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 Çuğun is licensed under CC BY 2.0
Richard Allen Miech, PhD
Research Professor, Survey Research Center
Institute for Social Research
University of Michigan 

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

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

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

MedicalResearch.com Interview with:

Reto-Auer.jpg

Prof. Reto Auer

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

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

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

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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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