IT DID NOT TEST POT SMOKERS ONLY!!!

Smoking marijuana and cigarettes may increase risk of lung problems compared to only smoking cigarettes, study suggests

LEGAL POT ALLOWED FOR THIS STUDY


Smoking marijuana and cigarettes may increase risk of lung problems

 compared to only smoking cigarettes, study suggests

Allana Akhtar
Tue, November 15, 2022 

A small study found higher rates of a rare form of emphysema, a lung condition that causes shortness of breath, in marijuana smokers versus tobacco-only smokers.Crystal Cox/Business Insider

A study found higher rates of emphysema among marijuana smokers compared to tobacco smokers of the same age.

The study author told Insider her research raises concerns that marijuana smoking is not safer than cigarettes.

The results suggest smoking both marijuana and cigarettes is more harmful than smoking tobacco by itself.

A small study found higher rates of emphysema, a lung condition that causes shortness of breath, among marijuana smokers compared to tobacco smokers of the same age. The study also suggests marijuana and tobacco use together could be more harmful than tobacco use by itself.

Dr. Giselle Revah, a cardiothoracic radiologist at The Ottawa Hospital and the study's lead author, looked at chest CT scans at Ottawa Hospital from 2005 to 2020 and identified 56 patients who reported using marijuana.

The majority of marijuana users — 50 out of the 56 patients — said they also smoked cigarettes. She compared them to 33 tobacco-only smokers and 57 non-smokers.

The tobacco-only smokers' ages skewed higher because Revah collected these patient chest CTs through her hospital's lung cancer screening event, which was open to patients over 50 who self-reported as heavy smokers. Marijuana smokers in her sample tended to get a chest CT for reasons unrelated to emphysema.

When the radiologist matched tobacco-only smokers to marijuana smokers of the same age, marijuana smokers had higher rates of emphysema: 93% (28 out of 30) compared to 67% of similarly-aged tobacco smokers.

The radiologist found marijuana users overall — including younger people who hadn't been exposed to as much smoke — had significantly higher rates in particular of paraseptal emphysema, a rare form of the condition that damages tiny ducts which connect the lung's air sacs.

The way marijuana smokers use the drug might damage air sacs. Marijuana users tend to take deep breaths and hold smoke in for longer, causing pressure changes that can irritate the lung's air sacs, Revah told Insider.

"The main message of the whole study is there's this public perception that marijuana is safe; people believe that it's safer than cigarettes," Revah said. "And this study raises concerns that maybe marijuana's not as safe as everyone thinks it is, and suggests that ultimately we need more robust research before we can make sweeping conclusions."

The paper sheds light on the under-researched health effects of marijuana. Literature on the chest CTs of marijuana smokers is sparse, Revah said, since Canada only legalized the drug in 2018. The US has not legalized cannabis nationally, and getting funding for marijuana research involves cumbersome legal steps.

Lung doctors told Insider more research is needed on the health effects of marijuana use.

Dr. Philip Diaz, a pulmonary disease physician at the Ohio State University Wexner Medical Center who was not involved in the study, said because most marijuana smokers in the study were cigarette smokers, it's possible smoking both marijuana and cigarettes increases risk for lung damage. But Diaz stressed the results of the small study should not be overstated.

"You don't want to dilute the fact that it's really the cigarette smoking that's the problem," Diaz told Insider. "I think all you could say is there could be some increased risk if you do both."

Revah said she is working on a prospective study that asks patients how much marijuana they use, and hopes a larger study will confirm her findings.

Dr. Albert Rizzo, the chief medical officer at the American Lung Association, told Insider scientists and doctors need longer, in-depth studies on the long term health effects of marijuana, especially as the drug quickly becomes legalized in states across the US.

"I think this study's a good one in trying to show or support the fact that airway use of marijuana leads to problems, emphysema being among them," Rizzo told Insider. "Smoking marijuana is not safe, and we don't know really what the long term effect of smoking marijuana is."

Read the original article on Insider

 

Is universal screening for type 1 diabetes around the corner?

Reports and Proceedings

DIABETOLOGIA

The the latest data on  universal screening for type 1 diabetes (T1D) is reveiwed in a session at this year’s Annual Meeting of the European Association for the Study of Diabetes (EASD) in Hamburg, Germany (2-6 October). The talk will be given by Dr Emily K. Sims, Associate Professor of Pediatrics, Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN, USA.

Research by various groups has established that individuals with multiple islet autoantibodies (biomarkers showing that the body is attacking and killing its own insulin producing beta cells in the pancreas) have a near 100% risk of developing T1D over their lifetime (Ziegler et al. JAMA. 2013 Jun 19;309(23):2473-9). Multiple groups including Ezio Bonifacio and colleagues from the TEDDY Consortium (Diabetes Care 2021) and Ghalwash and colleagues from Type 1 Diabetes Intelligence Study Group (The Lancet Diabetes & Endocrinology 2022) have shown that screening for islet auto-antibodies  at two ages – 2 and at 5-7 years - would predict most cases of type 1 diabetes that would develop by age 15 years.

Dr Sims will highlight that, although screening programs have previously most often focused on people with family members with T1D (who can have up to 15 times increased risk of developing T1D), most people who develop T1D (85-90%) have no family history of the condition. “Our knowledge of type 1 diabetes has now evolved from thinking it is a disease that suddenly develops, to knowing that it is something that gradually develops, after the appearance of multiple islet-autoantibodies. By screening children and adults to identify individuals with early, presymptomatic stages of disease, we can more accurately predict when they will first need insulin and prevent life-threatening DKA episodes that otherwise frequently occur at diagnosis,” she explains. “Natural history studies have shown us that once someone has reached the threshold of multiple islet autoantibodies, progression occurs similarly in relatives and those with no family history.”

Knowing who is likely to develop T1D will help prevent cases of diabetic ketoacidosis (DKA) that occurs when the body doesn't have enough insulin to allow blood sugar into the cells for use as energy. Instead, the liver breaks down fat for fuel, producing acids called ketones; the build-up of these ketones to dangerous levels causes DKA. These episodes can be dangerous and even fatal, causing a number of uncomfortable symptoms. The symptoms of DKA can be the first sign of T1D in people who haven’t yet been diagnosed.

Various research programs are going on worldwide to establish the best ways of implementing universal screening, including programmes in Germany, the USA, Israel, the UK, and Australia, and a new program (Edent1fi) has just been funded that is going to include multiple new countries in Europe, including the UK, Germany, Poland, Portugal, Italy and the Czech Republic.  “These are all research programs. The next steps before universal screening for type 1 diabetes becomes general policy will require guidelines for monitoring and endorsement of screening and monitoring guidelines by applicable societies,” explains Dr Sims. This will also be helped by broader access to disease modifying therapies to impact progression and the need to start insulin injections.

She explains that these research programmes are in many cases working with primary care doctors to obtain blood testing for autoantibodies - while some of them work through newborn screening (genetic testing performed on infant blood spots followed by antibody screening in individuals at higher genetic risk).
 

Dr Sims says: “The costs of screening, optimal ways to scale it up, and how to connect it with access to disease modifying therapies, such as the monoclonal anti-CD3 antibody that was recently FDA-approved in the US for delay of Stage 3 T1D in individuals meeting criteria for Stage 2 disease (multiple islet autoantibodies and changes in blood sugar), are all still to be worked out. Other important considerations moving forward include reaching traditionally understudied populations and more tailored approaches for individual patients.”

As the question of when we could see universal screening for T1D rolled, Dr Sims concludes: “ I think we will start to see increasing society endorsement of screening and monitoring guidelines over the next five years and that as this occurs, countries will start incorporating screening into routine care for young children at the general practitioner’s office – for example, when children are called for routine childhood vaccinations.” Screening for adults, who can also develop T1D, is less well studied. Although optimal approaches have yet to be clearly elucidated, this population will also likely benefit from identification of early stage disease and the advantages of education, monitoring, and access to therapy.

“Given that we know that individuals without a family history are the most likely to present with new T1D and that once they reach criteria for early stage disease, they are at similar risk to individuals with a family history, universal screening the of general population is key to ultimately allow the most individuals to benefit from access to education, monitoring, and disease modifying therapies.

Dr Sims will also take part in the embargoed press conference taking place at 1200H Noon CEST Hamburg time on Tues 3 Oct, in the Vienna Hall.

To join by zoom, use this link

https://us06web.zoom.us/j/86523053998?pwd=0CxM4PetJCn8K6CbnavJVbp3uIZ3aa.1

For press conference slide presentation, click here

---

ARTICLE PUBLICATION DATE

3-Oct-2023

COI STATEMENT

Dr Emily Sims, Associate Professor of Pediatrics, Center for Diabetes and Metabolic Disease, Indiana University School of Medicine, Indianapolis, IN, USA. Please e-mail to arrange interview. E) eksims@iu.edu Alternative contact in the EASD Press Room: Tony Kirby T) + 44 7834 385827 E) tony@tonykirby.com This press release is based on session S27 to take place in the Barcelona Hall at the European Association for the Study of Diabetes (EASD) Annual Meeting in Hamburg at 0900H AM CEST on Wednesday 4 October. The presenter is happy to answer any questions. Dr Sims will also take part in the embargoed press conference taking place at 1200H Noon CEST Hamburg time on Tues 3 Oct, in the Vienna Hall. To join by zoom, use this link https://us06web.zoom.us/j/86523053998?pwd=0CxM4PetJCn8K6CbnavJVbp3uIZ3aa.1

 For press conference slide presentation, click here

Metabolic signature can help predict which smokers will develop type 2 diabetes

UK Biobank analysis of over 93,000 adults finds that smoking increases the risk of type 2 diabetes in part through its effects on the metabolism

Reports and Proceedings

DIABETOLOGIA

New research being presented at this year’s Annual Meeting of The European Association for the Study of Diabetes (EASD), Hamburg (2-6 Oct) finds that cigarette smoking increases the risk of developing type 2 diabetes in part by affecting a variety of metabolites—small chemicals produced in the processes of metabolism—that circulate in the bloodstream.

The influence of these metabolic changes on diabetes risk appears to be amplified in individuals with genetic susceptibility to type 2 diabetes or insulin resistance.

The analysis of over 93,000 UK Biobank participants also identified a metabolic signature of 131 metabolic traits that can help predict which smokers are more likely to develop type 2 diabetes.

“Our metabolism is constantly changing depending on what we ingest or are exposed to”, says lead author Yuxia Wei from the Karolinska Institutet in Sweden. “Our study is the first to develop a metabolic signature for smoking based on comprehensive metabolomic profiles, and provides new insights into how smoking influences certain metabolites to increase the risk of type 2 diabetes. The findings underscore the importance of refraining from or quitting smoking to prevent diabetes, particularly for individuals with genetic risk factors for diabetes who seem to be more vulnerable to these changes.”

Previous observational evidence suggests that smokers are 20-60% more likely to develop type 2 diabetes, but the underlying mechanisms are unclear.

To address this knowledge gap, researchers used nuclear magnetic resonance spectroscopy (NMR) to analyse hundreds of metabolites in blood samples from 93,722 never, former, and current smokers (aged 37-73 years) without diabetes at the start of the study (2006-10) from the UK biobank—which holds genetic, health, and medical information from approximately half a million British volunteers. Metabolomics data were collected again in 2012-13.

During an average (median) follow-up of 13 years, 1,869 new cases of diabetes were identified.

The observational analysis and causal relationship analysis identified 131 metabolites affected by smoking, including glycoprotein acetyls (an inflammatory biomarker), fatty acids, and lipids, which collectively indicated whether an individual would go on to develop type 2 diabetes.

Compared with people who never smoked, current smoking increased the risk of type 2 diabetes by 73%; and 38% of this excess risk was mediated through the smoking-related metabolic signature (44% in men and 30% in women), after accounting for traditional diabetes risk factors such as age, sex, education level, ethnicity, BMI, physical activity, diet, and family history of diabetes.

For free fatty acids, smoking seemed to lead to higher levels of unhealthy saturated and monosaturated fatty acids, and lower percentages of healthy polyunsaturated ones such as DHA, omega-6 fatty acids, and omega-3 fatty acids (mainly found in seafood). Smoking was also positively associated with metabolites including different lipids in very-low-density lipoproteins (VLDL), triglycerides, and LDL cholesterol (also called ‘bad’ cholesterol), and lower levels of all forms of HDL cholesterol (often know as good cholesterol).

Importantly, the findings indicate that most of the smoking-related metabolic changes are reversible after quitting smoking.

The analysis also found that a high level of the metabolic signature was associated with a 61% higher risk of developing type 2 diabetes compared to a low level.

Genetic susceptibility also made a difference. Individuals with both a high level of the metabolic signature and a high genetic susceptibility to type 2 diabetes were three times as likely to develop the condition as those with low levels of the signature and genetic susceptibility.

The interaction between genetic susceptibility and the metabolic signature enhances their overall impact on type 2 diabetes. As the Wei explains: “The excess risk of developing type 2 diabetes in people with both a high genetic susceptibility and a high level of the signature surpasses what we would expect by simply adding the excess risk in people with only a high genetic susceptibility and the excess risk in people with only a high level of the signature. Our findings suggest that it is even more important for people with high genetic susceptibility to avoid smoking than the general population.”

The researchers further tested and verified the metabolic signature in blood samples from 3,626 participants in the TwinGene Study, a cohort nested in the Swedish Twin Register. They noted that the ability for the metabolic signature to determine risk of type 2 diabetes was highly reproducible despite the fact that individuals living in the UK and Sweden have different dietary habits, lifestyles, and environmental exposures.

“The reproducibility of the findings in the Swedish population indicate the robustness of the approach”, says Wei. “Nevertheless, more than half of the smoking-diabetes link was not explained by the metabolic signature, suggesting that other pathophysiological consequences of smoking play a role in diabetes development. These mechanisms may include the adverse effects of smoking on pancreatic tissue and beta cell function.”

Despite the important findings, the researchers note several limitations of the study, including that smoking status and metabolite levels may have changed during follow-up, which may have influenced the results; and that the study was conducted in people mainly of European origin, so the findings may not be generalisable to other populations.

This work was supported by the Swedish Research Council, FORTE, the Novo Nordisk Foundation, and the China Scholarship Council.

This press release is based on poster presentation 322 at the annual meeting of the European Association for the Study of Diabetes (EASD). The material has been peer reviewed by the congress selection committee. There is no full paper at this stage, but the research has been submitted to a medical journal for publication. The authors are happy to answer any questions.

 

---

ARTICLE PUBLICATION DATE

3-Oct-2023

COI STATEMENT

This work was supported by the Swedish Research Council, FORTE, the Novo Nordisk Foundation, and the China Scholarship Council.

 

New evidence links passive smoking with dangerous heart rhythm disorder

EUROPEAN SOCIETY OF CARDIOLOGY

Berlin, Germany – 7 April 2024:  Exposure to secondhand smoke – even at small amounts – is linked with greater risk of a serious heart rhythm disorder, according to research presented at EHRA 2024, a scientific congress of the European Society of Cardiology (ESC).1 The likelihood of atrial fibrillation increased as the duration of passive smoking lengthened. 

“The dangers of secondhand smoke were significant regardless of whether individuals were at home, outdoors, or at work, indicating that exposure universally elevates the risk of atrial fibrillation,” said study author Dr. Kyung-Yeon Lee of Seoul National University Hospital, Seoul, Republic of Korea. “We should all make every effort to avoid spending time in smoky environments. The findings should also drive policymakers to further curb smoking in public areas and support smoking cessation programmes to improve public health.” 

Atrial fibrillation is the most common heart rhythm disorder worldwide.2 Symptoms include palpitations, shortness of breath, fatigue, and difficulty sleeping. It is estimated that one in three Europeans will develop the condition during their lifetime. People with atrial fibrillation are five times more likely to have a stroke than their healthy peers. 2 

It is well established that passive smoking is linked to coronary artery disease and premature death.3-8 However, the links between secondhand smoke and atrial fibrillation have been unclear. This study examined the association between secondhand smoke exposure and the long-term risk of incident atrial fibrillation. The study included adults aged 40 to 69 years who had used the UK National Health Service (NHS) for any reason and were enrolled in the UK Biobank. Current smokers and those with atrial fibrillation at baseline were excluded from the study. 

A total of 400,493 adults were included in the analysis. The average age of participants was 56.5 years and 55.2% were women. A touchscreen questionnaire was used to ask participants the number of hours they had been exposed to other people’s smoke in a typical week over the past year at home and in other environments. Participants were categorised into the ‘exposed group’ if they had any contact with secondhand smoke and the ‘non-exposed group’ if they had no contact with secondhand smoke. Some 85,984 (21%) participants had been exposed to secondhand smoke in the previous year, with an average exposure of 2.2 hours per week. During a median follow-up of 12.5 years, atrial fibrillation developed in 23,471 (6%) participants. 

The researchers analysed the association between exposure to secondhand smoke and incident atrial fibrillation after adjusting for factors that could potentially affect the relationship, including age, sex, ethnicity, body mass index, daily alcohol consumption, moderate-to-vigorous physical activity, diabetes, high blood pressure, high blood lipids, socioeconomic status, and enrolment centre. The group exposed to secondhand smoke had a 6% higher risk of incident atrial fibrillation during follow-up compared with the non-exposed group after adjusting for the previously mentioned factors (hazard ratio 1.06, 95% confidence interval 1.03–1.10, p <0.001). 

A dose-dependent relationship was observed, whereby each increase in the duration of weekly passive smoking was linked with an even greater risk of atrial fibrillation. For example, 7.8 hours of passive smoking per week was associated with an 11% higher likelihood of the heart rhythm disorder compared with no passive smoking. The risk of atrial fibrillation for passive smokers was raised in homes, workplaces, and outside spaces. 

Dr. Lee said: “According to our study, once exposed to secondhand smoke, the likelihood of developing atrial fibrillation begins to increase, with the risk escalating significantly as the exposure time lengthens. The finding that passive smoking is harmful not only in enclosed indoor spaces but also outdoor environments underscores the importance of smoking bans to protect public health.” 

 

ENDS 

 

Authors: ESC Press Office  
Tel: +33 (0)489 872 075 

Email: press@escardio.org 

Follow us on X @ESCardioNews  

 

Notes to editor 

 

Funding: None. 

Disclosures: None. 

 

References and notes 

1The abstract ‘Secondhand tobacco smoke and risk of atrial fibrillation: an observational epidemiologic and gene-environment interaction analysis’ will be presented during the session ‘Atrial fibrillation: basic science - epidemiology’ which takes place on 7 April 2024 at 08:30 CEST at Moderated ePosters 1. 

2Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2020;42:373-498. 

3Yankelevitz DF, Cham MD, Hecht H, et al. The association of secondhand tobacco smoke and CT angiography-verified coronary atherosclerosis. JACC Cardiovasc Imaging. 2017;10:652-659. 

4Yankelevitz DF, Henschke CI, Yip R, et al. Second-hand tobacco smoke in never smokers is a significant risk factor for coronary artery calcification. JACC Cardiovasc Imaging. 2013;6:651-657. 

5Peinemann F, Moebus S, Dragano N, et al. Secondhand smoke exposure and coronary artery calcification among nonsmoking participants of a population-based cohort. Environ Health Perspect. 2011;119:1556-1561. 

6Gallo V, Neasham D, Airoldi L, et al. Second-hand smoke, cotinine levels, and risk of circulatory mortality in a large cohort study of never-smokers. Epidemiology. 2010;21:207-214. 

7Glantz SA, Parmley WW. Passive smoking and heart disease. Epidemiology, physiology, and biochemistry. Circulation. 1991;83:1-12. 

8Lv X, Sun J, Bi Y, et al. Risk of all-cause mortality and cardiovascular disease associated with secondhand smoke exposure: a systematic review and meta-analysis. Int J Cardiol. 2015;199:106-115. 

 

About the European Heart Rhythm Association 

The European Heart Rhythm Association (EHRA) is a branch of the European Society of Cardiology (ESC). Its aim is to improve patients’ quality of life and reduce sudden cardiac death by limiting the impact of heart rhythm disturbances.  

 

About the EHRA Congress     #EHRA2024 

EHRA 2024 is the annual congress of the European Heart Rhythm Association (EHRA) of the European Society of Cardiology (ESC). 

 

About the European Society of Cardiology  

The European Society of Cardiology brings together health care professionals from more than 150 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives. 

 

Information for journalists about registration for EHRA 2024 

EHRA 2024 will be held 7 to 9 April at the CityCube Berlin, Germany, and online. Explore the scientific programme.

• Free registration applies to accredited press. 

• Credentials: A valid press card or appropriate letter of assignment with proof of three recent published articles. Read the ESC media and embargo policy. 

• The ESC Press Office will verify the documents and confirm by email that your press accreditation is valid. 

• The ESC Press Office decision is final regarding all press registration requests. 

E-cigarettes can be 'gateway' to cigarettes for teens with no prior intention to smoke

CHILDREN'S NATIONAL HOSPITAL

Research News

 

Cigarette smoking remains a leading preventable cause of morbidity and mortality in the United States. And while adolescent cigarette smoking has declined over the past several decades, e-cigarette use presents a new risk for nicotine use disorder. a new study, published Nov. 9 in the journal Pediatrics, finds that e-cigarette use is associated with a higher risk of cigarette smoking among adolescents who had no prior intention of taking up conventional smoking. These findings have strong implications for practice and policy, researches say.

"Research is showing us that adolescent e-cigarette users who progress to cigarette smoking are not simply those who would have ended up smoking cigarette anyway," says Olusegun Owotomo, M.D., Ph.D., M.P.H., the study's lead author and a pediatric resident at Children's National Hospital. "Our study shows that e-cigarettes can predispose adolescents to cigarette smoking, even when they have no prior intentions to do so."

In one of the first theory-guided nationally representative studies to identify which adolescent e-cigarette users are at most risk of progressing to cigarette smoking, Researchers looked at data of more than 8,000 U.S. adolescents, ages 12-17, who had never smoked. The data was collected by the Population Assessment of Tobacco and Health (PATH) study, an NIH and FDA collaborative nationally representative prospective cohort study of tobacco use, from 2014-2016. Among adolescents who did not intend to smoke cigarettes in the future, those who used e-cigarettes were more than four times more likely to start smoking cigarettes one year later compared to those who did not use e-cigarettes.

E-cigarette use constitutes a relatively new risk factor for nicotine use disorder among U.S. adolescents. A 2019 study from the Centers for Diseases Control and Prevention found that 28% of high school students and 11% of middle school students were current e-cigarette users. With the recent emergence of newer and potentially highly addictive e-cigarette products, adolescents who use e-cigarettes are at increased risk of developing nicotine use disorder and progressing to smoke conventional cigarettes.

"Abstinence from e-cigarettes can protect teens from becoming future smokers and should be framed as a smoking prevention strategy by all concerned stakeholders," says Dr. Owotomo. "Pediatricians are best positioned to educate patients and families on the clinical and psychosocial consequences of e-cigarette use and should support education campaigns and advocacy efforts geared to discourage adolescent e-cigarette use."

###

Should e-cigarettes be licensed as medicines?

As the UK announces support for medicinal licensing of electronic cigarettes, experts debate the issue in The BMJ

Peer-Reviewed Publication

BMJ

Nicholas Hopkinson at Imperial College London welcomes the move, saying this will give doctors another means to help smokers quit.

E-cigarettes are currently regulated as consumer products so cannot be promoted as smoking cessation aids, he explains. Yet a Cochrane review already supports existing e-cigarettes as a smoking cessation aid, as does recently updated guidance from the National Institute for Health and Care Excellence.

The introduction of e-cigarettes that have been through a stricter medicinal licensing process “should provide further reassurance to healthcare professionals that they can help their patients to quit smoking in this way, particularly in mental health settings where smoking rates remain high,” he writes.

It is also likely to improve confidence among smokers who so far have been reluctant to try this approach, as well as reversing false beliefs about relative harm when compared with smoking, he adds.

He emphasises that medically licensed e-cigarettes, as and when they become available, will be only one among many tools to support smoking cessation, all ideally delivered alongside psychological support for behaviour change. 

It is also important to ensure that debate around e-cigarettes does not distract from other necessary tasks to achieve the UK’s ambition to be smoke free by 2030, such as introducing a “polluter pays” levy on tobacco industry profits and raising the age of sale from 18 to 21, he adds.

There are still more than six million people who smoke in the UK: medicinal licensing of e-cigarettes could help many of them to live longer, healthier lives, he concludes.

But Jørgen Vestbo at the University of Manchester and colleagues say that the effectiveness of e-cigarettes in helping people to quit is unproved and potentially harmful.

They point to trial evidence showing that people using e-cigarettes tend to continue vaping, whereas most people using medicinal nicotine products quit, and many restart smoking while they continue vaping (known as “dual use”). The widespread use of e-cigarettes also carries a substantial societal risk of accepting addiction, they add.

What’s more, many e-cigarettes are produced and marketed by companies owned by the tobacco industry - an industry with a history of lying to the public and spending fortunes on marketing, including to teenagers. “We should protect children and adolescents from these cynical marketeers and allow them to be the first generation in a century not addicted to nicotine,” they write.

To disguise e-cigarettes as a sensible harm reduction strategy “will risk weakening sustainable smoking cessation strategies,” they argue. 

“Instead, doctors should help to revive a decent NHS funded smoking cessation service, lobby politicians to increase taxes on products containing nicotine, and restrict smoking - as well as vaping - even more.” 

[Ends]

---

JOURNAL

The BMJ

DOI

10.1136/bmj.n2912 

ARTICLE TITLE

Head to Head: Should e-cigarettes be licensed as medicines?

ARTICLE PUBLICATION DATE

12-Jan-2022

June Pointer RIP

Here is a short and sweet tribute to June Pointer who passed away this week from cancer. She was of course one of the Pointer Sisters.

JUNE POINTER

1953-2006

While the kind of cancer was not made public I find it interesting that finally we are seeing reports on the increasing amount of lung cancer among non-smokers. Especially women.

It is an under-reported fact. On the the moral majority that is imposing its non-smoking agenda on us overlook. And I say it is a moral issue because it blames the victims of this addiction, and it blames the victims of lung cancer who may never have smoked. The non-smokers lobby wants cancer to be caused by one thing and one thing only, smoking. But of course it is easy to blame smokers, the whole anti-smoking movement has been based upon this mythology that it is ONLY smoking that causes cancer When in fact cancer is the result of industrial capitalism, and its resulting toxic environment; chemicals, pollution, etc.

Even though it is the leading cause of cancer deaths in the United States, lung cancer attracts much less research money than other major cancers, Dr. Siegfried said, largely because it is so strongly linked to smoking that people often blame the victims for giving the disease to themselves. The Thinkers: Celebrity deaths shine light on lung cancer

Lung cancer continues to be the leading cause of cancer death
for both men and women in Canada according to annual
statistics released this week by the Canadian Cancer Society.
Despite alarming trends, including an increasing
incidence of lung cancer in women and life-long non-smokers, 
Lung cancer tops list as biggest cancer killer

"A significant body of scientific evidence links exposure to radiation and synthetic chemicals to an increased risk of breast cancer," said Susan Roll, Associate Executive Director of the Massachusetts Breast Cancer Coalition and one of the event's primary organizers. "We hope that legislators and their constituents will begin to think about reducing toxic chemicals as one way of preventing some diseases and disorders."Exploring chemical links to disease

Also See:

Smoking At Home Will Be Banned

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If you feel unsafe in your neighborhood, a new study shows you are more likely to smoke

University of Houston report indicates perceptions of powerlessness also make it harder to quit smoking

UNIVERSITY OF HOUSTON

 

IMAGE: 

MICHAEL J. ZVOLENSKY, UNIVERSITY OF HOUSTON HUGH ROY AND LILLIE CRANZ CULLEN DISTINGUISHED UNIVERSITY PROFESSOR OF PSYCHOLOGY, IS REPORTING HIGHER LEVELS OF SMOKING AND MORE SEVERE PROBLEMS QUITTING AMONG THOSE WHO FEEL THREATENED IN THEIR NEIGHBORHOODS.

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CREDIT: UNIVERSITY OF HOUSTON

Research from the University of Houston indicates that more people smoke – and have trouble quitting – in neighborhoods where they feel unsafe. High crime rates, low police presence or trust, and a history of neglect in these neighborhoods result in heightened neighborhood vigilance among residents to protect against personal harm. 

According to the Center for Disease Control and Prevention, the neighborhoods people live in have a major impact on their health and well-being, making them key non-medical drivers of care. Although non-medical drivers have increasingly been understood as clinically important factors in the onset, maintenance and relapse of substance use behavior, little research has evaluated neighborhood vigilance in terms of smoking. 

"High levels of neighborhood threat shape perceptions of powerlessness among residents, amplifying a general sense of mistrust, that can promote maladaptive coping behavior like smoking,” reports Michael J. Zvolensky, Hugh Roy and Lillie Cranz Cullen Distinguished University Professor of Psychology, in the journal Substance Use & Misuse.  

Zvolensky examined the role of neighborhood vigilance in terms of smoking abstinence expectancies and severity of problems when trying to quit among adults who smoke. Abstinence expectancies pertain to the expected personal consequences of refraining from smoking. 

“Neighborhood vigilance was also associated with more severe problems when trying to quit smoking. The current findings suggest neighborhood vigilance represents an important contextual factor involved in certain negative beliefs about abstinence and challenges in quitting.” 

Participants in this analysis included 93 adult smokers who were seeking cessation treatment. Of the group 64.5% identified as Black or African American, 30.1% identified as White, 3.2% identified as Other and 2.2% identified as Asian. The group answered questions about their own socio-demographic characteristics and their neighborhoods. 

“Generally consistent with prediction, greater levels of neighborhood vigilance were associated with negative abstinence smoking expectancies, including negative mood and harmful consequences,” said Zvolensky.  

Zvolensky said the study indicates a need to continue building theoretical knowledge and clinical intervention programming for smoking cessation that more directly focuses on social context factors like neighborhood vigilance. His team includes Bryce K. Clausen, Justin M. Shepherd and Brooke Y. Redmond, all from UH. 

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JOURNAL

Substance Use & Misuse

ARTICLE TITLE

Neighborhood Vigilance in Terms of Abstinence Expectancies for Smoking and Severity of Problems When Quitting

 

Research supports Sunak’s ‘smoke-free generation’ policy but British ministers will miss key levelling up health targets

UK Government needs range of public health policies to close health inequalities

Peer-Reviewed Publication

CITY UNIVERSITY LONDON

The Government will miss key health inequalities targets that are a cornerstone of its levelling up agenda, new research suggests.

Although the study concludes that a notional immediate outright ban on tobacco sales would eventually increase healthy life expectancy by 2.5 years, it would not be enough for the Government to meet the targets for reducing health inequalities set out in its levelling up white paper. An immediate ban on smoking would, however, extend the working lives of both men and women, the paper concludes, with the greatest impact in more deprived areas.

Local government secretary Michael Gove’s 2022 levelling up white paper pledged to narrow the difference in ‘healthy life expectancy’ (HLE) between England’s most prosperous and most deprived local authorities by 2030, and to boost overall HLE by five years by 2035. HLE measures the number of years lived in at least reasonable health. In the UK it has risen more slowly than life expectancy in recent decades – meaning people are typically spending more years in poor health, with obvious implications for NHS and social care budgets.

The researchers, drawn from Bayes Business School (formerly Cass), Heriot-Watt University and LCP, analysed the likelihood of the 2035 target being met. They published their paper, The great health challenge: levelling up the UK, in The Geneva Papers on Risk and Insurance: Issues and Practice.

Lead author Les Mayhew, Professor of Statistics at Bayes Business School (formerly Cass), said: “It is clear that drastic smoking cessation intervention is necessary to increase healthy life expectancy across the population and to narrow pernicious health inequalities. The rolling ban proposed in the Government’s current legislation is a good first step but further research could strengthen the case for an outright ban.

“Policymakers need to commit to politically difficult policies even if improvements in population health are gradual and long-term. With an ageing population, the pressure on policymakers to intervene in behaviours that shorten working lives will become irresistible – as seen already with the current focus on sickness and disability benefits.”

The analysis confirmed that people who have never smoked typically enjoy an additional six years of HLE. Earlier research has shown that smoking kills around 78,000 people in England each year and leads to around 500,000 hospital admissions.

Recent research by the International Longevity Centre concluded that smoking cuts UK economic output by £19.1 billion, due to shorter working lives. Welfare and healthcare costs would boost that figure significantly.

The latest study also concluded:

• The nine year gap in average life expectancy between the richest and most deprived local authority areas almost doubles, to 17 years, for years lived in reasonable or good health.
• A 1-year improvement in health expectancy increases life expectancy by 4.5 months. This means the gap between lifespan and healthspan gets smaller so that people live both longer and in better health.
• Lung cancer deaths in different local authority areas revealed a correlation with the number of years spent in good health. HLE was lowest in cities, including London, the north of England and the midlands – and notably low in an arch linking Liverpool, Manchester, Leeds and Hull.
• A targeted campaign in areas with high levels of smoking would significantly reduce health inequalities but the results would take time to work through.
• Targeted smoking cessation policies would extend working lives, reduce the welfare bill and ease pressure on NHS and social care budgets.

Andrew Cairns, Professor of Actuarial Mathematics at Heriot-Watt University, said: "Our paper confirms that a smoking ban on those born in 2009 or later is one of the best ways to improve the health of people living in more deprived areas of the UK. The findings vividly illustrate the transformative impact of this measure on the health landscape. It coincides with a parliamentary debate, signalling a concerted effort towards a healthier future for all."

Mei Chan, Senior Statistician in LCP’s Health Analytics, said: “Our study has shone a light on the importance of measuring how much time people spend in good health rather than just focusing on life expectancy. While recent political events have put the issue of smoking into the spotlight, the UK Government already had ambitious targets in place. It’s clear that more needs to be done to meet the ambitious target to improve healthy life expectancy by five years and narrow the gap between the richest and poorest areas.

“The study also highlighted that lifestyle-related risk factors such as smoking, nutrition, alcohol consumption and physical activity are interconnected, particularly in more deprived communities. The rolling smoking ban is a promising start, though the use of joined-up policy approaches tackling multiple lifestyle factors would strengthen the long term impact of the smoke free generation policy.”

ENDS

 

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JOURNAL

The Geneva Papers on Risk and Insurance Issues and Practice

DOI

10.1057/s41288-024-00317-0 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

The great health challenge: levelling up in the UK

The F.D.A.’s Misguided War on Vaping

The government is putting stricter restrictions on vaping than on smoking. That’s bad for public health.


Clive Bates
Writes The Counterfactual by Clive Bates ·
Aug 8,2022


(Photo by Scott Olson/Getty Images)

While the boiling controversy over the use of e-cigarettes—popularly known as vaping—can seem like a quirky but noisy sideshow, in reality, millions of lives are at stake. E-cigarettes were first commercialized around 2006 and work by heating a nicotine liquid to create an inhalable mist, rather than by burning tobacco to create smoke. Though not completely safe, vaping is far less dangerous than smoking combustible cigarettes, the dominant product for nicotine use.

Despite this, the Food and Drug Administration has been cracking down on vaping—often claiming that vaping poses a health risk and is a threat to young people. This overly cautious approach is hindering a technology that will help eliminate the burden of disease, death, and suffering caused by smoking.

People smoke primarily to experience the effects of nicotine—for stimulation and pleasure; to reduce stress and anxiety; and to improve concentration, reaction time, and cognitive performance. For some people, these effects improve their quality of life. But on the dark side, nicotine use can lead to dependence.

Crucially, however, it is smoke, not nicotine, that causes the overwhelming burden of disease and death. Inhaling the toxic particles and gases from the burning tip of a cigarette exposes the body to thousands of chemicals, of which hundreds are known to be hazardous. The result is widespread death and disease, with cigarettes killing 480,000 Americans annually and leaving around 16 million suffering from a smoking-induced disease. Without the harmful effects of smoking, nicotine use starts to look more like moderate alcohol consumption—a modest substance use that fits within the normal risk appetites of modern society.

With vaping, we have a solution to two related problems. First, millions of American smokers have the option of switching from smoking to vaping, greatly improving their health prospects. Second, people in the future who want to use nicotine will be able to do so with considerably reduced consequences.

In a liberal society, we should not prohibit or aim to eliminate drug use or pretend that it can be risk-free, but we should try to limit the risks to the extent possible. Vaping is the best opportunity we have to do that for nicotine.

Critics of vaping typically rely on three main arguments.

First, we do not know the long-term consequences of e-cigarette use. This is true, as it is for any new product. We will have to wait another 50 years to know the full story. But what we do know today is that cigarettes are very dangerous. Additionally, all the available evidence suggests that vaping is much less harmful than smoking.

Second, vaping skeptics point to the outbreak of lung injuries in 2019 in the United States—which caused 2,800 hospitalizations and 68 deaths—as evidence that vaping is potentially extremely dangerous. But while this outbreak was initially attributed to e-cigarettes, it turned out to be caused by illegal and unregulated cannabis vaping products that included a dangerous cutting agent, Vitamin E Acetate, which is not added to nicotine liquids.

Third, opponents will claim that there is a “youth vaping epidemic,” pointing out that high school-age vaping reached 27.5% in 2019. While there has been a considerable uptick in youth e-cigarette use in recent years as the technology developed, the high 2019 numbers are an outlier. The headline number of the study measured any vaping in the past 30 days, and around two-thirds of users said they were making infrequent use of these products. Additionally, those vaping frequently were likely to have smoked previously, and it is possible that their vaping was a diversion from lifelong smoking. Furthermore, by 2021, the number of high-schoolers who had used a vape in the last 30 days had fallen to 11.3%, suggesting that claims of an “epidemic” were likely premature.

Together, these concerns have gained so much purchase among the general public that most Americans wrongly believe that vaping is just as harmful or more harmful than smoking. Even worse, the visceral politics around vaping, in particular the idea of the youth vaping epidemic, have driven the F.D.A. to apply overly burdensome and restrictive regulations on vaping products.

As a result, over one million vaping products have been denied access to the U.S. market, and the great diversity of flavors and device types have been cut down to a handful of uninspiring tobacco-flavored products. In stark contrast, no public health test applies to the 3,000 cigarette products that have been on the market for years throughout America. They were grandfathered in under the 2009 Tobacco Control Act.

In June, the F.D.A. announced that it had denied marketing applications made by Juul Lab Inc., one of the world’s biggest vaping companies with around three million adult users of its products. The F.D.A.’s case against Juul was very weak—it did not rely on youth vaping or any identified risk to health with the product but on some “inconsistent and conflicting data” in Juul’s 125,000-page application. These should have been addressed through discussions between the applicant and the regulator, but Juul argued in court that the F.D.A.’s “scientific” reasons were a feeble pretext for a politically-motivated attack. The F.D.A. withdrew from the legal proceedings and will review its approach internally.

Despite this recent victory for Juul, the F.D.A.’s interventions have resulted in an anarchic market of a few authorized vaping products, thousands of products either under review or pending legal challenge, and an emerging black market for unregulated vape products.

If the F.D.A. is taking a tough stance on safer alternatives, what is it doing about cigarettes, the product that causes the most harm? In 2023, it plans to publish a plan to reduce nicotine levels in cigarettes to very low levels. The F.D.A. argues that this would make the products minimally addictive, help smokers quit, and prevent youth uptake.

The problem with this approach is that it amounts, in practice, to a prohibition of cigarettes in their traditional form. But most smokers won’t just quit as the F.D.A. hopes. Some will buy cigarettes on a black market while others will hand-roll their own or switch to cigars. And though it would be good if some smokers responded by switching from smoking to vaping, the F.D.A. seems to be working hard to make that option more difficult.

Ultimately, the most likely fate of this poorly constructed proposal is that it will be debated until it is no longer needed. Many consumers who wish to use nicotine will switch to products such as e-cigarettes that cause them much less harm but still allow them to experience mild psychoactive effects of nicotine.

This transition is already underway and likely to continue because it is highly beneficial to those directly involved, both consumers and suppliers. The question is the extent to which misguided, highly risk-averse regulators and prohibitionist activists slow the pace of change. Every day of delay will mean more avoidable death and disease.

Clive Bates is Director of Counterfactual Consulting a public and sustainability practice. He is a former civil servant and former Director of Action on Smoking and Health (UK), a leading anti-smoking non-profit.

[The author has no conflicts of interest with respect to the industries discussed in this article. He has filed an amici curiae brief in support of Juul’s motion for a stay pending substantive review on public health grounds after the FDA denied Juul’s applications to market its products in the United States.]