Medication may help heavy-drinking smokers improve their health

UCLA study provides evidence that varenicline can aid them in quitting smoking, reducing drinking

UNIVERSITY OF CALIFORNIA - LOS ANGELES

Research News

 

IMAGE: LARA RAY, A UCLA PROFESSOR OF PSYCHOLOGY AND OF PSYCHIATRY AND BIOBEHAVIORAL SCIENCES WHO HOLDS UCLA'S SHIRLEY M. HATOS CHAIR IN CLINICAL NEUROPHARMACOLOGY. view more 

CREDIT: ELENA ZHUKOVA

A recent UCLA clinical trial has shown encouraging results in helping daily smokers who are also heavy drinkers quit smoking and cut down their alcohol intake.

The study of 165 people tested two prescription drugs -- varenicline, for smoking addiction, and naltrexone, which is used to treat alcoholism. Studies have shown that varenicline, marketed under the brand name Chantix, may also be effective in reducing alcohol consumption.

Participants, who ranged in age from 21 to 65, smoked at least five cigarettes a day, with male participants generally consuming more than 14 drinks a week and women more than seven per week.

Over the 12-week study period, each participant received 2 milligrams of varenicline twice a day. Roughly half the group -- 83 participants -- also received a 50-milligram dose of naltrexone daily, while the other 82 received placebo pills. They were all told to quit smoking and drink less.

When researchers followed up 26 weeks after the study's conclusion, they found that nearly 36% -- 59 participants -- had quit smoking.

"The overall smoking quit rate in the trial is impressive," said lead author Lara Ray, a professor of psychology and of psychiatry and biobehavioral sciences who holds UCLA's Shirley M. Hatos Chair in Clinical Neuropharmacology. She noted that previous studies have suggested varenicline has a success rate at six months of about 25% to 30%.

"We exceeded the overall expectation for this medication," she said. "This is especially important in a diverse group of people." Ray said that while some previous studies have shown lower-than-average smoking cessation rates among Black participants, that was not the case in the current trial, in which more than half of participants were Black.

Surprisingly, the researchers said, those who had received varenicline plus a placebo had a significantly higher smoking quit rate (45%, or 37 of 82 participants) than those who were given varenicline and naltrexone (27%, or 22 of 83 participants).

"The quit rate for varenicline alone in this sample is highly encouraging, as this is the first large-scale trial of varenicline efficacy focused solely on heavy-drinking smokers," Ray said.

While participants who received varenicline plus naltrexone had a lower smoking quit rate, they had slightly better success than the placebo group at curbing their drinking. At the start of the study, participants averaged nearly seven drinks per drinking day; those on the varenicline-naltrexone combination reduced their consumption to three drinks per drinking day over the 12-week study period, while those receiving the varenicline-placebo combination cut down to four drinks -- both impressive decreases, Ray said.

"I am excited about both the smoking cessation rates and the drinking reductions," said Ray, who is also a member of UCLA's Brain Research Institute. "These findings suggests that desirable outcomes for smoking cessation and drinking reduction are achievable."

The study, which found no difference in quit and reduction rates between men and women, was published online in the American Journal of Psychiatry June 3 and is scheduled for publication in the journal's September print issue.

Approximately 20% to 25% of smokers are also heavy drinkers. Smoking and heavy drinking are major public health concerns that reduce people's life span and quality of life, and both have also been linked to worse health outcomes for COVID-19.

As with all addictions, quitting smoking and reducing drinking are difficult and complex processes. This study confirms that medications can play a role, Ray said, but she noted that it can be challenging for patients to take more than one prescribed medication.

"Varenicline alone is doing a great job, and this trial indicates that there is not much room for naltrexone to make a difference," Ray said. "But even medications like varenicline have their limitations. Medication is only part of the solution. There remains much research to be done on addictions and how to treat them."

Ray says that those who wish to quit smoking and reduce drinking may consider talking to their doctor about the possibility of using varenicline, and she recommends that they try to quit smoking and reduce their drinking at the same time.

"There is evidence that varenicline can help them with both," Ray said. "Varenicline appears quite effective at reducing drinking and helping people to quit smoking. Given that varenicline has been found to reduce drinking in trials for alcohol use disorder, it is possible that its effects on both drinking and smoking present an optimal alternative for this group of heavy-drinking smokers."

ReJoyce Green, a UCLA doctoral student in clinical psychology who works with Ray, and Karen Miotto, a UCLA clinical professor of psychiatry and the medical director of the clinical trial, are among the study's 14 authors.

The clinical trial and Ray's research are funded by the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, both part of the National Institutes of Health.

The study was conducted between July 2015 and December 2019 at an outpatient research facility at UCLA.

###

UVA Health, community pharmacies partner to help Appalachia residents quit smoking

Collaboration tests effectiveness of several smoking cessation approaches

Grant and Award Announcement

UNIVERSITY OF VIRGINIA HEALTH SYSTEM

 

IMAGE: UVA SCHOOL OF MEDICINE RESEARCHER MELISSA LITTLE, PHD, MPH, IS LEADING AN INITIATIVE TO HELP MORE RESIDENTS OF RURAL APPALACHIA QUIT SMOKING. view more 

CREDIT: UVA HEALTH

Fourteen independent community pharmacies will team with UVA Health to help residents of rural Appalachia quit smoking and test the effectiveness of multiple smoking cessation programs, including one based on text messaging. The project ultimately aims to lower the region’s cancer rates, which are among the highest in the country.

Backed by more than $5 million in funding from the National Cancer Institute, 14 pharmacies selected for the program in Virginia, Kentucky, North Carolina, West Virginia and Tennessee will participate in the study. 

“It is clear that publicly available smoking cessation resources are not reaching residents in this region,” said Melissa Little, PhD, MPH, a researcher in the UVA School of Medicine’s Department of Public Health Sciences and the leader of this initiative. “We are hoping that by working with local community pharmacies, we’ll be able to help more smokers interested in quitting who otherwise may not have sought help with their quit attempt.”

The Impact of Smoking in Appalachia

Rural Appalachia has some of the highest smoking rates in the United States. For example, an analysis of data from 2015 to 2019 found the smoking rate in rural Appalachian counties was 20.9%, compared with a statewide smoking rate of 13.3%. Higher rates of cancer in rural Appalachia can be attributed to smoking, Little said, as studies have shown that cigarette smoking is estimated to account for 30% of all cancer deaths and 90% of all lung cancer deaths.

However, residents of rural Appalachia are less likely to take advantage of commonly available resources to quit smoking – such as phone counseling and nicotine-replacement therapy – which Little suspects may be due to the shortage of healthcare providers in the region.

She believes community pharmacists based in rural Appalachia are ideally positioned to help residents quit smoking.

“We conducted a small demonstration study in partnership with Gates Pharmacy, a community pharmacy in Mt. Airy, N.C., to determine the feasibility of the approach,” Little said. “Overall, the project was well received by both participants interested in quitting as well as the Gates pharmacists and technicians.”

“The process of recruiting and enrolling patients was simple, the intervention guides were clear and easy to follow, and our entire staff was able to contribute in their own way to the success of the project,” said Hayley Wood, the pharmacy manager at Gates Pharmacy.

The program will evaluate the effectiveness of different combinations of smoking cessation programs. All 768 participants will receive nicotine replacement therapy through gum, a patch or both. 

Additionally, participants will be randomly selected to participate in one of three programs:

• QuitAid: Participants will have one in-person meeting and five follow-up sessions by phone over a month with a pharmacist, who will provide support and help address any questions or concerns about the nicotine-replacement therapy.
• Tobacco Quitline: Participants will have four 20- to 30-minute phone calls over four weeks from a trained tobacco treatment specialist working on the project to assist them in quitting smoking and preventing relapse.
• SmokefreeTXT: A text messaging program developed by the National Cancer Institute that sends participants three to five text messages per day for seven weeks to assist participants in quitting and preventing relapses.

For More Information

The study is expected to begin in April 2023. Pharmacies and smokers interested in the program can learn more by emailing Quitaid@hscmail.mcc.virginia.edu or by calling study coordinator Taylor Reid at 434.924.8894.

UK

Boris Johnson’s former food tsar attacks Sunak’s smoking ban: ‘Odd to prioritise cigarettes over fast food’


Archie Mitchell and Rebecca Thomas
Thu, 5 October 2023 


Boris Johnson’s former food tsar has launched an attack on Rishi Sunak’s smoking ban, saying it is “odd” to prioritise tackling cigarettes over junk food, as health leaders pile pressure on the prime minister to do more to address the growing obesity crisis.

Henry Dimbleby told The Independent that smoking is “far less” of a health issue than a poor diet, adding that smoking rates among young people are already “in freefall”.

The celebrity chef and founder of the Leon restaurant chain said that whatever government is in power in 10 years’ time will be “crippled” by the obesity crisis, and called on the prime minister to do more to tackle the issue.

NHS bosses and a former Tory health minister are among a chorus of voices urging Mr Sunak to do more to curb junk food, which they say is fuelling an obesity epidemic.

It comes after Mr Sunak used his Conservative Party conference speech to announce a proposal that would effectively ban cigarettes for anyone now aged 14 or under, by raising the age at which it is legal to purchase cigarettes by one year every year.

Mr Dimbleby told The Independent: “It seems odd to choose to go after smoking when it is already far less of a health problem than poor diet. Smoking rates are in freefall among young people.

“By 2035, the NHS is forecast to spend more treating type 2 diabetes – just one diet-related health condition – than it does today on all cancers. And it isn’t just that our diet is making us sick. It is making us poor, too. The four most common conditions keeping 2.5 million people out of work are muscular-skeletal conditions, type 2 diabetes, hypertension, and mental [illness].

“Three of those are directly caused by poor diet, and one is exacerbated by it. Whatever government is in power in 10 years’ time will be crippled by the social and economic problems caused by diet-related ill health, if we don’t act now.”

Mr Dimbleby’s intervention came after an irritable Mr Sunak defended the policy in a terse interview with the BBC, insisting that cigarettes are “different to a pack of crisps or a piece of cake”.

Henry Dimbleby said poor diets are making people sick and poor as he called on Sunak to act (Rex Features/Jason Alden)

Grilled over why he had undone plans to tackle obesity on the grounds of protecting people’s freedoms, Mr Sunak said smoking was “fundamentally different”.

The prime minister said smoking is “unequivocally the single biggest preventable cause of death, disability and illness in our society”.

But research from BioMed Central in 2021 showed that obesity now accounts for more deaths in England and Scotland than smoking among people in middle and old age. National strategies to address adiposity should be a public health priority, it said.

It follows Mr Sunak delaying measures contained in the government’s anti-obesity strategy until October 2025, saying that he “firmly believes in people’s right to choose”. The rules, which would have banned two-for-one junk-food deals, had already been pushed back and were originally planned to come into force this month.

Tam Fry, a spokesperson for the National Obesity Forum, said Mr Sunak’s smoking ban had “diverted attention from obesity, which is actually far more serious in terms of early death”.

Mr Fry told The Independent that obesity is on course to overtake smoking as the leading cause of cancer.

Asked about the difference between banning smoking and restricting fast-food consumption, Mr Fry said: “Addiction is the crux here. You can be addicted to fast food, but you’re more likely to be addicted to smoking. And once it has gripped you, a lot of people suffer tremendously from it.”

He added that both are “fundamental public health issues” that need to be tackled. But he said: “The issue of fast food, and the fact that it’s got to such a degree now that it may well overtake smoking as a cause of cancer, in my opinion is far more serious.”

Former Tory health ministerJames Bethell also urged the PM to crack down on obesity, saying the smoking ban should be a “first step”. Lord Bethell told The Independent that, in order to address obesity, Britain needs “20 different measures, all of them quite complex”.

But he said Mr Sunak will “learn a lot” from the smoking ban, and insisted that health interventions “can really be popular”.

“It will remind Downing Street that the public are hard over on things like junk food levies, gambling levies and minimum prices for drinking,” he said.

The director of the Obesity Health Alliance, Katharine Jenner, said she was “delighted” that the PM had banned smoking for future generations, but that tackling obesity needs the same focus.

“If this government really is committed to seeing the next generation grow up healthily, they also need to tackle the flood of unhealthy food and drink in our supermarkets and on our high streets,” she said.

But she added that ministers have failed to implement their own laws to “stop children being relentlessly bombarded with manipulative advertising and promotions”.

“This is not about removing choice – it’s about making the healthy choice the easy choice,” she said, calling for restrictions on junk food advertising.

And Dr Layla McCay, director of policy at the NHS Confederation, which represents hospitals, said the health service would come under “unsustainable pressure” without action to tackle obesity.

“The prime minister’s intention to ban cigarette sales for younger generations is a powerful and important step, but it comes as his government has failed to implement its own food strategy, which recommended sugar and salt taxes and restrictions on advertising,” she said.

She said the decision was “hard to justify” given obesity is one of the leading causes of preventable death and causes a number of long-term illnesses.

“The government needs to tackle this issue head-on rather than hiding behind ‘nanny-state’ excuses,” she added.

First comparison of dangers of tobacco cigarettes, e-cigarettes and waterpipes

Any smoking and vaping technique may increase risk of COVID-19 infection and death

EUROPEAN SOCIETY OF CARDIOLOGY

IMAGE: IMAGE SHOWS TOXIC COMPOUNDS, DISEASE MECHANISMS, CLINICAL OUTCOMES AND ADVERSE HEALTH EFFECTS ASSOCIATED WITH TOBACCO CIGARETTES, E-CIGARETTES AND WATERPIPES. view more 

CREDIT: EUROPEAN HEART JOURNAL

Smoking and vaping, whether by means of tobacco cigarettes, e-cigarettes or waterpipes, stiffens the arteries, causes inflammation and damages DNA, leading to a variety of health problems, according to a study published today (Friday) in the European Heart Journal [1].

In addition, smoking and vaping may increase the risk of people being infected by COVID-19, suffering worse symptoms and dying from it, say the researchers. They join the World Health Organization (WHO), the US Centers for Disease Control and Prevention, the Food and Drug Administration and the European Society of Cardiology in urging smokers to try to give up the habit, regardless of which smoking method they use.

The study is the world's first comparison of the effects of the three forms of smoking and vaping on human health and the function of cells that line blood vessels (the endothelium). It provides an overview of the available evidence about the harmful chemicals produced and the mechanisms by which smoking and vaping affect the body. The researchers also looked at the effects of each on medical conditions ranging from stroke to heart attacks and lung cancer.

The researchers found there were multiple good studies showing that, overall, tobacco cigarettes were more harmful than e-cigarettes. However, there were few good, large studies about the adverse effects of waterpipes (often referred to as hookahs, shisha or narghile) and e-cigarettes on endothelial dysfunction and so the evidence was more variable. The researchers say the long-term effects of water pipes and e-cigarettes need to be investigated more thoroughly. In the meantime, they write, "waterpipe smoking is not less harmful than tobacco smoking and thus cannot be considered a healthy alternative".

The researchers reviewed a range of studies, which they graded as providing strong, good or medium levels of evidence on the harmfulness of the three types of smoking and vaping [2]. Compared to non-smokers, tobacco cigarettes increased the risk of chronic obstructive pulmonary disease (COPD) by 704% (good level of evidence), waterpipes by 218% (strong) and e-cigarettes by 194% (good); tobacco cigarettes and waterpipes increased the risk of lung cancer by 1210% (strong) and 122% (strong) respectively, while the level of evidence for e-cigarettes was not sufficient to draw reliable conclusions.

They also looked at how much the three smoking techniques stiffened the arteries, an important prognostic indicator for the risk of heart problems and stroke. Compared to non-smokers, tobacco cigarettes increased arterial stiffness by 10%, waterpipes by 9% and e-cigarettes by 7% (medium level of evidence for all three).

The first author of the review, Professor Thomas Münzel, of the Department of Cardiology of the University Medical Centre Mainz in Mainz, Germany, said: "Our review focuses primarily on the adverse effects of these three smoking and vaping techniques on endothelial dysfunction and the relation to oxidative stress and, secondly, on clinical disease. All three forms of smoking and vaping lead to increased production of oxygen-derived free radicals in blood vessel tissue, such as superoxide. This breaks down nitric oxide, which is released by the endothelium, and is important for helping blood vessels to dilate and for protecting against inflammation and clogging of the arteries."

The researchers say the main toxic chemicals in e-cigarette vapour include formaldehyde and acrolein, as well as traces of chemicals called transition metals and volatile organic compounds (VOCs), all of which are known to damage cells. In contrast, tobacco cigarettes and waterpipe smoke contain a much more complex mixture of harmful chemicals and other substances. Waterpipe smoke contains solid particulate matter, originating mainly from the charcoal used to burn the tobacco; this is also present in lower concentrations in cigarette smoke. Nicotine is present in all three tobacco products, is addictive and is responsible for harmful biological effects as well as, to a minor extent, some beneficial effects.

Prof. Münzel said: "These different as well as overlapping profiles of toxic compounds may be a key to understand the similarities and differences in the adverse health effects of smoking and vaping, and should be further investigated in detail by future studies."

The researchers looked at the effects of smoking and vaping on COVID-19 infections. In the EHJ paper, they write: "As outlined by the WHO, tobacco cigarette and waterpipe smoking may contribute to increased burden of symptoms due to COVID-19 compared to non-smoking, including being admitted to intensive care, requiring mechanical ventilation, and suffering severe health consequences."

They conclude: "There is no doubt...that smoking cessation is and will remain the most powerful approach to prevent smoking-induced cardiovascular and respiratory disease. This may be even more important in light of the...COVID-19 pandemic as the use of tobacco products likely increases the risk for COVID-19 associated cardiovascular and other severe complications in smokers and vapers."

Prof. Münzel said: "Given the well-established harms associated with tobacco use and second-hand smoke exposure, the WHO recommends that tobacco users should quit. Proven interventions to help users give up include toll-free quit lines, mobile text-messaging cessation programmes, nicotine replacement therapies and other approved medications, particularly if you have smoked for a long time, and especially if you use tobacco cigarettes and water pipes.

"The WHO also warns that although e-cigarettes appear to be less harmful than tobacco cigarettes, there is growing evidence that they also may cause side effects in the lungs, heart and blood vessels and that e-cigarette use may increase the risk of COVID-19 infection."

The authors also address the issue of tobacco advertising. In the EU, TV and radio advertising of cigarettes, and tobacco products is not permitted. Some countries, such as Slovenia and Norway, have strict laws that ban all types of advertising, even at the point of sale. Germany is the only EU country where tobacco products, including e-cigarettes, can be advertised in public spaces via billboards. In the US, advertising of both tobacco products and e-cigarettes on billboards is allowed. The EHJ study includes maps to show where in the world e-cigarette sales are legal, and where in Europe advertising permitted.

Prof. Münzel said: "E-cigarettes are mostly considered as tobacco products, but the regulations on their advertising are not always clear."

###

Notes:

[1] "Effects of tobacco cigarettes, e-cigarettes and waterpipe smoking on endothelial function and clinical outcome", by Thomas Münzel et al. European Heart Journal. doi:10.1093/eurheartj/ehaa460

[2] Examples of studies that provided strong evidence (shown as +++ in Figure 1 in the paper) were large meta-analyses; studies providing "good" evidence (++) were single studies with over 1,000 participants; and studies providing "medium" evidence (+) were single studies with fewer than 1,000 participants.

SO I HAVE TO ASK THE RHETORICAL QUESTION, IF THIS IS THE FIRST SUCH STUDY ON WHAT BASIS DID THE CITY OF EDMONTON DECIDE TO PASS A BYLAW BANNING WATER PIPE BARS AN LOUNGES, SHISHA BARS, POPULAR AMONG LEBANESE AND SYRIANS IN THE CITY.

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Edmonton looks at banning shisha lounges as early as July 2020. Edmonton will be following several Canadian cities in its clampdown on smoking shisha in lounges. In 2016, Toronto passed a bylaw banning the use of water pipes in all licensed establishments.Aug 27, 2019
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Lung cancer does not decrease in line with reduced smoking

UMEA UNIVERSITY

 

IMAGE: 

BENGT JÄRVHOLM, PROFESSOR AT DEPARTMENT OF PUBLIC HEALTH AND CLINICAL MEDICINE, UMEÅ UNIVERSITY, SWEDEN

view more 

CREDIT: MATTIAS PETTERSSON

Despite the fact that the number of people who smoke has decreased very sharply in Sweden, the number of cases of lung cancer in the population is not decreasing as much as expected. Among women lung cancer has in fact increased. This is shown in a new study at Umeå University, Sweden. The study means that the view of how long smoking affects health may change.

“Smoking is undoubtedly the most important risk factor for lung cancer. It is therefore surprising that the decline in smoking is not yet more visible in the statistics. More research is needed to find out why this is the case,” says Bengt Järvholm, professor at the Department of Public Health and Clinical Medicine at Umeå University.

The number of people who smoke has been declining in Sweden for many years. Today, one of twenty Swedes, about five percent, among men and women state that they smoke daily. In the 1960s, about one in two Swedish men between the ages of 18 and 69 smoked. Women generally started smoking later in history than men. In a large study in 1963, only slightly more than one in ten women, 11 per cent, aged 50–69 smoked, while 46 per cent of men were smokers. Among women, it was mainly younger people who smoked in the 1960s.

According to previous research, the risk of developing lung cancer decreases sharply and quickly after quitting smoking. According to a British study, the number of people who had lung cancer before the age of 75 fell from 16 percent to three percent among those who quit smoking before the age of 50.

The Umeå researchers have compared the change in smoking habits in Sweden from the 1950s with the incidence of lung cancer between 1970 and 2021 in men and women aged 40–84 years. They studied how the risk varied among men and women in different age groups. Previous studies have shown that squamous cell cancer is the form of lung cancer that has the strongest association with smoking.

The results showed that the risk of being affected varied greatly depending on the type of lung cancer, age and gender. Based on previous studies, it would have been expected that the risk of cancer would have decreased among the elderly as well. However, lung cancer was as common in 1970 as in 2021 among men aged 75–79 years. The number of squamous cell cancer had fallen sharply, while in 2021 it had instead increased six-fold for the other common form of cancer, adenocarcinoma. The risk of squamous cell cancer had increased among women in the age group 75-79 years to the same level as among men. For adenocarcinoma, the risk was similar for women and men, despite the fact that there were large differences in smoking habits among women and men in the 1970s.

The study does not provide an answer as to why the development of lung cancer does not correspond well with expectations. For that, other types of studies are required. However, there are several possible explanations. One explanation may be that people may underreport their smoking, i.e. that the reduction in smoking may be smaller in reality. Another possible explanation may be that previous assumptions have been exaggerated about how quickly the risk of being affected decreases when you quit smoking. Nor can it be ruled out that other environmental or lifestyle factors may play a role; Even those who have never smoked can get lung cancer, although it is less common. The fact that the trend is so much worse for women than for men is due to the fact that Swedish women generally started smoking later in history than men.

“The results should certainly not be interpreted as it is useless to quit smoking. On the contrary, the study emphasizes the importance of quitting early, preferably never starting, as it may be the case that the risk of lung cancer is elevated for longer than we previously thought,” says Bengt Järvholm.

The study shows that if the risk of developing lung cancer in 2021 was as high as the risk in 1970 in men and women aged 40–84, approximately 2,250 men would have suffered from lung cancer in 2021 instead of 1695 cases, i.e. a decrease of 555 cases. Among women, there would have been 544 cases instead of the current 2,181 cases, i.e. there has been an increase of 1,637 cases of lung cancer.

The study is based on data from the National Board of Health and Welfare's cancer registry, which was compared with statistics on tobacco smoking from surveys and from the sale of cigarettes.

---

JOURNAL

European Journal of Public Health

DOI

10.1093/eurpub/ckae050 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Changing smoking habits and the occurrence of lung cancer in Sweden—a population analysis

Physical activity and tailored support fails to deliver lasting benefits for smokers not ready to quit

Peer-Reviewed Publication

UNIVERSITY OF PLYMOUTH

Promoting physical activity and other behavioural support can help people wanting to reduce their smoking to quit in the short-term.

However, after nine months, physical activity delivers no noticeable benefits – compared with offering no additional support – in the rates of people stopping smoking, according to the findings of a major national study.

The Trial of physical Activity and Reduction of Smoking (TARS) study, led by the University of Plymouth with funding from the National Institute for Health and Care Research, took place across four cities – Plymouth, Nottingham, Oxford and London – before the COVID-19 pandemic.

Its aim was to provide a definitive answer as to whether future NHS services should be adapted to provide additional support to smokers not ready to quit but who do wish to reduce their smoking, with the hope of increasing sustained abstinence from smoking and associated health benefits.

The study also sought to look into previous suggestions that behavioural support for these smokers can lead to smoking reduction and more attempts to quit.

To answer these questions, half the 915 smokers recruited into the study were offered up to eight, weekly face-to-face or phone motivational support sessions to reduce their smoking and increase moderate to vigorous physical activity. It was an approach which had previously shown encouraging signs in a Plymouth pilot study, and was contrasted against the other half of participants who were offered the usual NHS advice on quitting.

The study showed that engaging with the motivational support had some short-term benefits, with 19% of those receiving the additional support saying they had at least halved the number of cigarettes smoked by three months – 14% had still halved their smoking after nine months. By contrast, around 10% of those receiving the standard advice reported having halved their cigarette intake at both milestones.

However, just 2% of those who received the additional support had abstained from smoking between three and nine months. Less than 1% of those receiving the standard advice managed to abstain from smoking for those six months.

In addition, while after three months people receiving the additional support took part in 81 minutes more physical activity each week than those receiving no support, researchers did not find evidence of sustained differences in physical activity at nine months.

With the additional support costing health services in the region of £240 per person, the study’s authors say their findings show the approach is neither effective for long-term smoking cessation or cost-effective.

The research, published in the journal Addiction, also involved the University Hospitals Plymouth NHS Trust, St George’s University of London, University of Oxford, University of Nottingham, University of Exeter, and Plymouth City Council.

Adrian Taylor, Professor in Health Services Research within the University of Plymouth’s Peninsula Medical School, is the study’s lead author. He said: “Generally, the smokers in our study were enthusiastic about the support they received to help reduce their smoking and increase physical activity, which avoided pressuring them to quit. However, they were unable to maintain increases in physical activity and smoking reduction did not lead to more smokers giving up completely, which is the best thing for an individual’s health. Helping smokers to move from wanting to reduce to quitting completely is far more challenging than other less rigorous studies had suggested.”

“This is a further demonstration of the scale of the challenge facing society if we are to achieve the UK Government’s stated aim of being smoke free by 2030. However, it is potentially only through additional difficult national policy decisions such as even higher taxation on tobacco, the subsidised promotion of vaping, and increasing the legal age of tobacco purchasing, in line with other countries such as New Zealand, that the huge costs of smoking for our NHS Services will be reduced.”

---

JOURNAL

Addiction

DOI

10.1111/add.16129 

METHOD OF RESEARCH

Randomized controlled/clinical trial

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Effectiveness and cost-effectiveness of behavioural support for prolonged abstinence for smokers wishing to reduce but not quit: Randomised controlled trial of physical activity assisted reduction of smoking (TARS)

ARTICLE PUBLICATION DATE

6-Mar-2023

Casablanca R Rated

For smoking. There goes the classics, like the full smoking Casablanca.

Smoking is now associated on the “Silver Screen” right up there with violence, language, nudity and drug abuse in ranking criteria. The MPAA brass are quoted saying “ There is a broad awareness of smoking as a unique public health concern due to nicotine’s highly addictive nature and no parent want their child to take up the habit.”

Apparently studies prove depictions of smoking in the movies have made children more likely to try cigarettes. The Attorneys General in 32 States have publicly called on the MPAA to put “R” ratings on movies containing scenes involving smoking.

The irony is that Casablanca is an anti-fascist movie, and of course anti-smoking laws are the moralist equivalent of fascism, since they are appeals to a prohibitionist state.

Meanwhile, we also learn about Rick’s life before he came to
Casablanca. He grew up during the Prohibition years, when
selling alcohol was illegal in America. Powerful gangsters ruled
New York at this time, bringing alcohol in from outside the country
and supplying it to clubs. The young Rick is given a job by one of
these gangsters, Solly Horowitz. Solly likes Rick and makes him
manager of the Tootsie-Wootsie, a gambling and drinking club.
But trouble breaks out between rival gangsters. Rick’s boss is
killed. Rick has to get away fast. He and Sam, his pianist from the
Tootsie-Wootsie, escape to Europe.

However, if we look beyond the nostalgia and the sentimental theme of lost love and redemption, we see that Casablanca actually presents a complex and intricate political and social commentary on the early days of World War II. The product of a decade when studios were routinely producing “a movie a week,” Casablanca surpasses its humble origins as “just another Warner Brothers’ picture” by exploiting wartime patriotism and the traditional “American values” of freedom, liberty, and equality to shape audiences’ perception of the war. In the most basic sense, Casablanca was an anti-fascist propaganda vehicle which was designed to support U.S. participation in the Allied Forces’ struggle for global justice and democracy at a time when most Americans believed that U.S. foreign policy should have promoted isolationism and neutrality.

With the coming of the Second World War, for which the civil war was a rehearsal, things changed. In the 1943 Ealing Studio tributes to the army in the Western Desert, Nine Men, and to the firefighters of the London blitz, The Bells Go Down, heroic figures are identified as veterans of the International Brigades.

That same year in Hollywood, Paramount filmed Hemingway's For Whom the Bell Tolls, the greatest novel about the war, and Warner Brothers allowed Rick Blaine in Casablanca to include on his CV his services to the Loyalist cause.


Richard "Rick" Blaine - Played by Humphrey Bogart The owner of Rick's Café Americain and the film's protagonist. When we first meet Rick, he is a jaded bar owner in Casablanca who wears a dour expression as he drinks and plays chess alone. He constantly proclaims his freedom from all bonds, be they political or personal. After Ilsa enters the picture, he undergoes a considerable change. In a flashback, we see Rick in Paris. He is in love with Ilsa and visibly happy, and he is devastated when she doesn't show up at the train station. Rick never turns back into the lighthearted lover he was in Paris, but he does overcome his cynicism and apathy to become a self-sacrificing idealist, committed to helping the Allied cause in World War II.

Rick Blaine is a worldly American who has a hidden past. He was on the losing side during the Spanish Civil War. He moved to Paris before WW II and was a gun runner smuggling guns into Ethiopia. General Strasser, (the representative of the Vichy Government of France), heard the rumors and came to question Rick. Rick tells him that he is an alcoholic and doesn’t know a thing about the visas. He says he does not belong to either side of the combatants in WW II because he has had enough of wars and he is ’neutral’.


The capitaine tells Rick that while many exit visits are sold at Café Americain he knows that Rick has never sold them and that is why he is permitted to stay open. Rick replies that he thought it was because he lets him win at roulette. The capitaine tells Rick that Victor Lazlo, a famous resistance leader from Czechoslovakia who has escaped three times from the Nazis, will be arriving shortly but that he will not be permitted to leave Casablanca. Rick suggests a 20,000-franc bet on whether Lazlo will get out of Casablanca, but the capitaine agrees only to a 10,000-franc bet, stating that he is "only a poor corrupt official." The capitaine also tells Rick that Lazlo is travelling with a very beautiful woman and tells Rick that he suspects that "under that cynical shell" Rick is a sentimentalist as he is familiar with Rick's having supplied guns to Ethiopia when that country was invaded by Italy in 1935 and with his fighting the Loyalist government the next year in the Spanish Civil War.

I guess I take inspiration from this heroic failure, in the battle against the anti-smoking statists.

Heroic failure describes a person or group failing to accomplish their goal, but somehow gaining the moral upper hand or becoming ennobled in the attempt.

The film Casablanca mentions two heroic failures to develop the Humphrey Bogart character Rick Blaine.

"Oh, laugh if you will, but I happen to know your record. Let me point out just two items. In 1935 you ran guns to Ethiopia. In 1936, you fought in Spain on the Loyalist side.^[1]

The first reference is to the Second Italo-Abyssinian War. In September 1935 Italy invaded Ethiopia. Ethiopia lost, but opponents of colonialism and fascism supported their cause. The second reference describes the Spanish Civil War in which rebels led by Francisco Franco gained control of the country. "The Loyalist side" refers to supporters of the losing republic. Thus Rick has fought for the causes of freedom and democracy and earned an admirable (although losing) record.

And so inspired by the great classic of anti-fascism and anti-prohibition we say here's looking at ya kid.

We have much to learn from the characters of Casablanca: in the final scene the airport is dark, the drone of the airplane fills the air and fearless, they venture out into the fog. Into the unexpected.

See:

Rememberance or Revisionism

Kenney is A Funny Guy

Christy Moore - Viva La Quince Brigada

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US Cigarette sales jumped during COVID-19 pandemic, study says

By Cara Murez, HealthDay News

Researchers say an increase in cigarette sales during the COVID-19 pandemic may reflect people falling back on old habits or picking up new ones because of stress caused by the coronavirus. Photo by Free-Photos/Pixabay

As COVID-19 has surged throughout the United States for the past year and a half, some may have picked up an old bad habit or started a new one.

How do researchers know this? They discovered that cigarette sales jumped during the first 15 months of the pandemic, exceeding their own estimates by 14%.

It's not entirely clear whether that's because current smokers are smoking more, former smokers have restarted or new smokers have joined their ranks. Yet experts are concerned.

"The study provides indirect evidence of increased smoking," said study co-author Samuel Asare, a principal scientist with the American Cancer Society. "We don't directly show whether there was increased smoking. We know that there is a strong correlation between sales and consumption."

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For the study, the researchers compared cigarette sales from March 2020 to June 2021 with predicted sales based on the long-term declining trend before the pandemic, from January 2007 to February 2020, then adjusted for expected changes, including seasonality.

The investigators gathered data from the U.S. Department of the Treasury's Alcohol and Tobacco Tax and Trade Bureau.

Cigarette sales exceeded expected sales during all months after the onset of the pandemic.

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Many reasons could have contributed to the increase, Asare said.

"Some of them are the stay-at-home orders," Asare said. "Remember, some people used to work in workplaces where we have smoking bans. Now that they're staying at home, they have their freedom to do whatever they want at home."

For others, smoking can be a strategy for coping with stress. Programs that provided aid to Americans during the pandemic may have led households to increase their spending, which could include increasing cigarette purchases for smokers, Asare said.

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Stockpiling of cigarettes early in the pandemic may also have had an impact on the sales numbers.

Further research would be needed to more firmly determine which of these contributed to the increases.

Researchers do know that smoking cessation programs experienced a sharp decline in requests for help.

"Participation in calls to quitline or cessation counseling declined drastically during the pandemic," Asare said. "The North American Quitline Consortium found a 27% decline in calls to the quitline in 2020 for cessation counseling compared to 2019," he added.

The apparent increase in smoking couldn't come at a more challenging time.

"There are a number of studies that have shown that smokers are more vulnerable to COVID-19-related complications compared to nonsmokers," Asare said.

What's needed now? Restoring calls for smoking cessation counseling and increasing tobacco control policies, Asare said.

"It is important to get back to a trend or to a level we had before the pandemic, so that whatever goals we have, we can actually achieve," Asare said.

The findings of the research report were published online Tuesday in the Annals of Internal Medicine.

Patricia Folan is director of the Center for Tobacco Control at Northwell Health in Great Neck, N.Y. She was not surprised to hear that cigarette sales had increased in these past months.

"During the pandemic, there have been many reports indicating increases in other substance use, as well as increases in mental distress, such as anxiety and depression, which are often triggers for relapse," said Folan, who was not involved in the study.

"After the attacks on 9/11, an increase in smoking and relapse to smoking was noted, particularly among first responders. Although very different situations, the stress felt in both instances may have contributed to increased smoking or relapse to smoking," Folan said.

Folan said the smoking cessation program she leads has seen an increase in enrollment during the pandemic.

As Asare suggested, Folan said patients reported smoking more while working remotely at home, without the smoke-free environment at their usual workplaces. They also reported relapsing due to feelings of stress, anxiety and isolation, Folan said.

"Health care providers should continue to ask patients about their tobacco use even if they have quit in the past and, if relapsed, counsel and refer them to the supportive services of a local program or state quitline," Folan said. "Explaining the connection between poor outcomes for smokers with COVID-19 may motivate patients to engage in quit attempts."More information

The U.S. Centers for Disease Control and Prevention offers resources to help you quit smoking.

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