during pregnancy, the children appeared to go through puberty, on average, three to six months earlier than the children of non-smoking mothers. Continue reading

Paternal Smoking Can Affect Multiple Generations of Descendants

MedicalResearch.com Interview with:
"Photo booth: The Smoking Man" by simpleinsomnia is licensed under CC BY 2.0Pradeep G. Bhide, Ph.D.
Professor | Jim and Betty Ann Rodgers Eminent Scholar Chair of Developmental Neuroscience
Director, Center for Brain Repair
Department of Biomedical Sciences
Florida State University College of Medicine
Tallahassee, FL

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

Response: Until now, much attention had been focused on the adverse effects of cigarette smoking by pregnant women on their children’s cognitive development. Some reports suggested that cigarette smoking during pregnancy can produce harmful effects in multiple generations of descendants (transgenerational effects).

Not much had been known about the effects of paternal smoking, although more men smoke cigarettes than women. Our study shows that paternal nicotine exposure can be deleterious to the offspring in multiple generations. That is, cognitive function may be compromised in children and grandchildren of a nicotine-exposed male. Of course, our study was done in mice and not men.  However, since studies done in mice on maternal nicotine exposure produced results consistent with studies done in women and children, we believe that he findings from our present study likely can be extrapolated to humans.  Continue reading

2 Million Never-Smokers Now Use E-Cigarettes

MedicalResearch.com Interview with:
"Electronic Cigarette/E-Cigs/E-Cigarettes" by Chris F is licensed under CC BY 2.0Mohammadhassan (Hassan) Mirbolouk, MD
American Heart Association Tobacco Regulation Center (A-TRAC)
Johns Hopkins Hospital
Baltimore, MD 21224.

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

Response: E-cigarettes were introduced first in US market as a less harmful method of nicotine delivery which potentially would help smokers to have a less harmful option.

However, overtime e-cigarette found its niche of consumers in the younger/tobacco naïve population. Our study is amongst the first studies that describes those who use e-cigarette without any history of combustible-cigarette smoking.  Continue reading

Skyrocketing JUUL Sales Especially Popular Among Youth

MedicalResearch.com Interview with:
"Electronic Cigarette/E-Cigs/E-Cigarettes" by Chris F is licensed under CC BY 2.0Brian King, PhD
Lead author and Deputy Director for Research Translation
Office on Smoking and Health.
CDC

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

Response: Since first entering the U.S. marketplace in 2007, e-cigarettes have been a rapidly evolving product class. Typically, national surveys provide annual, self-reported estimates of e-cigarette use among adults and youth. However, given the dynamic nature of the e-cigarettes landscape, data collected at a sub-annual level can be useful for identifying rapid changes and patterns. For example, retail sales data, which is available at more frequent intervals, such as weekly, can complement annual surveys and help keep a pulse on emerging trends. This study assessed e-cigarette retail sales data in the United States from 2013 through 2017.

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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

Thousands of Students Sneak JUUL To Use School Hours

MedicalResearch.com Interview with:

Jon-Patrick Allem, Ph.D., M.A. Research Scientist Keck School of Medicine of USC

Dr. Allem

Jon-Patrick Allem, Ph.D., M.A.
Research Scientist
Keck School of Medicine of USC

MedicalResearch.com: What is the background for this study? Would you briefly explain what is meant by JUUL? 

Response: The JUUL vaporizer is the latest advancement in electronic cigarette technology, delivering nicotine to the user from a device about the size and shape of a thumb drive.

JUUL has taken the electronic cigarette market by storm experiencing a year-over-year growth of about 700 percent.

In our most recent study, we wanted to document and describe the public’s initial experiences with JUUL. We collected posts to Twitter containing the term “Juul” from April 1, 2017 to December 14, 2017. We analyzed over 80,000 posts representing tweets from 52,098 unique users during this period and used text classifiers (automated processes that find specified words and phrases) to identify topics in posts.

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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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Lung Cancer Risk Drops Almost 40% Within 5 Years of Quitting Smoking

MedicalResearch.com Interview with:
Hilary Tindle, MD, MPH

“Used Cigarette Butts” by Indi Samarajiva is licensed under CC BY 2.0Associate Professor of Medicine and theWilliam Anderson Spickard, Jr., MD Chair in Medicine
Founding Director of ViTAL, the Vanderbilt Center for Tobacco, Addiction and Lifestyle
Division of Internal Medicine & Public Health and Vanderbilt Ingram Cancer Center (VICC)

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

Response: Lung cancer is the most common cause of cancer related death for men and women ,and cigarette smoking is responsible for almost 9 of our every 10 lung cancers in the US. Lung cancer screening can reduce the risk of death from lung cancer by about 20% or even higher if screening is combined with quitting smoking.

We know that lung cancer risk is lower in people who quit smoking, compared to those who continue to smoke, but it was not clear how quickly this risk drops after quitting. Most prior studies on this subject assessed smoking status (current, former, never) at relatively few timepoints. By asking about smoking more frequently (every couple of years), we can get a better picture of a person’s true exposure to cigarette smoke and take into account periods where someone may have smoked more, less, or even quit altogether. Some people may start and stop multiple times over their lifetime.

Another question was exactly how long the risk of lung cancer stays elevated after quitting smoking. Again, by asking about smoking multiple times over someone’s lifetime, we get a better picture of how long they were truly smoke free.

MedicalResearch.com: What are the main findings?

  •  We analyzed data from the Framingham Heart Study Original and Offspring cohorts (almost 9000 people total) to study the risk of lung cancer after quitting smoking, and to determine if the risk of lung cancer ever goes back to that of someone who has never smoked (termed a “never smoker”). Study participants were followed for a median of almost 30 years, and were asked about smoking every 2-4 years.
  • We focused on heavier smokers, who had smoked more than 21 pack-years. (A “pack-year” is a way to quantify how much someone has been exposed to cigarette smoke. Pack years are the product of years of smoking times the amount smoked. For example, someone who smoked 1 pack of cigarettes per day for 20 years would have 20 pack years. Another person who smoked 2 packs per day for 10 years would also have 20 pack years.) As expected, the risks of lung cancer were highest among current smokers, followed by former smokers, followed by never smokers.
  • Compared to never smokers, former smokers had higher lung cancer risk: about 12 times higher within 10 years since quitting (YSQ), about 7 times higher from 10-15 YSQ, about 6 times higher from 15-25 YSQ, and over 3 times higher even after 25 YSQ.
  • Compared to current smokers, former smokers had lower lung cancer risk: 39% lower within 5 YSQ, which continued to drop over time.
  • Among all former smokers, about 4 in 10 lung cancers occurred after more than 15 YSQ, which is beyond the window of eligibility for current screening guidelines.

In the future, after additional study, guidelines may decide to extend the window of lung cancer screening beyond 15 YSQ. However, additional modeling studies are likely needed before making that determination. For now, anyone who qualifies for lung cancer screening based on age, pack years, and years since quitting, should have it.

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

Response: If you currently smoke cigarettes, now is a great time to quit. The results of this study show that lung cancer risk drops almost 40% within 5 years since quitting, compared to people who continue to smoke.

If you already quit smoking, congratulations on taking that major step.

Whether you currently smoke, or if you quit smoking within the last 15 years, talk to your doctor to see if you are eligible for lung cancer screening. 

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

 Response: We would like to see additional research from different groups to determine if the current lung cancer screening guidelines should potentially be altered to include those who quit more than 15 years ago. Again, this is a decision may require additional study, including an understanding of why some former smokers remain at elevated risk of lung cancer. Perhaps studying genetic variation could shed some light on this question.  

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

Response: Yes, we would like to thank the NIH and particularly the NHLBI for supporting the Framingham Heart Study (FHS) and studies like it, and also to all the participants in the FHS for giving their information for decades, to the benefit of all Americans and the world. We consider studies such as the FHS to be “national treasures” in that they provide critical information for doctors and researchers to improve healthcare. The FHS is most often thought of as a cardiovascular dataset, but it also captures information on cancer. In the case of the current study, we re-analyzed information that was already collected, which is one of the efficient and low cost methods of conducting research. 

Citation:

 Hilary A Tindle, Meredith Stevenson Duncan, Robert A Greevy, Ramachandran S Vasan, Suman Kundu, Pierre P Massion, Matthew S Freiberg. Lifetime Smoking History and Risk of Lung Cancer: Results From the Framingham Heart Study. JNCI: Journal of the National Cancer Institute, 2018; DOI: 10.1093/jnci/djy041

 

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Smokers At Increased Risk of Prostate Cancer Recurrence

MedicalResearch.com Interview with:
“Stop smoking!” by Emil_95 is licensed under CC BY 2.0Shahrokh F. Shariat, M.D.
Professor and Chairman
Department of Urology,
Comprehensive Cancer Center
Medical University Vienna
Adjunct Professor of Urology and Medical Oncology
Weill Medical College of Cornell University, New York, NY, USA
Adjunct Professor of Urology
UT Southwestern, Dallas, TX

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

Response: We know that tobacco smoking produces more than 70 carcinogens and is associated with worse prognosis in many solid cancers.

Although the association between cigarette smoking and prostate cancer death has been demonstrated, such association regarding other end points is still unclear. We evaluated different disease endpoints, such as recurrence, occurrence of metastasis and cancer-specific mortality at an earlier stage of disease. We found that smokers who underwent primary treatment for localized prostate cancer – such as radical prostatectomy and radiotherapy – are at increased risk of recurrence, metastasis and cancer-specific mortality.  Continue reading

More Young Women Than Men Now Get Lung Cancer

MedicalResearch.com Interview with:
“Woman smoking” by Pedro Ribeiro Simões is licensed under CC BY 2.0Ahmedin Jemal, DVM, PHD
Scientific Vice President, Surveillance & Health Services Rsch
American Cancer Society, Inc.
Atlanta, GA 30303

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

Response: Historically, lung cancer rates have been higher in men than women at all ages because of the substantially higher cigarette smoking prevalence in men.

However, cigarette smoking prevalences over the past few decades have become similar between young men and women. Consistent with this pattern, we previously reported the convergence of lung cancer rates between young men and young women. In this paper, we examined the lung cancer incidence rates in young women versus young men in the contemporary cohorts.

We found that the historically higher lung cancer incidence rates in young men than in young women have reversed in whites and Hispanics born since the mid-1960s. However, this emerging incidence patterns were not fully explained by sex difference in smoking prevalence as cigarette smoking prevalences among whites and Hispanics were not higher in young women than young men.

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Consumers Trying But Not Continuing E-Cigarettes

MedicalResearch.com Interview with:
“E-Cigarette/Electronic Cigarette/E-Cigs/E-Liquid/Vaping” by Vaping360 is licensed under CC BY 2.0
Wei Bao, MD, PhD
Assistant Professor
Department of Epidemiology,
College of Public Health,
University of Iowa,
Iowa City, IA 52242 

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

Response: Although the health effects of e-cigarettes remains unclear, e-cigarettes have been marketed as an approach for smoking cessation. Previous studies have reported an increase in e-cigarette use in US people since 2010. The current study showed that from 2014 to 2016, there was an increase in ever use of e-cigarettes but decline in current use of e-cigarettes.  Continue reading

Smoking: The Great Brain Drain

MedicalResearch.com Interview with:
“Stop smoking!” by Emil_95 is licensed under CC BY 2.0Janina Markidan MS III, MD Student

University of Maryland School of Medicine

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

Response: In a study of 1,145 young men, we found a strong dose-response relationship between the number of cigarettes smoked daily and the risk of ischemic stroke.

We categorized the participants as never smokers, former smokers and current smokers. Current smokers were divided into groups based on the number of cigarettes smoked daily, 1 to 10, 11 to 20, 21 to 39, or 40 or more.

We found that men who smoked were 88 percent more likely to have a stroke than men who never smoked. Among current smokers, men who smoked fewer than 11 cigarettes daily were 46 percent more likely to have a stroke than those who never smoked. But the heavier smokers, smoking at least two packs a day, were nearly 5 times (466%) more likely to have a stroke than those who never smoked.  Continue reading

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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Fewer Cigarettes But More Vaping Among Today’s Adolescents

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

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

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

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Trained Volunteers Can Deliver Effective Brief Smoking Cessation Advice

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

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

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

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

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Cheap Cigarettes in Europe Associated With Increased Infant Mortality

MedicalResearch.com Interview with:

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

Dr. Filippidis

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

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

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

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

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

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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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