Tag Archives: smoking

New Zealand wants to become smoking-free. The country will ban tobacco for anyone born after 2008

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New Zealand has some of the most stringent anti-tobacco laws in the world. Smoking is banned in virtually all public spaces, except for some dedicated places. It also levies huge taxes, representing 70% of the final cost of the tobacco product. These measures have worked, dropping the daily smoking rates down to 11.6% in 2018, from 18% a decade earlier. But the island nation ultimately wants to become smoking-free altogether and is now preparing to ban the sale of cigarettes to anyone born after 2008.

The country where no one will be able to start smoking

Although tobacco is legal across the world, smoking is the number one cause of preventable death. Worldwide, tobacco use causes more than 7 million deaths per year. One in four cancers in New Zealand is caused by smoking. The effects are most-felt among Māori, New Zealand’s indigenous people, with Māori women having the country’s highest smoking rates, with about 30% smoking daily. 

Quitting smoking is one of the hardest things nicotine users experience, which is why New Zealand wants to solve its smoking epidemic by nipping the habit in the bud.

“We want to make sure young people never start smoking, so we are legislating for a smoke-free generation by making it an offense to sell or supply tobacco products to those aged 14 when the law comes into effect,” said Dr. Ayesha Verrall, New Zealand health official, during a press conference on Thursday.

“As they age, they, and future generations, will never legally be able to purchase tobacco,” Verrall added. “Because the truth is, there is no safe age to start smoking.”

According to SmokeFree.nz, the average age at which people start smoking in the island nation is around 15 years, despite the fact that the sale of cigarettes is banned for those under 18. Those affected by the new ban are about to turn 14, so the new restrictions aim to keep them smoking-free for their entire lifetimes even as they age into adulthood.

During the same announcement of the unprecedented smoking ban, the local government also said it would restrict the sale of tobacco products, cutting the number of stores that are allowed to sell cigarettes and other tobacco products from 8,000 to only 500. The vast majority of these tobacco retailers could be found in low-income regions, where the smoking rates are also the highest. The country also said it would only allow the sale of low-nicotine tobacco. There are no new restrictions on vaping (e-cigarettes that vaporize nicotine).

Older citizens who started smoking a long time ago will also find new types of support to help them quit, thanks to public health outreach programs.

Doctors and public health experts have hailed the new tough crackdown on tobacco, but critics say the measures lack teeth and will likely incentivize the formation of a thriving black market. In recent years, organized criminal groups have accelerated large-scale smuggling of tobacco products. To their credit, the New Zealand health ministry has acknowledged these risks, noting “customs will need more resource to enforce border control”.

In the future, there’s a good possibility that the sale of tobacco products will be banned entirely across all age groups. Previously, the New Zealand government said it has a goal of becoming totally smoke-free by 2025.

The CDC started a vaping panic — now they think they found the culprit, and it’s not legal e-cigarettes

Shady sellers, shady products

The US was rocked by what seemed to be a vaping epidemic. Vaping-related lung injuries have killed at least 39 people and sickened more than 2,000 others.

The CDC signalled the dangers that e-cigarettes pose — devices that allow you to inhale nicotine in a vapour rather than smoke. But right from the start, something was weird about this situation.

For starters, the problems only seemed limited to the US. No other country reported similar trends; vaping was actually recommended as a way to reduce the negative impact of smoking (and as a stepping stone to quitting completely).

“E-cigarettes aren’t completely risk free but they carry a small fraction of the risk of cigarettes,” wrote the British National Health Service (NHS).

Vaping has been around for more than a decade, with tens of millions of users already — and nothing of this sort has ever been reported previously. It seemed that this was not a generalized problem, but to be on the safe side, the CDC advised everyone to not use any e-cigarette, or vaping products.

Now, after a thorough investigation, CDC officials believe they’ve found the culprit: Vitamin E.

“For the first time, we have detected a potential toxin of concern, vitamin E acetate, from biological samples from patients,” said Dr. Anne Schuchat, principal deputy director of the CDC. “These new findings are significant,” Schuchat added. “We have a strong culprit.”

Vitamin E is safe to ingest as a vitamin pill or as a lotion, but inhaling it can be harmful. However, because it is so cheap and available, it is often used on the black market of vape cartridge as a thickener in vaping fluid — which was killing and injuring consumers, the CDC believes.

The substance was detected in all 29 lung samples that the CDC analyzed, suggesting a strong correlation. While causation has not yet been proven, the link seems convincing. Nevertheless, Schuchet added that “many substances are still under investigation”.

The main takeaway is that you should never ever buy counterfeit or otherwise illegal e-cigarettes. You should steer clear of shady online or unregulated sellers, and only buy from licensed dispensaries. However, Schuchat warns users that it’s too soon to say whether it’s safe to use products even from licensed dispensaries. Which opens up a different side of the problem.

Has the CDC’s approach caused more harm than good?

According to a Reuters poll, 63% of adults disagree with the statement that “vaping is healthier than traditional cigarettes.” That is up 16 percentage points from a similar Reuters/Ipsos poll that ran in the spring of 2016. In addition, a mere 29% of adults think vaping is a good way to help people quit smoking. This is in strong contrast to what other researchers and health have been saying.

An NHS report found that e-cigs are 95% less harmful than regular cigarettes. E-cigarettes are most definitely not a good thing, and vaping is not a healthy habit — but the general position seems to be that when done properly, it is the lesser of two evils.

The CDC’s communication has led to a decline in vaping sales and, conversely, an increase in the sales of regular cigarettes. This could transform into a dangerous trend with long-lasting consequences.

Michael Siegel, an American tobacco control expert and public health researcher was very critical of the CDC’s approach.

In addition, as several governors rush to ban the same of e-cigs, this will only fuel the ‘bootleg’ production of e-cigs, which are the biggest danger in the first place.

This position was echoed by Dr. Mark Tyndall, Professor of Medicine at the University of British Columbia’s School of Population and Public Health

The investigation is still ongoing.

Electronic cigarettes aren’t good for you — in some respects, they’re worse than traditional cigarettes

E-cigarettes aren’t harmless. Although viewed as a healthier alternative, the study finds that e-cigarette smoking impacts heart health similar to the smoking of traditional cigarettes.

Image via Pixabay.

Several heart disease risk factors — cholesterol, triglycerides, and glucose levels, as well as decreased blood flow in the heart — are negatively impacted by e-cigarette smoke. The findings will be presented at the American Heart Association’s Scientific Sessions 2019, later this month.

Not harmless by far

“There is no long-term safety data on e-cigarettes. However, there are decades of data for the safety of other nicotine replacement therapies,” explains Rose Marie Robertson, M.D., FAHA, the American Heart Association’s deputy chief science and medical officer.

The American Heart Association (AHA) recommends the use of FDA-approved smoking cessation aids, which are proven safe and effective. Robertson says that people often choose e-cigarettes as an alternative to quitting (as it is perceived as being safer than traditional tobacco), or as a temporary solution while working to quit altogether. In the latter case, however, she warns that people should also plan how to subsequently stop using e-cigarettes. There is a striking lack of data on the long-term safety of such devices, and growing concerns over the physiological effects caused by the chemical cocktails therein.

One study used in this report — the Cardiovascular Injury due to Tobacco Use (CITU) Study — compared cholesterol, triglycerides, and glucose levels in healthy adult nonsmokers, e-cigarette smokers, traditional cigarette smokers, and dual smokers (who use both traditional and e-cigarettes). Participants were aged 21-45, didn’t have any preexisting cardiovascular disease, and took no relevant medication. Out of the total of 467 participants, 94 were non-smokers, 52 were dual smokers, 45 were e-cigarette smokers, and 285 were traditional cigarette smokers.

After adjusting for age, race, and sex, the team reports that total cholesterol was lower for e-cig smokers, but their low-density lipoprotein (LDL, ‘bad’ cholesterol) levels were higher, compared to nonsmokers. High-density lipoprotein (HDL, ‘good’ cholesterol) was lower in dual smokers.

“Although primary care providers and patients may think that the use of e-cigarettes by cigarette smokers makes heart health sense, our study shows e-cigarette use is also related to differences in cholesterol levels. The best option is to use FDA-approved methods to aid in smoking cessation, along with behavioral counseling,” said study author Sana Majid, M.D., a postdoctoral fellow in vascular biology at the Boston University School of Medicine.

Another study looked at heart blood flow as a measure of coronary vascular function in 19 young adult smokers (ages 24-32) immediately before and after smoking either e-cigarettes or traditional cigarettes. The study looked at this metric both at rest and after performing a handgrip exercise (meant to simulate physiological stress).

For smokers of traditional cigarettes, the team saw a “modest” increase in blood flow after cigarette inhalation, which decreased with subsequent stress. E-cig smokers, however, saw blood flow decrease both at rest and after the handgrip exercises. All in all, e-cigarette use seems to be associated with coronary vascular dysfunction to a greater degree than seen in traditional cigarettes.

“These results indicate that e-cig use is associated with persistent coronary vascular dysfunction at rest, even in the absence of physiologic stress,” said study author Florian Rader, medical director of the Human Physiology Laboratory and assistant director of the Non-Invasive Laboratory, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles.

“Providers counseling patients on the use of nicotine products will want to consider the possibility that e-cigs may confer as much and potentially even more harm to users and especially patients at risk for vascular disease,” added study co-author Susan Cheng, director of Public Health Research at the Cedars-Sinai Medical Center.

The studies were funded by The National Heart, Lung, and Blood Institute and the FDA Center for Tobacco Products, and The California State Tobacco-related Disease Research Program High Impact Pilot Research Award. The American Heart Association Tobacco Center for Regulatory Science provided research materials for the first study.

The findings will be presented at the American Heart Association’s Scientific Sessions 2019 conference, November 16-18 in Philadelphia, USA (sessions Mo3106, Sa3199).

Cigarette consumption in decline in the UK, showing tobacco tax works

Amid government efforts and health concerns, people are ditching cigarettes in England, with around 1.4 billion fewer cigarettes being smoked per year, according to new research funded by Cancer Research UK.

Credit: Flickr

The study, published in Jama Network Open, showed that average monthly cigarette consumption fell by nearly a quarter between 2011 and 2018. This represents around 118 million fewer cigarettes being smoked every month. Stricter tobacco laws and taking action to encourage people to quit smoking can be linked with the results.  

Based at UCL, the researchers looked at cigarette sales data for England and compared this with the monthly self-reported cigarette use of over 135,000 individuals from the Smoking Toolkit Study.

Over the period analyzed, the average number of cigarettes smoked monthly declined by 24.4% based on survey data and 24.1% based on sales data from 3.40 billion and 3.41 billion a month to 2.57 billion and 2.58 billion, respectively.

“It’s brilliant that over a billion fewer cigarettes are being sold and smoked in England every year. The decline in national cigarette consumption has been dramatic and exceeded the decline in smoking prevalence, which, over the same time period, was around 15%,” said lead author Dr Sarah Jackson.

Currently, 16% of English adults smoke cigarettes. That’s far from 1974 when almost half of the adults in the UK smoked. Now the government wants to “finish the job” and make smoking tobacco obsolete in England by 2030. This would help to deal with the daily 200 deaths from smoking-related illnesses.

In a green paper released on July 22, the Department of Health and Social Care (DHSC) laid out its plans for a cigarette-free England. The goal will be to crack down on the industry and pledging to help smokers quit or move to reduced-risk products like e-cigarettes.

An annual YouGov survey commissioned in early 2019 by Action on Smoking and Health showed that 72% of adults were in favor of manufacturers paying a levy or license fee to help smokers quit and prevent young people from starting. About 64% of the survey participants would be in favor of inserts in tobacco products with information on how to quit

“Big tobacco said that introducing stricter regulation wouldn’t work and campaigned against it, but this is proof that smoking trends are heading in the right direction. But smoking is still the biggest preventable cause of cancer, and certain groups have much higher rates of smoking, such as routine and manual workers, so we can’t stop here and think job done,” said George Butterworth, senior policy manager at Cancer Research UK.

Cigarette smoke breeds drug-resistant bacteria

In what could be a new reason against smoking, new research from the University of Bath in the UK showed that cigarette smoke can make bacterial strains more resistant to antibiotics.

Credit: Flickr

 

Some strains of Staphylococcus aureus, a microbe present in a large part of the global population and responsible for many diseases, can become more invasive and persistent due to exposure to the smoke from cigarettes, according to the researchers, whose work was published in Scientific Reports.

“We expected some effects, but we didn’t anticipate smoke would affect drug-resistance to this degree. It seems reasonable to hypothesize that stressful conditions imposed by smoking induce responses in microbial cells,” said Dr. Maisem Laabei, the lead author.

Working with colleagues from Spanish research institutes, the experts at Bath carried out a set of lab-based experiments. They exposed six reference strains of the most important ‘superbug’ Methicillin-resistant S. aureus (MRSA) clones to cigarette smoke.

The strains were chosen for their clinical relevance and genetic diversity, known to cause several infections. While not all responded the same way, the strains showed increased resistance to the antibiotic rifampicin and increased invasiveness and persistence after being exposed to cigarette smoke.

The changes seen on the trains were linked by researchers to the emergence of so-called Small Colony Variants (SCVs), a slow-growing subpopulation of bacteria with distinctive phenotypic and pathogenic traits. SCVs have been linked to chronic infections in smokers in previous research.

“These Small Colony Variants are highly adhesive, invasive and persistent. They can sit around for a long time, are difficult to kick out, and are linked to chronic infections. We hope that our work provides another reason for people not to smoke and for current smokers to quit,” said Laabei.

The next step for the researchers will be to study how air pollution, from diesel exhaust fumes and other sources, might affect the microbes in nasal passages as many of the pollution compounds are the same as in cigarette smoke.

“Smoking is the leading cause of preventable death worldwide, and cigarette smoke has over 4,800 compounds within it,” said Laabei. “We wanted to study S. aureus because it’s so common in humans and it can cause a range of diseases, so we wanted to see what happened when we exposed it to smoke.

What is nicotine withdrawal: symptoms, coping, and treatment

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Many people swear that quitting smoking is one of the most difficult things in their lives. Although nicotine — the addictive substance found in tobacco — doesn’t produce an intense high like cocaine or heroin, it can be just as hard to quit as these dangerous illegal drugs. This is due to the strong physical and psychological withdrawal symptoms that begin immediately when nicotine starts to leave the body.

Nicotine withdrawal symptoms are experienced differently by each person, some feeling them more heavily than others. Generally speaking, withdrawal symptoms peak after 1-3 days and gradually decrease over a period of 3-4 weeks. After this time nicotine should be completely flushed out of the body. But, even after all this time, psychological effects may still linger.

Understanding the effects of nicotine withdrawal is essential for successful smoking cessation. Being aware of the real challenges involved in quitting smoking helps people mentally prepare and seek treatment.

Before we delve into more details about the symptoms of nicotine withdrawal, it’s helpful to understand why the substance is so addictive in the first place.

Your brain on nicotine

When an individual inhales tobacco smoke, nicotine — alongside thousands of chemical byproducts, many of which cause cellular damage, DNA changes, and cancer — is absorbed through the lining of the nose mouth, and lungs. From there, nicotine enters the bloodstream, eventually reaching the brain where it activates reward and pleasure circuits by boosting dopamine levels. Nicotine is also known to affect areas of the brain regulating breathing, memory, appetite, and heart rate.

The brain can quickly become addicted to this effect. A typical tobacco user smokes 20 cigarettes a day, and each cigarette offers more than a dozen nicotine hits. Over the years, the brain becomes primed for smoking by thousands of instances in which it is “rewarded” by the nicotine stimulation. This is one of the reasons why the psychological withdrawal symptoms of nicotine are so taxing — a user often associates smoking with all sorts of activities ranging from socializing with friends to waiting for the bus. For a heavy smoker, even leaving the house can be a trigger to smoke.

The symptoms of nicotine withdrawal

The itching cravings. When nicotinic receptors in the brain are suddenly deprived of nicotine, the release of the “feel-good” neurotransmitter dopamine also halts — and this is when the trouble starts, too. Only a few hours after your last smoke, you’ll notice an intense yearning for smoking — something to which the body has adapted and become tolerant to over the years. Nicotine cravings last for anything from 5 to 30 minutes and can be extremely uncomfortable, to say the least. The good news is that they eventually go away, fading and spiking in waves.

Snacking and constantly feeling hungry. The urge to eat more often and in larger quantities is a normal effect of quitting smoking. Nicotine triggers the release of glucose from the muscles and liver and alters your insulin response. In the absence of nicotine, the body experiences a drop in blood sugar, triggering an urge to consume carbs. Many turn to sweets during these sudden bouts of hunger — so you can see how easy it is to gain weight in these circumstances. It is normal for individuals who quit smoking to gain 10 pounds (4-5kg) on average during the first year of quiting smoking, with most of the gains seen in the first three smoking-free months.

Trouble sleeping. The sudden disruption of the dopamine system can lead to trouble sleeping, which can manifest itself in a spectrum of symptoms ranging from insomnia to needing more sleep during the day. According to studies, quitting smoking can disrupt rapid eye movement (REM), affecting the quality of sleep. A good idea is to perform relaxation exercises before bed and reduce your caffeine intake during the day.

Coughing. This might sound counterintuitive, but people who quit smoking tend to develop a persistent cough. This is actually a sign that your lungs and airways are healing. Our airways are lined by finger-like projections called cilia, which become flattened from smoking. When you quit, the cilia return to their normal shape and, in the process, expel deposits out of the lungs to be coughed up.

Mood swings and grumpiness. This is a tough symptom to bear not only for the would-be smokers but also for their friends and family. One of the first things you’ll notice in the first days of quitting smoking are feelings of heightened stress and irritation. Even the most trivial gestures can make you angry or trigger irrational outbursts. Unpredictable changes in mood come with the territory — they’re due to the dramatic changes in the body’s hormonal and central nervous systems. So, warn your friends you’ll not quite be yourself for the first few weeks of quitting smoking.

Fatigue. Remember, nicotine is a stimulant, so it’s normal for you to feel a lot more tired than usual. The stress and mental energy you expend when quitting smoking also add up to make you feel more tired. Generally, it takes two to four weeks for your energy levels to get back to normal. In the meantime, get some rest and exercise to improve these symptoms.

Memory problems and difficulty concentrating. Another side effect of the dysregulation of the dopamine system will be remembering recent events. You’ll also find it difficult to focus on tasks that would have otherwise been easy during the smoking life (nicotine actually enhances the ability to concentrate). Other psychological symptoms of smoking cessation include anxiety or depression, which, in extreme cases, may require medication.

Constipation. One in six smokers will experience bouts of constipation, which can last for one to two weeks. The sudden absence of cigarette smoke in the gut can alter the motility and contraction of the intestines, thereby slowing the rate at which food is digested. Constipation may also be exacerbated by the increased intake in food caused by the munchies that come with quitting. In order to reduce the risk of constipation, doctors recommend drinking plenty of water and including more fiber in your diet.

Timeline of nicotine withdrawal

Here’s what you can expect from the moment you extinguish your last (and, hopefully, final) cigarette:

  • 30 minutes to 4 hours: The effects from the nicotine will wear off and you’ll start to crave another cigarette. The heart rate drops and returns to normal. Blood pressure begins to drop, and circulation may start to improve.
  • 10 hours: Feelings of restlessness and cravings for a cigarette will start to fill your mind. You might also feel unusually sad. On the flipside, the body has already cleansed itself from all that excess carbon monoxide, increasing the oxygen levels in the blood.
  • 24 hours: Irritability kicks in and your appetite increases. In as little as one day after quitting smoking, a person’s blood pressure begins to drop, decreasing the risk of heart disease from smoking-induced high blood pressure. Exercising and physical activity, in general, becomes a lot easier.
  • 2 days: Headaches become common and intense as nicotine is flushed out of the system. You’ll also notice an improved sense of smell and taste as nerve endings responsible for these senses that were destroyed by smoking are now regenerating.
  • 3 days: Most of the nicotine in your body should be gone. This is the hardest day for quitting smoking because this is when both physical and psychological nicotine withdrawal symptoms are at their worst. The good news is that cravings start to taper off.
  • 2 to 4 weeks: You’ll still feel fatigued but at least some of the brain fog will be clearing up. Symptoms of coughing, depression, and anxiety improve. Generally, after one month, lung function begins to improve so you may notice a heightened ability for cardiovascular activities, such as running.
  • 1 to 3 months. Blood circulation continues to improve as there is no stimulant to raise blood pressure and potentially form clots. If you made this far, congratulations are in order! You’ve crossed the dangerous point in time where most people rebound.
  • 9 months. The lungs have now significantly healed themselves. As clia cells recover, the body is now able to push more mucus out of the lungs and better fight infections. You should notice a decrease in the frequency of lung infections.
  • 1 year. Your risk of coronary heart disease has now decreased by half compared to your days as a smoker.
  • 5 years. Arteries and blood vessels begin to widen. This means that blood is less likely to clot, lowering the risk of a stroke. As the body heals more and more, the risk of stroke will continue to reduce over the next 10 years.
  • 10 years. The risk of developing cancer is roughly cut in half compared to a smoker. In particular, the risk of developing mouth, throat, or pancreatic cancer is significantly reduced.
  • 15 years. The likelihood of developing coronary heart disease and pancreatic cancer is equivalent to a non-smoker.
  • 20 years. The risk of dying from smoking-relating causes (i.e. lung disease and cancer) drops to the level of a person who never smoked in their life.

Treatments for nicotine withdrawal

Quitting cold turkey will make nicotine withdrawal symptoms harsher than those who seek counseling and smoking cessation aids. In order to avoid relapsing, it’s a good idea to try treatments such as nicotine replacements. These are products that deliver doses of nicotine to the body without the harmful byproducts of tobacco smoke. These include chewing gum, skin patches, inhalators, tablets, and nasal or mouth sprays. E-cigarettes, which deliver nicotine as vapor, can also be a good alternative to smoking. However, the health risks of e-cigs are still understudied.

Nicotine replacement therapy (NRT) can reduce the chance of relapsing by up to 60%. The idea is to gradually reduce the nicotine dosage until a person is ready to stop permanently. However, people may experience side effects when using NRT, such as nausea, dizziness, insomnia, and headaches.

There are also medications that reduce cravings for smoking, such as varenicline (known as Chantix) and bupropion (known under the brand name Zyban).

Lastly, people shouldn’t be afraid to try counseling alongside NRT, in order to address the difficult psychological withdrawal symptoms.

Bottom line: Quitting smoking is highly challenging but the effort is well worth it. If there’s only one lifestyle choice you can make in order to dramatically improve your health and vitality, choose to quit smoking.

Credit: Pixabay.

Fathers-to-be who smoke can harm babies

Credit: Pixabay.

Credit: Pixabay.

Despite considerable progress, there are still many pregnant women who are not fully aware of the significant risks that smoking poses to babies. But it’s not just mothers that need to stay away from smoking. According to a new study, fathers-to-be who smoke may place their offspring at an increased risk of congenital heart defects.

Smoking during pregnancy causes adverse health outcomes that can affect women and infants during and after pregnancy — such as placenta previa, placental abruption, miscarriage, preterm birth, and premature membrane rupture. Infants born to women who smoke are also at higher risk for low birthweight (LBW), stillbirth, infant death (sudden infant death syndrome, or SIDS). Smoking can also lead to conceptual delay and infertility in women of childbearing age. Despite these risks, according to US Pregnancy Risk Assessment Monitoring System, 23% of US women smoked in the 3 months before pregnancy and almost 11% smoked during the last trimester of pregnancy.

The reason why tobacco smoke is associated with so many harmful effects has to do with the high number of carcinogens — chemicals that cause cancer — that it contains. These carcinogens accumulate in the body causing damage to all organs, including the reproductive ones, but also the developing fetus. Because smoking alters the chemical environment of the smoker’s body, for instance by lowering oxygen supply, this can affect the outcome of a healthy pregnancy even before a woman conceives.

“Smoking is teratogenic, meaning it can cause developmental malformations. The association between prospective parents smoking and the risk of congenital heart defects has attracted more and more attention with the increasing number of smokers of childbearing age,” Dr. Jiabi Qin, from the Xiangya School of Public Health, Central South University in China, said in a statement.

Congenital heart defects are the leading cause of stillbirth, affecting 8 in 1,000 babies born worldwide. One of the leading causes of congenital heart defects is smoking during pregnancy.

While most studies have focused on women smokers, Qin and colleagues performed the first study that examined the relationship between paternal smoking and the risk of congenital heart defects in offspring. The researchers combed through 125 studies involving 137,574 babies born with congenital heart defects 8.8 million parents.

Strikingly, the risk of congenital heart defects was much greater in men who smoke than in woman smokers. According to the results of the meta-analysis, the associated risk of congenital heart defects increased by 74% for men smoking, 124% for passive smoking in women, and 25% for women smoking (all compared to no exposure). These risks are significant because maternal passive smoking and paternal smoking are more common than maternal active smoking. This may be due to the many pregnant women who are aware that they risk harming their babies if they smoke but place less emphasis on exposure to tobacco smoke in their environment.

“Women should stop smoking before trying to become pregnant to ensure they are smoke-free when they conceive,” said Dr. Qin. “Staying away from people who are smoking is also important. Employers can help by ensuring that workplaces are smoke-free.”

“Doctors and primary healthcare professionals need to do more to publicize and educate prospective parents about the potential hazards of smoking for their unborn child,” he added.

The findings appeared in the European Journal of Preventive Cardiology.

Smoking

Benefits of quitting smoking offset weight gain in people with diabetes

Smoking

Credit: Pixabay.

It’s normal for people who’ve just quit smoking to gain weight. Being overweight or obese can lead to diabetes, and both smoking and diabetes are risk factors for heart attacks and strokes. So, it seems like there are also health risks to quitting smoking. But according to a new study, the health benefits of quitting smoking far outweigh the risks that come with gaining a few extra pounds.

Smoking tobacco suppresses appetite and increases your metabolism. When you quit smoking, your appetite and metabolism return to normal, which may lead you to eat more and burn fewer calories. Taste and smell also improve so food might become more appealing once you quit smoking.

A 2015 study found that the amount of weight gain following smoking cessation depends on the number of cigarettes a person puts off. Heavy smokers and those who were obese before taking on smoking are especially vulnerable, gaining up to 10kg (22 pounds) on average after quitting.

Researchers at the Harvard T. H. Chan School of Public Health in Boston wanted to see which is worse for people with diabetes: the weight gain from quitting smoking or all the cardiovascular problems arising from smoking itself? They analyzed data from two previous studies, including 10,895 men and women with diabetes.

Compared to individuals with diabetes who continued smoking, those who quit experienced a significantly lower risk for heart attacks, stroke, and other cardiovascular diseases. The risk for cardiovascular disease was 34% lower among recent quitters (six or fewer years since quitting) without weight gain, 25% lower among long-term quitters (more than six years since smoking cessation), and 41% lower among never-smoking adults with diabetes. Those who gained up to 5kg (11 pounds) after quitting smoking saw no increase in the risk of developing cardiovascular disease.

“Weight gain concerns should not stop people from being encouraged to quit smoking after they’re diagnosed with diabetes. And for those who do quit, preventing excessive weight gain would further maximize the health benefits of smoking cessation,” said Gang Liu, lead author of the study.

People who have just quit smoking are advised to exercise often, make wiser food choices (smaller portions and limiting sweets and alcohol), and work with a dietitian for personalized weight management support.

The findings were presented this week at the American Heart Association’s Epidemiology and Prevention: Lifestyle and Cardiometabolic Health Scientific Sessions 2019. A second study presented at this conference investigated the link between cognitive decline and smoking. Researchers at the Bloomberg School of Public Health at Johns Hopkins in Baltimore found that compared to individuals who never smoked, those who smoked a pack of cigarettes a day for 25 years or more had twice as severe signs of cognitive impairment — such as poorer performance of memory, reasoning, and other mental functions.

Nicotine fluorescent.

Nicotine works inside our neurons to reinforce addiction

New research is looking into how nicotine works on a cellular level.

Nicotine fluorescent.

A biosensor targeted at a cell’s endoplasmic reticulum glows green in the presence of nicotine
Image credits Caltech / Lester laboratory.

Smoking tobacco makes you feel good because it floods the brain with nicotine. This nicotine latches onto specific receptors on the surface of neurons, producing feelings of happiness.

However, that’s not the whole story — only what we knew so far. To find out what happens after nicotine enters the cells, a  team of researchers at the California Institute of Technology has developed a protein sensor that glows in the presence of nicotine, allowing them to follow its movements inside cells and reveal more about the nature of nicotine addiction.

Inside job

The research was led by Henry Lester, Professor of Biology at Caltech. He has previously found that some nicotinic receptors (nAChRs) enter neurons and make a beeline for the endoplasmic reticulum (ER). Think of the ER as the cell’s protein assembly line. It synthesizes and packages proteins in order to be shipped to various other locations both inside and outside of the cell. Nicotinic receptors (nAChRs) are among these proteins.

After being synthesized in the ER, nicotinic receptors relocate to the cell’s surface. When nicotine molecules enter the body, they travel through the bloodstream and reach these nAChRs on the surface of neurons. Their merger triggers a chemical release as a reward — which we feel as happiness or pleasure. However, some of these nAChRs remain in the ER, inside the cell. In a way, they’re kept ‘in storage’ until they are needed.

In a bid to understand what nicotine does inside cells, Lester’s team developed a biosensor to allow them to track the substance inside cells. The biosensor is, in essence, a protein that can fold into an open or closed state, and an inactivated fluorescent protein. The first protein closing activates this fluorescent part, making it glow brightly. Because the first protein closes around nicotine, this biosensor allows the team to easily track where nicotine molecules pool up and how many of them are present in a given cell.

The team placed their biosensors on the endoplasmic reticulum and the surfaces of “mouse hippocampal neurons and human stem cell-derived dopaminergic neurons” among other types of cells in the lab, and then filmed the results. They report that nicotine entered into the endoplasmic reticulum within a few seconds of it reaching a cell’s surface. Nicotine levels observed inside the cells were also more than enough to affect nAChRs during their synthesis or as they were in transit towards the cellular membrane.

This last tidbit makes neurons more sensitive to the effects of nicotine, the team explains, enhancing the pleasure derived from a cigarette or an e-cigarette. It makes a person get a buzz more quickly and easily the more they smoke, the team adds. This is likely a key mechanism underpinning part of nicotine addiction.

The team’s efforts focused on isolated neurons in a lab setting. They plan to expand on their findings in the future, to determine whether nicotine behaves the same way in the neurons of live mice. They also plan to develop similar biosensors for other compounds, especially for opioids and antidepressants.

The paper “Determining the Pharmacokinetics of Nicotinic Drugs in the Endoplasmic Reticulum Using Biosensors” has been published in The Journal of General Physiology.

No Smoking.

Lab-tailored enzyme shows promise as a new and powerful treatment against tobacco addiction

New research from the Scripps Institute may pave the way to more efficient — and more enjoyable — ways of weaning off of nicotine.

No Smoking.

Image via Pixabay.

Nicotine addiction is an immensely powerful force, one that makes smokers keep smoking despite the habit’s well-documented impact on health. It’s what gets people hooked, and what makes most of those who gave up smoking relapse. Current estimations point to 60% of those who try cigarettes ending up as daily smokers, about 75% of daily smokers relapsing after quitting. However, one new, lab-tailored enzyme could help us fight against nicotine addiction by breaking most of it down before reaching the brain.

The compound was, thus far, shown to be efficient in rat models.

Nic-No-Tine

“This is a very exciting approach because it can reduce nicotine dependence without inducing cravings and other severe withdrawal symptoms, and it works in the bloodstream, not the brain, so its side effects should be minimal,” says principal investigator Olivier George, Ph.D., associate professor at Scripps Research.

The enzyme the team tested is known as NicA2-J1, and it’s a variation of a natural compound produced by Pseudomonas putida — which, interestingly, is the first patented organism in the world. This compound has previously been shown to reduce nicotine levels in the blood of mice.

And there lies the crux of the researchers’ interest in the enzyme. It breaks down nicotine before it even reaches the brain, making it very attractive as a means of fighting nicotine dependence. However, the original enzyme didn’t scrub nicotine fast enough for such a treatment strategy to work. So George’s team started by tweaking the enzyme to make it more efficient, increase its staying time in the bloodstream, and add a few other pharmacological properties.

The next step was to treat nicotine-dependent rats with the tweaked enzyme. For the first stage of the experiments, rats spent 21 hours per day, for 12 days, in a chamber where they could press a lever to receive a shot of nicotine. The rats soon understood the system, and self-administered nicotine until they became addicted to the substance. After these 12 days, the rats were only allowed access to nicotine once every 48 hours.

The rats experienced obvious withdrawal symptoms between these windows of time. They started escalating their intake while nicotine was available — a hallmark of deepening addiction — in a psychological bid to reduce discomfort caused by withdrawal.

However, not all rats fared the same. Those treated with the highest doses of NicA2-J1 (10 mg/kg) continued to pull the lever for a shot of nicotine if given the chance, but had significantly lower blood-nicotine levels compared to the rest of the animals. They also exhibited less pronounced signs of nicotine withdrawal, such as such as susceptibility to pain and aggressiveness, compared to the control group. One of the most encouraging finds is that NicA2-J1 treatment didn’t instantly trigger withdrawal symptoms, which usually happens when nicotine is blocked in a highly-dependent animal — think of quitting ‘cold-turkey’, but much more abruptly.

“It’s as if they were smoking 20 cigarettes but receiving the nicotine dose of only one or two, so that made their withdrawal process much less severe,” says study first author Marsida Kallupi.

“[W]hat’s unique about this enzyme is that it removes enough nicotine to reduce the level of dependence, but leaves enough to keep the animals from going into severe withdrawal,” George adds.

One of the most insidious effects of nicotine dependence is the continuation of use despite its adverse consequences — short-term impairment of lung function and physical fitness, alongside the longer-term risks of cancers, heart disease, or stroke. In other words, the compound is so addictive that users are compelled to seek it out no matter the cost. NicA2-J1 could also help in this regard, the team writes. When each lever-press had a 30% chance of directing an electric shock to the rats’ feet, those treated with NicA2-J1 quickly reduced their lever presses; those in the control group did not.

To model how effective the enzyme would be at fighting relapses, the team took the rats off of nicotine for 10 days straight — any smoker here will shiver at the mere thought (yes, nicotine addiction is that bad). The team gave each rat an injection of nicotine after the 10 days to restart their desire for the drug, and then restored their access to the lever. Untreated rats responded in a rather predictable way: they pressed the lever as much as they could, as fast as they could. Rats treated with NicA2-J1, in contrast, used the lever more sparingly. The same effect was seen when the team triggered relapse in all the rats using a stress-inducing compound (which was meant to mimic the way stress can cause relapse in humans).

 

[panel style=”panel-info” title=”Nicotine Addiction” footer=””]Nicotine is an extremely hard habit to kick as it fosters both physical and psychological dependence, and users develop tolerance over time. It’s an extremely addictive compound, similar to heroin and cocaine. Discontinuation of use (after dependence sets in) is particularly nasty, involving both affective (mood-related) and somatic (body-related) withdrawal symptoms, ranging from anxiety and poor mood to tremors. Withdrawal effects peak in the first few days of discontinuation but can last for upwards of several weeks. Most people don’t make it past the first few days.

“The majority of smokers would like to stop smoking, and each year about half try to quit permanently. Yet, only about 6 percent of smokers are able to quit in a given year,” reports the National Institute on Drug Abuse (NIDA).[/panel]

Since nicotine is extremely addictive, it’s hard to give up; even worse, those that do manage this feat are very prone to relapse. That, in itself, isn’t necessarily a bad thing; as the team notes in the paper’s opening line, however, “[t]obacco use disorder is the leading cause of disease and preventable death worldwide” (which is very bad). The CDC also supports this statement. NicA2-J1 shows a lot of promise as a treatment to help smokers wean off of nicotine since it prevents the substance from reaching the brain in the first place, takes the edge off of withdrawal, and makes relapses less likely to happen. The team hopes to start clinical trials with human subjects soon — but first, they’ll work on making the enzyme even more effective.

The paper “An enzymatic approach reverses nicotine dependence, decreases compulsive-like intake, and prevents relapse” has been published in the journal Science Advances.

What big tobacco companies don’t want you to know about smuggling

A new study has just shown that big tobacco companies are still supporting tobacco smuggling — while attempting to control a global system designed to prevent it. Oh, and they’re probably fooling your government in the process.

The tobacco industry certainly has a lot to account for. Not only are they responsible for a gargantuan toll on human health, but they’ve also tried to lie and cover the truth (much like the oil industry is doing now, but that’s a different story). Nowadays, although it’s still a multi-billion dollar industry, the influence of big tobacco is not at its peak — but that doesn’t mean they’re out of tricks. According to a new report, not only are they still facilitating tobacco smuggling, but they’re positioning themselves to manipulate government and other regulatory bodies.

Major tobacco companies are acting as corporate chameleons — on one hand, they’re spending copious amounts of money on advertising, trying to convince the world that they’ve changed their ways, but on the other hand, they’re doing much of the same. In order to understand the background and context of tobacco smuggling, there are two things you need to know beforehand.

For starters, they actually make money from smuggling. The money comes from distributors who buy the product, so they don’t care if it ends up on the black market or not. However, smuggled tobacco products are generally much cheaper than legal ones, which means you can sell more and make more money. Secondly, this isn’t a new thing — in the 1990s, several tobacco companies were caught orchestrating the smuggling of their own cigarettes in vast quantities. At the time, a third of the global tobacco supply went missing — turns out, not only was it smuggled, but smuggling was a core aspect of their business strategy.

The tobacco companies opted for an unlikely defense: they claimed they were the victims. They were had by something outside of their control. Even though they were making money, even though they were facilitating this whole process, they played the victim.

In order to combat tobacco smuggling, world governments adopted the Illicit Trade Protocol. Among other things, this protocol requires the implementation of a global ‘Track and Trace’ system. Basically, packs of cigarettes and rolling tobacco are to be marked with a unique ID so they can be tracked from manufacture to point of sale. If they end up on the black market, you can trace it back and see where in the supply chain things went awry. In other words, you’d be able to see if companies were indeed the victim or if they were involved in the process.

But the tobacco companies pushed their own tracking system, ‘Codentify’, a unique, supposedly unpredictable set of 12 letters and numbers that are machine generated. Having a tracking system developed by the industry that’s supposed to be regulated sounds like a bad idea, critics quickly pointed out. This would allow them to continue smuggling “with impunity,” researchers say. Aware of their own lack of credibility, big tobacco devised a conspiracy to push this system and convince governments to use it. Leaked documents show how at least four major transnational tobacco companies hatched a joint plan to use front groups and third parties to promote Codentify to governments and convince them it would be run independently of industry and under full government control.

The scale of their efforts is stunning. The companies would fund surveys and reports exaggerating the scale of the counterfeiting. They then used these reports to say that they are the victim of counterfeiting and smuggling and used this as leverage to push their own tracking system. They poured money into ex-policemen and front groups to be their “credible voice”. They used corporate espionage and peak into negotiations to which they shouldn’t have had access to, while constantly using their money and influence to try to sway public opinion, as well as the opinion of several key policymakers. The scale of this conspiracy is truly baffling, and it’s also amazing to see how many organizations and even governments gobbled it up. It seems that quite often, authorities would swallow the pill carefully crafted by the tobacco companies.

All this, researchers conclude, they continued to orchestrate tobacco smuggling.

Fool me once

These groundbreaking results have been published in two studies from the Tobacco Control Research Group at the University of Bath — an all-new $20 million global tobacco industry watchdog aiming to counter the negative influences of the tobacco industry on public health.

The primary conclusion is clear as daylight: Codentify simply cannot be trusted. There needs to be a truly independent tracking method. Andy Rowell, co-author of the first paper states:

“Governments need to be alert to what the tobacco industry is doing and to realise it is now operating via a complex web of front groups and companies. Any track and trace system linked to ‘Codentify’ simply cannot be trusted.”

The bigger conclusion, however, is even more striking. It seems that international tobacco companies have been involved in a wide array of practices ranging from ethically questionable to very illegal. They have attempted to manipulate and deceive public opinion, governments, and all sorts of regulatory bodies. Strikingly, they smuggle their own products.

Professor Anna Gilmore, Director of the Tobacco Control Research Group, explains:

“This has to be one of the tobacco industry’s greatest scams: not only is it still involved in tobacco smuggling, but big tobacco is positioning itself to control the very system governments around the world have designed to stop it from doing so. The industry’s elaborate and underhand effort involves front groups, third parties, fake news and payments to the regulatory authorities meant to hold them to account.”

But you could try to make an argument that tobacco companies are still funding important research into tobacco-related aspects — including smuggling. But quite often, this ‘research’ doesn’t do anything but murky the waters.

Lead author Allen Gallagher from the Tobacco Control Research Group at Bath says much of the tobacco-funded research is all smoke and mirrors:

“Our latest findings fit with the tobacco industry’s long history of manipulating research, including its extensive efforts to undermine and cause confusion on science showing the negative health impacts of smoking and second-hand smoke.”

Dr. Karen Evans-Reeves, another author of the study, adds:

“Despite far-reaching concerns over industry-funded data on this topic, tobacco companies continue to spend millions of pounds funding research into the illicit tobacco trade. As recently as 2016 Philip Morris International’s PMI IMPACT initiative pledged 100 million USD for this purpose. Yet, if industry-funded data consistently fails to reach the expected standards of replicable academic research, we must question if it has any use beyond helping the industry muddy the waters on an important public health issue.”

The team now call on governments and regulatory bodies to crack down on the wrongdoers — but will this really happen?

The two studies, along with an accompanying editorial, have been published in the British Medical Journal.

Nicotine.

Newly-devised molecule might help people quit smoking by blocking nicotine break-down

Drugs that can actually help to quit smoking may soon find their way to a pharmacy near you.

Nicotine.

Image credits Lydia / Flickr.

Researchers from the Washington State University (WSU) have synthesized over a dozen compounds that can help smokers curb their dependence on nicotine, a new paper reports. The compounds work by slowing down the rate at which nicotine is broken down in the body, which should help people reduce their consumption of tobacco — or kick the habit altogether.

Breaking down the breaker-downs

Nicotine, like most other drugs, triggers the release of dopamine and serotonin in the brain — two chemicals that make us feel good. However, from the body’s point of view, nicotine isn’t very nice, so it has to go. Our liver produces an enzyme — dubbed CYP2A6 — to break the compound down (or ‘metabolize’ it). This process, however, can have nasty side-effects. Patients who have developed a dependence on nicotine can experience withdrawal symptoms ranging from anxiety and irritability to tingling in their extremities as the substance is flushed out of their system.

The process of metabolization, coupled with our bodies’ tendency to develop tolerance to active substances such as nicotine, means that users tend to increase intake of substances such as nicotine over time.

However, the process of metabolization could also help us kick the habit altogether. In the mid-90s, researchers found that people who had fewer copies of the gene that encodes the CYP2A6 enzyme tend to smoke less and are less likely to become addicted to smoking. In a bid to artificially-induce these traits into people with normal levels of CYP2A6, the team designed dozens of molecules that can bind to the enzyme and limit its ability to process nicotine.

This is the feeling that the researchers are targeting, said Travis Denton, assistant professor of pharmaceutical sciences, lead author and a former tobacco chewer who has been working on solutions to nicotine dependence for 15 years.

“I quit cold turkey and I know how hard it is. Would this have helped? I believe so, because again, the people who want to quit, really want to quit,” says lead author Travis Denton, assistant professor of pharmaceutical sciences at the WSU.

“They just can’t because it’s too doggone hard. Imagine if you could take this pill and your jitters don’t come on as fast — it’s just super reinforcing to help you quit.”

Co-author Philip Lazarus, Boeing distinguished professor of pharmaceutical sciences, says that inhibiting CYP2A6 shouldn’t have any effect on your overall health.

“If we could specifically target this enzyme, people should be fine, and it will possibly help them stop smoking or at least decrease their amount of smoking.”

So far, the team has been able to test the substances and make sure they don’t interfere with other major enzymes in the body — 18 of their molecules passed the test. The next step is for the Food and Drug Administration to approve clinical trials of the compounds, to see exactly what effect each of these compounds would have on the human body.

Molecules smoking.

Some of the 18 molecules the team developed and tested and their interaction with CYP2A6.
Image credits Travis T. Denton et al., 2018, JoMC.

Should even one of these molecules prove effective, it could bring significant benefits to public health. Smoking is the leading cause of preventable death worldwide, causing an estimated 6 million deaths per year. Cigarette smoking causes nearly one in every five deaths in the United States.

The paper “Identification of the 4-Position of 3-Alkynyl and 3-Heteroaromatic Substituted Pyridine Methanamines as a Key Modification Site Eliciting Increased Potency and Enhanced Selectivity for Cytochrome P-450 2A6 Inhibition” has been published in the Journal of Medicinal Chemistry.

Daily e-cigarette usage doubles risk of heart attack

Credit: Pixabay.

Many people seem to think that inhaling e-cig vapor is harmless or, at least, not nearly as dangerous as smoking tobacco. More and more studies, however, suggest that e-cigs do pose health risks, and those recent risks are not trivial. One recent study found that, compared to people who don’t use tobacco or vape, e-cigarette users have twice the risk of having a heart attack.

Meanwhile, people who smoked “normal”, tobacco cigarettes had nearly a tripled risk of having a heart attack compared to non-smokers. What was truly surprising was that in people who both smoked tobacco and e-cigs, the risk of a heart attack was five times greater than in non-smokers/non-vapers — so the two risks seem to stack together somewhat. According to the study published in the American Journal of Preventive Medicine by researchers at the University of California San Francisco along with a team from George Washington University, nearly 66% of e-cigarette users also smoke tobacco.

The study relied on two datasets involving more than 69,000 people 18 and older, who were surveyed in 2014 and 2016. The findings stood even after the researchers controlled for variables such as age, sex, body mass index, high blood pressure, high cholesterol, and diabetes.

Of the 9,352 participants who were current or former e-cigarette users, 333 (3.6%) had experienced a heart attack at some point. The highest percentage of heart attacks (6.1 percent) was among those who used e-cigarettes daily.

“Most adults who use e-cigarettes continue to smoke cigarettes,” said senior author Stanton Glantz, PhD, a UCSF professor of medicine and director of the UCSF Center for Tobacco Control Research and Education.

“While people may think they are reducing their health risks, we found that the heart attack risk of e-cigarettes adds to the risk of smoking cigarettes,” Glantz said. “Using both products at the same time is worse than using either one separately. Someone who continues to smoke daily while using e-cigarettes daily increases the odds of a heart attack by a factor of five.”

The good news is that once people quit smoking tobacco or inhaling e-cig vapor, a person’s health quickly and dramatically improves.

“The risk of heart attack starts to drop immediately after you stop smoking,” said Glantz. “Our results suggest the same is true when they stop using e-cigarettes.”

An electronic cigarette works by delivering an aerosol of nicotine and usually other flavors by heating a liquid. These products are marketed as the safer alternative to smoking conventional cigarettes, which generate nicotine by burning tobacco. However, e-cigs aren’t harmless. While they deliver lower levels of carcinogens than tobacco, e-cigs generate ultrafine particles (up to 100th the thickness of a human hair) that can hurt the lung and airways, as well as toxins that have been linked to cardiovascular and non-cancer lung diseases.

The was only an observational study, so no direct causality was established. Nevertheless, the association between e-cig use and heart disease is significant, suggesting that vaping isn’t really a healthy alternative to smoking. The best thing a smoker can do is stop both.

A million French smokers quit in 2017 thanks to anti-smoking campaigns

Credit: Pixabay.

There are now a million fewer people in France lighting up tobacco products than there were between 2016 and 2017. This is a staggering amount of people who have suddenly decided to kick the bad habit — a change the likes of which hasn’t been seen in over a decade, a Public Health France official said. This significant decline can be attributed to commendable anti-smoking measures supported by the government.

Some of these measures include neutral packaging, reimbursements for people using tobacco substitutes, higher cigarette pricing, and campaigns like the national tobacco-free month. Arguably, the most important detractor for smoking is the government’s escalating cigarette pricing. The plan is to hike the price of a pack of cigarettes to €10 ($12) by 2020.

The bulk of the people who quit smoking last year in France were teenagers and low-income individuals.

“Tobacco is a trajectory of inequality, it weighs particularly on the most disadvantaged and it gets worse,” said France’s Health Minister Agnès Buzy, who welcomed the results.

According to the survey carried out by Public Health France, 26.9% of 18- to 75-year-olds smoked every day in 2017, whereas the figure stood at 29.4% a year earlier. This amounts to a drop from 13.2 million smokers to 12.2 million over the surveyed period.

Despite the encouraging trend, there are still way too many people smoking tobacco — which is the number one risk factor for lung cancer, responsible for 87 percent of lung cancer deaths. Smoking is also responsible for causing chronic obstructive pulmonary disease, heart disease, stroke, asthma, diabetes, premature underweight babies, macular degeneration, and over 10 other types of cancer.

Quitting smoking now is the single best thing you can do for your health for immediate results. Unfortunately, although the percentage of people who smoke has dropped significantly in the last 25 years, due to population increase there are now more people smoking than at any other moment in history. 

According to one study carried out by the Institute for Health Metrics and Evaluation at the University of Washington, there are one billion people smoking tobacco products daily. The researchers concluded that more than one in ten deaths were due to smoking in 2015. Half of all these preventable deaths occurred in China, India, the U.S., and Russia. These 6.4 million deaths which were attributed to smoking represent a 4.7% increase from 2005. In other words, despite our best efforts, more people are dying from smoking than ever.

“Greater success in tobacco control is possible but requires effective, comprehensive, and adequately implemented and enforced policies, which might in turn require global and national levels of political commitment beyond what has been achieved during the past 25 years,” the researchers conclude.

Quitting smoking is very good for you. Cutting back, not so much

A new study once again concludes that reducing smoking doesn’t even close to as many benefits as quitting does.

Cigarette smoking harms nearly every organ of the body, causes many diseases, and reduces the health of smokers in general — that’s the first thing the CDC website says about smoking. Smoking causes about 90% of lung cancers and can cause cancers in mouth, lips, throat, bladder, kidney, liver, stomach, pancreas — you name it, smoking damages it. Smoking also drastically increases your risk of developing conditions such as coronary heart disease or a heart attack, while also damaging your lungs in a number of ways. Okay, you probably get it by now: smoking is really bad for you. Unfortunately, 1.1 billion smokers worldwide don’t get it, or at least, they don’t care enough.

Thankfully, more and more people are starting to give up smoking (also, more and more people are picking it up, but that’s a different story).

Quitting smoking is never easy. In fact, as millions of people can likely attest, it’s extremely challenging. This is why some are content with only cutting down on smoking. But that, researchers say, just doesn’t work.

In a new study, scientists analyzed data collected over 30 years from 3,140 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Participants underwent periodic spirometry to assess lung function and a chest CT scans 15, 20 and 25 years after enrolling.

“The CARDIA dataset gave us a unique opportunity to learn about the impact of different levels of smoking on lung health and lung disease risk,” said lead author Dr. Amanda Mathew, research assistant professor at Northwestern University Feinberg School of Medicine. “Participants were asked about their smoking each year, which minimized recall bias and allowed us to model changes in smoking habits over time.”

Unsurprisingly, heavy smokers experienced the greatest decline across all groups: they were 26x more likely to develop emphysema and nearly 8x more likely to develop obstructive lung disease than non-smokers.

Researchers also analyzed the impacts of light smoking, defined as less than 10 cigarettes per day, comparing it to former smokers who have quit. They found that even heavy smokers who quit fare much better than active light smokers.

“We were surprised to find that those who quit had lower disease risk than the group we identified as stable, low-rate smokers, even though those who quit had a greater lifetime exposure to cigarettes,” Dr. Mathew said.

Light smokers are often ignored in clinical trials, but this is not the first study to find that light smoking does not have light consequences. A recent study found that just one cigarette a day can be devastating for your health, while another review concluded that alcohol and tobacco are the two biggest health culprits in society. For smokers, the take-home message is clear:

“There is no safe threshold of smoking on lung health,” she concludes.

Findings will be presented at the ATS 2018 International Conference.

Alcohol and tobacco, not illegal drugs, are the biggest threat to human health

What should we be more worried of: the legal, fairly common consumption of alcohol and tobacco, or the illegal drugs? Most people would answer the latter, but they’d be wrong. A new study found that the burden of death and disease falls heavily on alcohol and tobacco, both of which are legal and enjoyed by a significant portion of the population.

The study compiled the best, most up-to-date data on alcohol, tobacco, and illicit drug use. The study analyzed the impact in terms of disability-adjusted life years or DALY (a measure commonly used to assess health cost) — one DALY is one lost year of healthy life. Researchers found that in 2015, tobacco cost the world 170.9 million DALYs while alcohol cost 85 million DALYs. Meanwhile, illicit drug use turned out to be the lowest of the three, being responsible for “only” 27.8 million DALYs. While still very significant, the damage caused by illegal drugs is dwarfed by alcohol and cigarettes, which are much more common.

Available data suggests that nearly 1 in 7 adults regularly smoke tobacco, and about 1 in 5 drink heavily at least once a month. Europeans seem to take the crown for both smoking and drinking. Central, Eastern, and Western Europe recorded consistently higher alcohol consumption  — 11.61, 11.98 and 11.09 liters of pure alcohol per year, respectively. These areas also recorded the highest smoking figures, at 24.2%, 23.7%, and 20.9% respectively. However, when it comes to drug consumption, US and Canada severely outranked Europe, having one of the highest rates of cannabis, opioid, and cocaine dependence.

The authors explain that mortality rate, however, wasn’t as big in Europe as the alcohol and tobacco consumption would suggest — perhaps being offset by quality, universal healthcare.

“Europeans proportionately suffered more but in absolute terms, the mortality rate was greatest in low and middle-income countries with large populations and where the quality of data was more limited,” the authors wrote.

The authors also note an important limitation of the study: data collection is not equally reliable all over the world, so in some areas, the damage (especially that caused by illegal drugs) might not be properly understood — this is especially the case in Africa, Caribbean, and some regions of Latin America and Asia.

This study shouldn’t be understood in the sense that equal consumption of tobacco/alcohol and illegal drugs are equally damaging — of course, people consume much more alcohol and tobacco than drugs, which is why the damage is much more severe. However, for policymakers, it’s important to understand the biggest burdens to public health, and focus efforts to alleviate it. So put that cigarette down, and skip that extra beer.

The study “Global statistics on alcohol, tobacco and illicit drug use: 2017 status report” by Peacock et al. was published in Addiction.

Study: medication alone won’t help you quit smoking

Pharmaceutical interventions are often used to help people quit smoking, but a new study found that despite promising results in clinical trials, cessation drugs don’t really work in the real world.

Giving up smoking is a difficult task, as millions of people worldwide can attest to.There’s no silver bullet when it comes to quitting. Of course, some things tend to work better than others, but overall, people find the drive to quit through different methods. Because this habit is so difficult to shake off, medical treatments are especially appealing to some. There are several different treatments available from shops, pharmacies, or on prescription to help you beat this addiction and reduce withdrawal symptoms. Of course, the best treatment depends on personal preference, age, and many other parameters, but the treatments seemed to work –with ‘seemed being the key phrase here.

“Thirty-four percent of people who are trying to quit smoking use pharmaceutical aids and yet most are not successful,” said senior study author John P. Pierce, PhD, Professor Emeritus in the Department of Family Medicine and Public Health at UC San Diego School of Medicine and Moores Cancer Center.

“The results of randomized trials that tested these interventional drugs showed the promise of doubling cessation rates, but that has not translated into the real world.”

In a new study, Pierce and his colleagues assessed the effectiveness of three first-line medications recommended by clinical practice guidelines: varenicline, bupropion, and nicotine replacement therapy (patch). Unfortunately, the results they found weren’t good — essentially, the treatments didn’t work.

“We found no evidence that the pharmaceutical cessation aids that we assessed improved the chances of successfully quitting. This was both surprising, given the promise of smoking cessation seen in randomized trials, and disappointing because of the need for interventions to help smokers quit,” Pierce added.

He also proposes a theory why the treatments worked in the clinical trials but failed in real life: it was because of the intensive behavioral counseling. Researchers suggest that if people want to replicate the success that cessation drugs reported in clinical trials, they should also enroll in counseling programs. Otherwise, the odds of relapse increase drastically.

“Smokers who are committed to quitting and want to use a pharmaceutical aid should also enroll in a program that could help them track their progress and support them in their attempt,” said first author Eric Leas, PhD, who conducted the research while a graduate student researcher at UC San Diego and is now a postdoctoral scholar at the Stanford University School of Medicine.

Thankfully, counseling is available in many shapes and forms so you don’t necessarily need to go to the counseling office. Many states offer free behavioral counseling over the phone, and e-counseling is also becoming more and more prevalent.

The study “Effectiveness of Pharmaceutical Smoking Cessation Aids in a Nationally Representative Cohort of American Smokers” has been published online in the Journal of the National Cancer Institute. https://doi.org/10.1093/jnci/djx240

marijuana-smoke

The health risks of second-hand marijuana smoke shouldn’t be ignored

Inhaling marijuana second-hand smoke inhibits the arteries’ ability to expand properly, mirroring the effects of second-hand tobacco smoke. With such findings in mind, public safety regulations on cannabis use in public ought to mirror those for tobacco, i.e. no smoking indoors.

marijuana-smoke

Credit: Pixabay.

It’s more of a smoke problem than a cannabis one

Matthew Springer, a biologist and professor in the division of cardiology at the University of California, San Francisco, recently spoke to NPR about the often ignored effects of second-hand marijuana smoking. He argues that Californians, and San Franciscans in particular, are very intolerant to smoking cigarettes in public, as they should be. But when it comes to smoking marijuana, people are far more lenient. Was the public’s impression that just because there was no research or debate about the potential hazards of marijuana second-hand smoke, then it must be benign? At his UCSF lab, Springer already had experience studying the effects of tobacco-second smoke in rats, when he decided to do the same for marijuana.

Last year, Spring and colleagues published a paper showing that exposure to marijuana second-hand smoke has the same physiological effects as second-hand smoke from tobacco. The research showed that the rats’ arteries lost some of their ability to expand and allow a healthy flow of blood. This effect lasted for 30 minutes after exposure. The arteries took 90 minutes to recover compared to the 30 minutes with cigarette smoke.

“People think cannabis is fine because it’s ‘natural,’ ” Springer told NPR. “I hear this a lot. I don’t know what it means.”

Spring says that smoke itself is bad for the lungs, heart and blood vessels. Currently, other researchers are exploring associations between smoking cannabis and cancer. He also urges caution around vaping, which although doesn’t generate combustible products (smoke), it still releases a cloud of aerosolized chemicals. The effects of such chemicals is still a subject of research.

“We in the public health community have been telling them for decades to avoid inhaling secondhand smoke from tobacco,” Springer said. “We have not been telling them to avoid inhaling secondhand smoke from marijuana, and that’s not because it’s not bad for you — it’s because we just haven’t known. The experiments haven’t been done.”

Cannabis is still illegal at the federal level in the United States, but more than 20 cities or states have legalized it in one way or another. Not too long ago, marijuana use was severely stigmatized by a society which unfairly saw no medical use whatsoever to cannabis and put it at the same level of hazard with hard drugs. To this day, marijuana is classed as a schedule 1 drug, at the same level with heroin, LSD, ecstasy, methaqualone, and peyote. Drugs like cocaine and methamphetamine are schedule II substances, meaning they have a lower potential for abuse than marijuana. Such classifications, which were established in the 1970s by the Nixon administration and have changed very little since then, are largely arbitrary and certainly not based on science, at least not in the case of marijuana.

Against this backdrop of prohibition and stigma, a counter-culture emerged which fought back to redeem marijuana’s reputation in the eye of the public. The cultural shift towards marijuana has been the backbone that enabled the legislature changes of the past decade for medical and recreational use of cannabis. In the process, however, marijuana has gone from reefer madness to ambrosia, in the minds of many people. Anecdotal reports of marijuana being able to cure anything from ADHD and Alzheimer’s to cancer abound on the internet. Medical studies that support such claims are a different matter, however. Because marijuana is still illegal at the federal level, scientists find it incredibly difficult to jump through all the regulatory hoops, including going past the DEA. There is only one accepted supplier that scientists can contact to access marijuana for research — the University of Mississippi, which runs the only legal marijuana farm, from a federal perspective. To make matters worse, the marijuana grown here is alleged of poor quality, according to some researchers. 

The point I’m trying to make is that marijuana is extremely understudied — at least not proportional to the staggering number of people who use it on a regular basis. As such, people should express caution and a balanced outlook. Research is luckily accelerating work that investigates cannabis’ health effects, but also those of other psychoactive substances like LSD, psilocybin or MDMA, which appear to have medical properties, particularly in treating addiction and mental disorders. It might take another decade before we can reach a consensus of how safe and in what kind of setting such substances can be used.

 

Even a single cigarette a day can be devastating for your health

A review of 141 studies, published in the British Medical Journal found that even a single cigarette a day significantly increases the risk of developing coronary heart disease and stroke. Researchers found that smoking one cigarette a day brings about half the risk of smoking 20 per day. The study debunks the idea of a “safe level” of smoking and suggests that smokers should aim to quit, not cut down.

Image credits: Patrick Brinksma.

The idea that smoking is bad for you isn’t news to anyone — it’s about as established as it can get. Still, many myths about smoking are still floating about, refusing to disappear. Among them is the idea that if you “mostly” quit smoking — if you only smoke one or a few cigs a day — you get rid of most of the health hazards. That simply isn’t true, as study after study has shown. Now, University College London researchers have carried out a review of 141 such studies, finding that even one cigarette a day is still very hazardous.

“We have shown that a large proportion of the risk of coronary heart disease and stroke comes from smoking only a couple of cigarettes each day,” say the authors. “This probably comes as a surprise to many people. But there are also biological mechanisms that help explain the unexpectedly high risk associated with a low level of smoking.”

Cardiovascular diseases and not cancer are the main culprit when it comes to smoking, causing about 48% of smoking-related premature fatalities. Scientists compared the effect that smoking one cigarette a day has to smoking 20 cigarettes a day (a typical pack). Men who smoked 1 cig a day had 46% of the excess risk of heart disease and 41% of the excess risk of stroke associated with smoking 20 cigarettes per day, while for women the figures were 31% and 34% respectively.

“No safe level of smoking exists for cardiovascular disease,”  the researchers add in the study. “Smokers should quit instead of cutting down, using appropriate cessation aids if needed, to significantly reduce their risk of these two common major disorders.”

The take-home message for smokers is that “any exposure to cigarette smoke is too much,” they conclude.

Of the 1.22 billion smokers, 1 billion of them live in developing or transitional economies, and over 800 million are men. Eastern European countries such as Russia, Belarus, and Montenegro are the “leaders” when it comes to smoking averages. However, in developed countries, smoking has already peaked and is starting to decline, especially where anti-smoking legislation has been passed. For years, researchers have urged policy-makers to implement such legislation. In the US, adults aged 16 and above smoke an average of 1687.56 cigarettes a year.

Journal Reference: Allan Hackshaw et al. Low cigarette consumption and risk of coronary heart disease and stroke: meta-analysis of 141 cohort studies in 55 study reports. https://doi.org/10.1136/bmj.j5855

 

Almost 2 out of 3 people who try smoking develop a daily habit

A global study suggests that 69% of the people who tried smoking became daily smokers, even if just for a while.

Over 60% of the adult respondents answered ‘yes‘ when asked if they ever had a cigarette. Out of this whopping percent, over 2/3 started smoking daily for different periods of time. These numbers make the need to prevent teenage smoking even more pressing.

Source: Pixabay/klimkin.

Tobacco’s deceiving story

The irony lies in tobacco’s history. During a 1585 expedition, astronomer Thomas Harriot relayed that tobacco “openeth all the pores and passages of the body” so that the natives’ “bodies are notably preserved in health, and know not many grievous diseases, wherewithall we in England are often times afflicted.”

Source: Wikipedia

People genuinely believed in the therapeutical and spiritual properties of tobacco. It’s quite understandable why smoking gained such popularity worldwide. James Albert Bonsack, the American who invented the first cigarette rolling machine back in 1880, also helpeda lot in making smoking fashionable and accessible.

Bonsack’s cigarette rolling machine, as shown on U.S. patent 238,640.
Via: Wikipedia

Results of the meta-analysis encourage anti-smoking campaigns

The paper was published in the journal Nicotine & Tobacco Research and gathered data from surveys between 2000 and 2016. These surveys involved 215,000 English speakers from the UK, US, Australia and New Zeeland.

Professor Peter Hajek from Queen Mary University of London stated in a press release that it was the first time that “the remarkable hold that cigarettes can establish after a single experience has been documented from such a large set of data.”

Via Pixabay/HansMartinPaul

“In the development of any addictive behavior, the move from experimentation to daily practice is an important landmark, as it implies that a recreational activity is turning into a compulsive need. We’ve found that the conversion rate from ‘first time smoker’ to ‘daily smoker’ is surprisingly high, which helps confirm the importance of preventing cigarette experimentation in the first place”, he added.

Keeping in mind the introduction of e-cigarettes and heat-not-burn tobacco in this past few years, new questions arise. Has classical smoking come to an end? Are the new smoking alternatives actually reducing regular tobacco use?

Via Pixabay/lindsayfox

Professor Peter Hajek says: “Concerns were expressed that e-cigarettes could be as addictive as conventional cigarettes, but this has not been the case. It is striking that very few non-smokers who try e-cigarettes become daily vapers, while such a large proportion of non-smokers who try conventional cigarettes become daily smokers. The presence of nicotine is clearly not the whole story.”

All in all, this study brings good news. The UK has recorded a dramatic reduction in smoking at the moment and this corresponds with findings that only 19 percent of 11-15-year-olds have ever tried a cigarette. The world, even just for a fleeting moment, seems to be on the right tracks.