Category: Smoking

Knowledge regarding environmental factors influencing the risk of Alzheimer's disease is surprisingly scarce, despite substantial research in this area. In particular, the roles of smoking and alcohol consumption still remain controversial. A new study published this month in the Journal of Alzheimer's Disease suggests a protective effect of alcohol consumption on the risk of Alzheimer's disease, particularly in women who do not smoke.

Researchers at the University of Valencia, the Generalitat Valenciana, and the Institut Municipal d'Investigació Mèdica, Barcelona, in Spain, carried out a study comparing personal and clinical antecedents of subjects affected with Alzheimer's disease with healthy people, both groups with the same age and gender distribution. Women included in the study were mainly light or moderate alcohol consumers. The risk of Alzheimer's disease was unaffected by any measure of tobacco consumption, but a protective effect of moderate alcohol consumption was observed, this effect being more evident in nonsmoker women.

"Our results suggest a protective effect of alcohol consumption, mostly in nonsmokers, and the need to consider interactions between tobacco and alcohol consumption, as well as interactions with gender, when assessing the effects of smoking and/or drinking on the risk of AD," according to lead investigator Ana M. Garcia, PhD, MPH, Department of Preventive Medicine and Public Health, University of Valencia.

"Interactive effects of smoking and drinking are supported by the fact that both alcohol and tobacco affect brain neuronal receptors."

Journal Reference:

1. Ana M. García, Nieves Ramón-Bou and Miquel Porta. Isolated and joint effects of tobacco and alcohol consumption on risk of Alzheimer's disease. Journal of Alzheimer's Disease, 2010; 20 (2): 577-586 DOI: 10.3233/JAD-2010-1399

 In a study published in the journal Addiction, researchers have determined that treatment for smoking dependence is as effective among people with severe mental illnesses as it is for the general population. Importantly, they also found that offering such treatments does not appear to cause deterioration in mental health.

This is good news: people with severe mental illnesses (SMI) such as schizophrenia have some of the worst physical health of any section of the population. They are two to three times more likely to smoke, and smoking-related illnesses contribute significantly to their high sickness and death rates. Mortality rates for those with SMI are three times that of the rest of the population.

Although treatment for smoking dependence would improve the physical health of people with SMI, the medical community has traditionally ignored health promotion and worried that such treatments would worsen people's mental states.

The authors brought together the most rigorous evidence on smoking cessation treatment among people with SMI. They were able to determine the effectiveness of smoking cessation treatment and chart any predictable adverse effects. In general, people with SMI responded well to pharmaceutical and behavioural treatments, which doubled their chance of quitting.

Because most of the studies focused on people with well controlled psychiatric conditions, it was not possible to state how well people with acute mental illness (such as those who have experienced recent hospitalisation) would respond to smoking cessation treatment.

Professor Simon Gilbody from the University of York & Hull York Medical School, who co-authored the review, commented that "schizophrenia is a devastating condition which causes people to die 25 years earlier than the rest of the population. This is a huge health inequality, and it is largely due to smoking-related illness rather than schizophrenia itself."

Dr Lindsay Banham, who led the review, added "what this review suggests is that quit-smoking treatments like nicotine replacement therapy may work just as well for people with disorders like schizophrenia. Smoking by those with SMI has largely been ignored and people with schizophrenia are not consistently offered treatment or services. We found evidence that smoking cessation treatments are effective and safe. We hope our research leads to better services for this neglected population."

Professor Gilbody concluded, "Despite huge expansion in smoking cessation services in recent years, people with severe mental illness have been left behind. The challenges for health services are to ensure people with schizophrenia are offered these treatments, and that services reflect the needs of this population.''

Journal Reference:

1. Lindsay Banham, Simon Gilbody. Smoking cessation in severe mental illness: what works?Addiction, 2010; DOI: 10.1111/j.1360-0443.2010.02946.x

A randomized trial compared three ways to deliver a behavioral smoking cessation program using varenicline (Chantix®): by phone, Web, or both. Although phone counseling had greater treatment advantage for early cessation and appeared to increase medication adherence, abstinence outcomes did not differ at six months.

The findings suggest the three programs are all effective treatment options when combined with varenicline. Nonprofit scientific research institute SRI International, Group Health Research Institute, and Free & Clear, Inc. conducted the trial, published in the May 2010 American Journal of Preventive Medicine.

Proactive telephone behavioral counseling and Web-based services are popular tools for smoking cessation. Although both phone- and Web-based services are known to be effective, previous studies have not examined whether combining these services improves outcomes over either method alone. The trial aimed to determine the relative effectiveness of a widely used smoking cessation program (Free & Clear Quit For Life® Program) delivered in three ways: standard proactive telephone behavioral counseling, Web-based delivery, and a program that combined the two.

The trial was among the first "real-world" examinations of varenicline use since the original phase III studies that the manufacturer sponsored. The researchers tracked more than 1,200 Group Health adult patients who received behavioral therapy and varenicline to quit smoking. All participants received 12 weeks of varenicline, printed guides, a 5-10 minute orientation call, and access to a toll-free phone number for support as needed.

"Our findings provide important data regarding the real-world use of varenicline and show that a supportive treatment philosophy along with individualized information matter most for long-term smoking cessation success," said Gary Swan, PhD, director of the Center for Health Sciences at SRI International and lead author of the study. "Any of the programs shows promise as a counseling tool when used in combination with varenicline."

Varenicline is a non-nicotine prescription medicine specifically developed to help adults 18 and older quit smoking. It targets nicotine receptors in the brain, attaches to them, and blocks nicotine from reaching them. Based on the observed smoking abstinence outcomes, researchers found that data obtained in real-world behavioral therapy settings are comparable to those from the varenicline phase III clinical trials. Gastrointestinal disturbances and abnormal dreams were the most common varenicline side effects, similar to the proportion of study participants reporting side effects in the phase III trials. No serious neuro-psychiatric incidents attributable to varenicline use occurred during the trial.

Co-authors were Group Health Research Institute Senior Investigator Jennifer B. McClure, PhD, and Associate Investigator Sheryl L. Catz, PhD; Project Manager Julie Richards, MPH; and Affiliate Investigators Susan M. Zbikowski, PhD, and Timothy A. McAfee, MD, MPH, both of Free & Clear; Mona Deprey, MS, of Free & Clear; and Lisa M. Jack, MA, and Harold S. Javitz, PhD, of SRI International.

The project described is registered at www.clinicaltrials.gov (NCT00301145). It was 97.85 percent funded ($3.3 million) by the National Cancer Institute (Grant R01CA071358). Pfizer Inc. provided study medication and nominal support (2.15%) for recruiting participants ($72,000).

Journal Reference:

1. Gary E. Swan, Jennifer B. McClure, Lisa M. Jack, Susan M. Zbikowski, Harold S. Javitz, Sheryl L. Catz, Mona Deprey, Julie Richards, Timothy A. McAfee. Behavioral Counseling and Varenicline Treatment for Smoking Cessation. American Journal of Preventive Medicine, 2010; 38 (5): 482 DOI: 10.1016/j.amepre.2010.01.024

The brain's nucleus accumbens (NAC) is a core region of the mesocorticolimbic dopaminergic system and is interconnected with the ventral tegmental area (VTA) and the prefrontal cortex. The mesocorticolimbic system is thought to be central to the reinforcing effects of many drugs and plays an important role in addiction. A new study has found that alcohol abuse elevated the expression of a distinct set of genes in the NAC and VTA, while nicotine blunted this effect in the VTA.

Results will be published in the July 2010 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

"In spite of their differences in pharmacology, alcohol and tobacco consumption are often intimately linked," said Traute Flatscher-Bader, a postdoctoral research fellow at The University of Queensland and corresponding author for the study. "Nonetheless, the molecular mechanisms that underlie alcohol and nicotine abuse, and particularly their co-abuse, are still incompletely understood."

"One thing that researchers have encountered is that it is often difficult to find 'pure' alcoholics, that is, alcoholics that only abuse alcohol and nothing else," agreed Simon Worrall, director of postgraduate coursework programs in molecular biology at The University of Queensland. "Many alcoholics are poly-drug abusers, with the most common other drug being nicotine. Thus, many studies which have studied the effects of alcohol on the brain and other organs have been compromised because they have not taken account of the effects of nicotine addiction which is often superimposed on the effects of alcohol addiction."

In the first part of the current study, Flatscher-Bader and her colleagues used DNA microarray technique to study the expression of many thousands of genes in the brains of non-smoking and smoking alcoholics and non-drinking smokers.

"We examined the impact of alcoholism and smoking on gene expression in the NAC in 20 chronic alcohol abusers and controls with and without recent smoking history," said Flatscher-Bader. "The results revealed that in this brain region, the abuse of alcohol and nicotine had distinct effects on the expression of genes. In addition, altered expression of a number of genes was associated with both alcohol and nicotine abuse. Within the latter group was a set of genes which play a crucial role in a molecular pathway regulating cell structure."

The researchers then went on to investigate in more detail the altered expression of six selected genes within the pathway regulating cell structure in two brain regions, using 30 cases comprised again of smoking and non-smoking controls and alcohol abusers. For this part of the study they used the method called "real time polymerase chain reaction."

"This expanded investigation revealed that one of the genes, called RHOA, was elevated by alcohol abuse and its highest expression was evident in the smoking alcoholics in both brain regions," said Flatscher-Bader. "The RHOA gene had previously been implicated in the initiation of tobacco smoking. In the NAC, the expression of a further four of the six selected genes was increased by alcohol abuse. Interestingly, the highest expression for each of the genes in the NAC was in the smoking alcoholics. In the other brain region called the VTA, alcohol abuse had a similar effect and elevated the expression of all six selected genes. In contrast to the NAC, however, concurrent smoking dampened the induction of five of these alcohol-sensitive genes in the VTA."

"Many studies have analyzed the changes in gene expression in this brain system to try to untangle the molecular pathology of alcohol addiction," said Worrall, "but this is amongst the first to take into account the effect of co-administration of nicotine with alcohol.

Flatscher-Bader stressed that there are several cell types in the brain and there are several steps between gene expression and impact on cell structure and function. "It has to be emphasized that our study is important as a first step in identifying molecular pathways underlying the effects of alcohol abuse and smoking and their co-joint abuse on the human NAC and VTA, "she said. "It now needs to be tested if our findings are, indeed, associated with changes to neuronal structure and function."

"A better understanding of the molecular basis of withdrawal may help in the development of new treatments to ameliorate the symptoms," added Dr Worrall. "Not many previous studies took into account the potential effects of nicotine addiction that may be superimposed on top of those from alcohol, so these results may help clinicians better use present therapy/drugs to treat patients abusing both alcohol and/or nicotine and may also lead to the development of new drugs."

Journal Reference:

1. Traute Flatscher-Bader, Erin Harrison, Izuru Matsumoto, Peter A. Wilce. Genes Associated with Alcohol Abuse and Tobacco Smoking in the Human Nucleus Accumbens and Ventral Tegmental Area. Alcoholism: Clinical & Experimental Research, 2010; DOI: 10.1111/j.1530-0277.2010.01207.x

NewsPsychology (May 4, 2010) — Electronic cigarettes, or ‘E-cigarettes’, are used mainly to quit smoking, and may be useful for this purpose. Researchers writing in the open access journal BMC Public Health polled 81 users and former users of the devices, finding that although the majority was happy with them, several concerns remain unaddressed.

Jean-François Etter, from the University of Geneva, Switzerland, carried out the research. He said, “Currently, there is a difficult balance between the need to protect consumers and the possibility now being offered to smokers to use a new, acceptable and potentially effective device to stop smoking. Given the enormous burden of disease and death caused by tobacco smoking, there is an urgent need for research into the toxicity, efficacy and public health impact of e-cigarettes.”

Almost all of the respondents (95%) had found e-cigarettes at least somewhat helpful to stop smoking. However, users were concerned about potential toxicity. Poor quality, lack of reliability and frequent failures were also mentioned by several of the people surveyed.

Summarizing the responses, Etter said, “Although users’ comments were generally positive, many were concerned about safety and toxicity, and questioned why no study has yet investigated these aspects. Several respondents were also concerned about the future legal status of e-cigarettes, and that they may possibly be banned. Very few studies have investigated these devices and research is now urgently required.”

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The above story is reprinted (with editorial adaptations by newsPsychology staff) from materials provided by BioMed Central, via EurekAlert!, a service of AAAS.

Journal Reference:

1. Jean-Francois Etter. Electronic cigarettes: a survey of users. BMC Public Health, 2010; (in press) [link]

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of NewsPsychology or its staff.

Kids who have just started smoking, but not on a daily basis, don't seem to recognize the early symptoms of dependence, according to a new study.

Published in the latest issue of Pediatrics by Chyke Doubeni, MD, MPH of the University of Massachusetts, the study found that among kids who have started smoking, "an urge to smoke or being irritable because they are not able to smoke is a sign of early dependence. But they don't seem to recognize that symptoms such as irritability are harbingers of addiction."

"Previous studies have already shown that there is a strong correlation between symptoms of nicotine dependence and nicotine addiction. This study shows that adolescents who start smoking, don't appear to recognize the early signs of dependence," Doubeni said. Other signs of early dependence that go unnoticed include experiencing a desire to smoke or craving for a cigarette.

The study concluded that nondaily use of tobacco can trigger any of these early signs of dependence. Early dependence promotes increased smoking. That in turn accelerates additional signs of dependence, which leads to even higher frequencies of smoking. Eventually, it leads to addiction.

The conclusions are based on a study that surveyed adolescent smokers every three to four months, over a four-year period from 2002-2006. The study found that over those four years, of the 370 subjects who had inhaled from a cigarette, 62% smoked at least once per month, 52% experienced dependence symptoms, and 40% went on to become daily smokers.

The study, "Early Course of Nicotine Dependence in Adolescent Smokers," provides additional evidence supporting the Food and Drug Administration's (FDA) recent rules placing restrictions on tobacco marketing to youth. Tobacco companies are challenging some of the FDA's rules in court.

Doubeni's study was funded by the Substance Abuse Policy Research Program (SAPRP) of the Robert Wood Johnson Foundation. The research supplemented an existing SAPRP grant to Joseph DiFranza, MD, also of the University of Massachusetts.

Journal Reference:

1. Chyke A. Doubeni, George Reed, and Joseph R. Difranza. Early Course of Nicotine Dependence in Adolescent Smokers. Pediatrics, May 2010 DOI: 10.1542/peds.2009-0238

Tobacco imagery is still relatively common in films rated suitable for kids and young teens, despite significant declines in the cinematic depiction of smoking over the past 20 years, indicates research published in Thorax.

Based on their findings, active product placement may still be taking place, particularly in UK films, say the authors.

They analysed the occurrence of depictions of tobacco use, including brand appearances and smoking paraphernalia, for periods of at least five minutes (tobacco intervals) in the 15 most commercially successful films screened in the UK between 1989 and 2008.

Commercial success was defined as accounting for around 50% or more of each year's gross box office takings, while smoking paraphernalia included ashtrays, lighters, etc.

Between 1989 and 2008, the average occurrence of five minute tobacco intervals plummeted from 3.5 per hour to 0.6 for all films, a fall of 80%.

But imagery persisted in all age categories of films given a certificate by the British Board of Film Classification. This included those deemed suitable for children and young teens.

Two thirds of films classified for under 18s and over half (61%) classified for under 15s featured tobacco intervals. Between 2004 and 2008, of the films containing tobacco intervals, 92% were rated as suitable for those under 18.

Among the 15 most popular films, tobacco intervals occurred in seven out of 10 films, over half of which (56%) were classified as suitable for those under 15 and 92% for those under 18.

The film with the highest number of brand appearances was Pulp Fiction, which was classified for adults (18).

But brand appearances were nearly twice as likely to occur in films with UK involvement. UK producers were involved in one out of five films and were solely responsible for 3% between 1989 and 2008.

Twelve different brands appeared in Bridget Jones's Diary (certificate 15) — the highest for any film. In About a Boy (certificate 12), the main character smoked Silk Cut regularly throughout the film, yet in the book on which the film was based, the lead character smoked infrequently and no particular brand was mentioned.

Marlboro and Silk Cut were the two brands most likely to be featured. While Marlboro has more than 42% of market share in the US, Silk Cut has just 5% of UK market share, prompting the authors to suggest that its appearance was "disproportionate."

"The specific repeated occurrence of some brands of cigarette in some films raises the possibility that product placement by tobacco companies is still occurring," they suggest.

Smoking in films is a potent driver of youth and adult smoking, say the authors, who suggest that film certification should take smoking into account for films targeted to young people.

." ..it is apparent that children and young people watching films in the UK are still exposed to frequent and at times specifically branded tobacco imagery, particularly in films originating from the UK," they conclude.

Dr James White from Cardiff University's School of Medicine undertook a three-year-study, involving some 3,500 11 to 15 year-olds, as part of the British Youth Panel Survey — a self report survey of children in the British Household Panel survey.

Results indicated that one of the strongest protective factors for reducing the risk of experimenting with smoking in early adolescence was how often fathers talked with their children, both boys and girls, about 'things that mattered'.

Dr White, who presented his findings to the British Psychological Society's Annual Conference on April 15 said: "This study suggests that a greater awareness of parents' and especially fathers' potential impact upon their teenagers' choices about whether to smoke is needed. Fathers should be encouraged and supported to improve the quality and frequency of communication with their children during adolescence.

"The impact of teenager parenting is relatively un-researched and further research is very much needed."

Only children who had never smoked at the time the study began took part. As well as their smoking, the children were also asked about the frequency of parental communication, arguments with family members and the frequency of family meals.

The frequency of family arguments and family meals did not have a significant effect.

After three years, the responses of children who had remained non smokers were compared to those who said they had experimented with smoking at some point.

Recognised risk factors for smoking, such as age, participant sex, household income, parental monitoring and parental smoking, were all taken into account during analysis of the study's findings.

New research finds any beneficial effect of drinking moderate amounts of alcohol on stroke may be counteracted by cigarette smoking, according to research that will be presented as part of the late-breaking science program at the American Academy of Neurology's 62nd Annual Meeting in Toronto, April 10-17, 2010.

Scientists followed the drinking and smoking habits of 22,524 people in the United Kingdom who were between the ages of 39 and 79 and did not have a history of heart attack or stroke at the start of the study. During the 12-year study, 864 strokes occurred.

The study found that the association between alcohol drinking and stroke was significantly different between smokers and non-smokers. In non-smokers, people who consumed moderate amounts of alcohol were 37 percent less likely to develop stroke than non-drinkers, while in smokers this association was not observed. This finding suggests that smoking may modify the relationship between alcohol intake and stroke risk. Moderate drinking was defined as consuming up to 21 units of alcohol per week, which is equal to about two to three regular glasses of red wine a day.

"Our findings could have public health implications in that we appear to have a clearer understanding of the dangers of combining smoking and moderate drinking on overall stroke risk," according to Yangmei Li, MPhil, with the University of Cambridge in the United Kingdom.

"While heavy alcohol consumption is considered to increase the risk of stroke, the relationship between light to moderate drinking and stroke has varied considerably among studies," said Li. "It's possibly these conflicting results could be explained by the interaction between cigarette smoking and alcohol on stroke risk." This reinforces the evidence that smoking not only increases stroke risk on its own but may additionally affect adversely how other lifestyle factors may relate to stroke risk.

The study was supported by the Medical Research Council in the United Kingdom and Cancer Research UK.

NewsPsychology (Apr. 2, 2010) — “Only dopes use dope,” goes the memorable warning about drugs. Now a Tel Aviv University researcher cautions that the same goes for cigarettes.

A study led by Prof. Mark Weiser of Tel Aviv University’s Department of Psychiatry and the Sheba Medical Center at Tel Hashomer Hospital has determined that young men who smoke are likely to have lower IQs than their non-smoking peers. Tracking 18- to 21-year-old men enlisted in the Israeli army in the largest ever study of its kind, he has been able to demonstrate an important connection between the number of cigarettes young males smoke and their IQ.

The average IQ for a non-smoker was about 101, while the smokers’ average was more than seven IQ points lower at about 94, the study determined. The IQs of young men who smoked more than a pack a day were lower still, at about 90. An IQ score in a healthy population of such young men, with no mental disorders, falls within the range of 84 to 116.

An addiction that doesn’t discriminate

“In the health profession, we’ve generally thought that smokers are most likely the kind of people to have grown up in difficult neighborhoods, or who’ve been given less education at good schools,” says Prof. Weiser, whose study was reported in a recent version of the journal Addiction. “But because our study included subjects with diverse socio-economic backgrounds, we’ve been able to rule out socio-economics as a major factor. The government might want to rethink how it allocates its educational resources on smoking.”

Making the results more significant, the study also measured effects in twin brothers. In the case where one twin smoked, the non-smoking twin registered a higher IQ on average.

Although a lower IQ may suggest a greater risk for smoking addiction, the cross-sectional data on IQ and smoking found that most of the smokers investigated in the study had IQs within the average range nevertheless.

Obesity, drug addiction also at issue

In the study, the researchers took data from more than 20,000 men before, during and after their time in the military. All men in the study were considered in good health, since pre-screening measures for suitability in the army had already been taken. The researchers found that around 28 percent of their sample smoked one or more cigarettes a day, 3 percent considered themselves ex-smokers, and 68% said they never smoked.

Prof. Weiser says that the study illuminates a general trend in epidemiological studies. “People on the lower end of the average IQ tend to display poorer overall decision-making skills when it comes to their health,” says Prof. Weiser. He adds that his finding can help address a serious concern among health counsellors at grade and high schools. Schoolchildren who have been found to have a lower IQ can be considered at risk to begin the habit, and can be targeted with special education and therapy to prevent them from starting or to break the habit after it sets in.

“People with lower IQs are not only prone to addictions such as smoking,” Prof. Weiser adds. “These same people are more likely to have obesity, nutrition and narcotics issues. Our study adds to the evidence of this growing body of research, and it may help parents and health professionals help at-risk young people make better choices.”

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The above story is reprinted (with editorial adaptations by newsPsychology staff) from materials provided by American Friends of Tel Aviv University.

Journal Reference:

1. Mark Weiser, Salman Zarka, Nomi Werbeloff, Efrat Kravitz, Gad Lubin. Cognitive test scores in male adolescent cigarette smokers compared to non-smokers: a population-based study. Addiction, 2010; 105 (2): 358 DOI: 10.1111/j.1360-0443.2009.02740.x

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of NewsPsychology or its staff.