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Tag: Cigarette

  • Cost becomes a significant factor in smoking cessation efforts

    Cost becomes a significant factor in smoking cessation efforts

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    Health concerns are still the primary motive for more than half of those who say they want to stop smoking in England, but cost is now a key factor for more than 1 in 4, finds an analysis of national survey responses, published in the open access journal BMJ Public Health.

    Given this shift in thinking, making much more of the potential savings to be had might encourage more people to stub out for good, suggest the researchers.

    Health concerns are generally the primary motive for people trying to stop smoking, with social and financial concerns, plus advice from a health professional, also commonly cited reasons, explain the researchers.

    But since 2020, England has undergone a period of substantial societal instability, prompted primarily by the COVID-19 pandemic, which might have triggered changes in the reasons smokers give for wanting to ditch tobacco, they suggest.

    To find out, the researchers looked at time trends in motives for trying to stop smoking between March 2018 and May 2023, exploring differences by age, sex, socioeconomic status, presence of children in the household and vaping status.

    They drew on responses to the ongoing Smoking Toolkit Study, a monthly survey of a representative sample of around 1700 adults in England.

    The responses were limited to those who were either current smokers or who had stopped smoking in the past year and had made at least one serious attempt to quit during that time.

    Respondents were asked to name the reason(s) behind their most recent quit attempt from among: advice from a health professional; TV advert for a nicotine replacement product; government TV/radio/press advert; a new stop smoking treatment; cost; smoking restrictions; knowing someone else who was quitting; health warning on a cigarette packet; contact from a local NHS stop smoking service; current or future health problems; attending a local stop smoking activity or event; comments by family, friends, children; significant birthday; pregnancy; simple decision to quit; COVID-19 pandemic.

    Out of the 101,919 survey respondents between 2018 and 2023, 17,812 reported smoking in the past year. Of these,17,031 (96%) provided data on quit attempts over the past 12 months, 5777 (34%) of whom reported having made at least one serious attempt to do so.

    Health concerns were the most frequently cited motives, reported by more than half the sample (52%) across the entire period—especially concerns about future health, reported by more than 1 in 3 (35.5%) compared with 1 in 5 (19%) who were motivated by current health problems.

    Cost was the next most frequently cited motive, reported by nearly 1 in 4 (23%), followed by social factors, reported by around 1 in 5 (19%) and advice from a health professional (12%). 

    Around 4% said they were motivated by health warnings on a cigarette packet, while smoking restrictions prompted 3.5% to try and stop; a simple decision to quit was cited by just over 3%. The other reasons attracted only around 1% each.

    Up to the start of 2020, 1 in 2 quit attempts was motivated by health concerns; 1 in 5 by current health problems (20%), and 1 in 3 by concerns about future health (34%). One in 5 was motivated by social factors (20%) and cost (20%), and 1 in 6 by health professional advice (16.5%).

    While there was little overall change in the proportion of quit attempts motivated by health concerns across the entire study period, the proportion of quit attempts motivated by cost increased significantly, rising from just over 19% in March 2018 to just under 25.5% in May 2023.

    But the proportion of quit attempts motivated by health professional advice fell significantly over the entire study period, dropping from just over 14% in March 2018 to 8.5% in May 2023.

    The COVID-19 pandemic, which began to affect England in March 2020, is likely to have influenced the proportion of respondents reporting health concerns, social factors, and cost as motives for trying to stop smoking, suggest the researchers. 

    The proportion of quit attempts motivated by future health concerns increased during 2020 and 2021.”It is likely the pandemic made health concerns (an already prevalent motive) even more salient, particularly during its first year when the virus was spreading rapidly and vaccinations were not yet available,” they write. 

    Once the immediate threat of the virus had subsided thanks to the vaccination programme, the proportion of health-related attempts to quit returned to pre-pandemic levels.

    The pandemic probably influenced other motives, suggest the researchers, because it prompted loss of income and jobs for many people.

    “These economic pressures probably contributed to the rise in cost-motivated attempts to quit around this time. But while the pandemic’s acute risks to health—and, as a result, attempts to quit motivated by concern for health or social factors—waned over time, its economic impacts have been compounded by a cost-of- living crisis,” they explain.

    The pandemic’s impact on access to, and availability of, healthcare services may also have contributed to the decline in the proportion of respondents citing healthcare professional advice as a motivating factor, they add.

    The researchers acknowledge various caveats to their findings, including that all the study data were self-reported and relied on personal recall, and may not apply to other countries with different attitudes to smoking, tobacco control policies, and provision of smoking cessation services.

    But they conclude: “These findings have implications for smoking cessation interventions and clinical practice. ..They indicate that cost is an increasingly important factor motivating people to try to stop smoking. 

    “Communicating the potential savings people can make by stopping smoking (even if they switch to alternative nicotine products) could therefore be an effective means for motivating attempts to quit.” 

    Source:

    Journal reference:

    Jackson, S. E., et al. (2024). Trends in motives for trying to stop smoking: a population study in England, 2018–2023. BMJ Public Health. doi.org/10.1136/bmjph-2023-000420.

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  • E-cigarette use linked to increased risk of heart failure, large study finds

    E-cigarette use linked to increased risk of heart failure, large study finds

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    People who use e-cigarettes are significantly more likely to develop heart failure compared with those who have never used them, according to one of the largest prospective studies to date investigating possible links between vaping and heart failure. The findings are being presented at the American College of Cardiology’s Annual Scientific Session.

    Heart failure is a condition affecting more than 6 million U.S. adults in which the heart becomes too stiff or too weak to pump blood as effectively as it should. It can often lead to debilitating symptoms and frequent hospitalizations as people age. Electronic nicotine products, which include e-cigarettes, vape pens, hookah pens, personal vaporizers and mods, e-cigars, e-pipes and e-hookahs, deliver nicotine in aerosol form without combustion. Since they were first introduced in the U.S. in the late 2000s, electronic nicotine products have often been portrayed as a safer alternative to smoking, but a growing body of research has led to increased concern about potential negative health effects.

    More and more studies are linking e-cigarettes to harmful effects and finding that it might not be as safe as previously thought. The difference we saw was substantial. It’s worth considering the consequences to your health, especially with regard to heart health.”

    Yakubu Bene-Alhasan, MD, a resident physician at MedStar Health in Baltimore and the study’s lead author

    For the study, researchers used data from surveys and electronic health records in All of Us, a large national study of U.S. adults run by the National Institutes of Health, to analyze associations between e-cigarette use and new diagnoses of heart failure in 175,667 study participants (an average age of 52 years and 60.5% female). Of this sample, 3,242 participants developed heart failure within a median follow-up time of 45 months.

    The results showed that people who used e-cigarettes at any point were 19% more likely to develop heart failure compared with people who had never used e-cigarettes. In calculating this difference, researchers accounted for a variety of demographic and socioeconomic factors, other heart disease risk factors and participants’ past and current use of other substances, including alcohol and tobacco products. The researchers also found no evidence that participants’ age, sex or smoking status modified the relationship between e-cigarettes and heart failure.

    Breaking the data down by type of heart failure, the increased risk associated with e-cigarette use was statistically significant for heart failure with preserved ejection fraction (HFpEF)-;in which the heart muscle becomes stiff and does not properly fill with blood between contractions. However, this association was not significant for heart failure with reduced ejection fraction (HFrEF)-;in which the heart muscle becomes weak and the left ventricle does not squeeze as hard as it should during contractions. Rates of HFpEF have risen in recent decades, which has led to an increased focus on determining risk factors and improving treatment options for this type of heart failure.

    The findings align with previous studies conducted in animals, which signaled e-cigarette use can affect the heart in ways that are relevant to the heart changes involved in heart failure. Other studies in humans have also shown links between e-cigarette use and some risk factors associated with developing heart failure. However, previous studies attempting to assess the direct connection between e-cigarette use and heart failure have been inconclusive, which Bene-Alhasan said is due to the inherent limitations of the cross-sectional study designs, smaller sample sizes and the smaller number of heart failure events seen in previous research.

    Researchers said the new study findings point to a need for additional investigations of the potential impacts of vaping on heart health, especially considering the prevalence of e-cigarette use among younger people. Surveys indicate that about 5% to 10% of U.S. teens and adults use e-cigarettes. In 2018, the U.S. Surgeon General called youth e-cigarette use an epidemic and warned about the health risks associated with nicotine addiction.

    “I think this research is long overdue, especially considering how much e-cigarettes have gained traction,” Bene-Alhasan said. “We don’t want to wait too long to find out eventually that it might be harmful, and by that time a lot of harm might already have been done. With more research, we will get to uncover a lot more about the potential health consequences and improve the information out to the public.”

    Bene-Alhasan also said e-cigarettes are not recommended as a tool to quit smoking, since many people may continue vaping long after they quit smoking. The U.S. Centers for Disease Control and Prevention recommends a combination of counseling and medications as the best strategy for quitting smoking.

    Researchers said that the study’s prospective observational design allows them to infer, but not conclusively determine, a causal relationship between e-cigarette use and heart failure. However, with its large sample size and detailed data on substance use and health information, Bene-Alhasan said the study is one of the most comprehensive studies to assess this relationship to date.

    Source:

    American College of Cardiology

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  • Study sheds light on the interplay of genes in smoking addiction

    Study sheds light on the interplay of genes in smoking addiction

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    Take a puff of nicotine for the first time, and your DNA plays an important role, alongside social and environmental factors, in shaping what happens next. 

    In recent years, scientists have identified thousands of genetic variants believed to influence everything from when people first try smoking to how good that first cigarette feels to how often they light up and how hard it is to quit. Some variants influence how quickly we metabolize nicotine, while others underlie how sensitive we are to it. But little is known about how they interact with each other and with other genetic differences.

    A new University of Colorado Boulder study sheds unprecedented light on these interactions and provides new insight on the most well-known smoking-related variant to date – commonly nicknamed “Mr. Big”.

    “We know that smoking is highly heritable, with genetic differences accounting for 40% to 75% of the differences in people’s smoking behaviors,” said Pamela Romero Villela, a PhD student in the Department of Psychology and Neuroscience and first author of the study in the journal Drug and Alcohol Dependence. “The more we can understand what those genes do and how they interact, the better equipped we will be to develop personalized approaches to helping people quit.”

    Beyond Mr. Big

    About 22% adults worldwide use nicotine and smoking is linked to one in five deaths in the United States.

    A lot of people still smoke, and it is one of the hardest drugs to quit.”

    Romero Villela, researcher with CU Boulder’s Institute for Behavioral Genetics

    For the study, Romero Villela collaborated with Integrative Physiology Professor Marissa Ehringer, who has studied substance use disorders for more than 20 years. 

    They zeroed in on the single nucleotide polymorphism (SNP), or genetic variant, rs16969968, known as “Mr. Big” because it has been the mostly widely replicated genetic variant associated with smoking behaviors.

    Mr. Big is located in a gene called CHRNA5F (nicotinic acetylcholine receptor 5) and influences how well nicotine binds to receptors in the brain. People with a certain version of Mr. Big, known as the AA version, are less sensitive to nicotine and have been shown to smoke more. 

    “It kind of numbs your response so in order for you to feel the same effect as someone who smoked one cigarette you might have to smoke almost one and a half cigarettes,” said Romero Villela. 

    As their study reveals, the story does not end there.

    A personalized approach

    When analyzing genetic information from about 165,000 current or former smokers of European, South Asian, and Finnish descent, the team discovered genes and variants in a completely different region of the genome that appear to interact with Mr. Big in a way that influences smoking habits. 

    Notably, when people had the risk-boosting version of Mr. Big but also had a genetic variant called rs73586411, they smoked significantly less than expected. 

    “We basically found another variant that ameliorates the effect of Mr. Big,” said Romero Villela.

    More research is needed to understand just what the genes highlighted in the study do. (Interestingly, one called TMEM230 has previously been associated with Parkinson’s disease. Nicotine is known to blunt some symptoms of the disease).

    The study authors imagine a day when people could be given a “polygenic risk score” which considers their gene variants and interactions to provide personalized recommendations for quitting. For instance, preliminary studies have already suggested that people with high-risk genotypes in the CHRNA5 region may benefit more from medications targeting nicotinic receptors. 

    Eventually, if researchers could determine what a variant does to dull the craving to smoke, they might be able to develop medications that mimic that action.
    Bigger picture, the authors hope the study inspires more research looking not just at individual genes but also how genetic variants work together.

    “Genes don’t operate in a vacuum,” said Ehringer. “If our ultimate goal is more personalized medicine, we have to understand these interactions better.”

    Source:

    University of Colorado at Boulder

    Journal reference:

    Romero, P. N., et al. (2024). Loci on Chromosome 20 Interact with rs16969968 to Influence Cigarettes per Day in European Ancestry Individuals. Drug and Alcohol Dependence. doi.org/10.1016/j.drugalcdep.2024.111126.

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  • Study reveals e-cigarette users with limited smoking history show similar DNA alterations as smokers

    Study reveals e-cigarette users with limited smoking history show similar DNA alterations as smokers

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    A recent Cancer Research study assessed the effect of tobacco smoking and electronic cigarette (e-cigarettes) use on DNA methylation changes associated with carcinogenesis.

    Study: Cigarette smoking and e-cigarette use induce shared DNA methylation changes linked to carcinogenesis. Image Credit: Andrey_Popov/Shutterstock.com
    Study: Cigarette smoking and e-cigarette use induce shared DNA methylation changes linked to carcinogenesis. Image Credit: Andrey_Popov/Shutterstock.com

    Background

    In comparison to tobacco smoking, the use of e-cigarettes and smokeless, non-combustible tobacco has often been considered to be less harmful. However, recent studies have highlighted some of the potential adverse effects linked to e-cigarette use, including DNA damage and endothelial dysfunction. Therefore, it is imperative to understand the molecular changes and their long-term effects on health.

    E-cigarette use has been associated with similar biomarker changes to cigarette smoking. It is essential to identify biomarkers that indicate the risk of cancer. Some of the characteristic features that must be present in biomarkers are (a) modifiability through tobacco smoking and e-cigarette use, (b) lie in genes linked to carcinogenesis, (c) induce cancer progression in a premalignant lesion, and (d) reflective of long-term cancer risk in a surrogate tissue to aid non-invasive monitoring.

    The epigenome is a set of chemical modifications of DNA or proteins linked to DNA. Many studies have elucidated the role of epigenomics in carcinogenesis. This information has helped shed light on the long-term impacts of tobacco smoking and e-cigarette use.

    DNA methylation (DNAme) at the cytosine C-5 position is an epigenetic modification. Its alterations enriched in genes are associated with smoking-related diseases. Some epigenetic changes remain persistent even after smoking cessation. These biomarkers could be used as an indicator of lung cancer. 

    Epithelial cells that are exposed (e.g., oral mucosa and lungs) or not (e.g., cervix) to smoking or e-cigarette use are the key cells of origin for tobacco-related malignancies. Furthermore, smoking-related DNAme changes found in buccal samples are primarily of epithelial origin.

    About the study

    The current study addressed the aforementioned issues to understand better tissue- and cell-specific epigenetic impacts of e-cigarette or tobacco use on DNAme. It used more than 3,500 cervical, buccal/saliva, or blood samples from immune and epithelial cells at directly and indirectly exposed sites. Additionally, a control sample set was used for validation.

    This study is a part of the female cancer prediction using cervical omics to individualize screening and prevention (FORECEE) study. The participants came from five European countries, were between 18 and 86 years of age, and completed an epidemiological questionnaire. The effect of tobacco use on epithelial and immune cells was analyzed systematically using computational deconvolution and cell type-specific DNAme inference.

    The effect of direct (proximal) and indirect (distal) exposure to the use of smoking, smokeless tobacco (e.g., snuffs), or e-cigarettes on epithelial and immune cells was assessed. Furthermore, whether these uses also affected lung cancer tissue and prognosis were evaluated. The evaluation of the biomarkers at the cell-level is a key contribution of this study, as the majority of existing studies, including those predicting lung cancer, have used blood samples.

    Study findings

    The cell-specific alterations following cigarette and e-cigarette use that are associated with carcinogenesis have been uncovered in this study. Smoking was found to elicit changes in protected stem and submucosal gland cells. Cigarette smoking affected epithelial hypoM and this change was found in both proximal and distal exposure. Furthermore, DNAme alterations linked to specific proximal epithelial hyperM and distal epithelial hyperM were also identified.

    Smoking was seen to affect the myeloid more prominently than the lymphoid lineage. No significant genetic overlap linked with specific functions was observed in the samples obtained from five different sites. Mostly, epithelial hypoM sites were linked with detoxification responses, whereas proximal epithelial hyperM sites entailed DNA damage responses.

    The smoking-related DNAme loci (CpGs) identified here were clustered into four functional group based on anatomical site and cell type. Loci hypermethylated in cheek cells of smokers associated with the NOTCH1/RUNX3/growth factor receptor signaling showed a higher level of methylation in progressing lung carcinoma in situ lesions and cancer tissue. Alarmingly, the aforementioned CpGs were also noted to be hypermethylated in e-cigarette users who reported a limited smoking history.

    This study further highlighted a partial reversibility of smoking-induced epigenetic alterations in former tobacco smokers. This observation was based on the fact that epithelial hypoM could not be distinguished between ex-smokers and those who never smoked. This observation could imply that the hypermethylated cells disappeared due to cell death or the displacement of the methyl group in the living cell.

    Smokeless tobacco induces similar changes in DNAme in the epithelial hypoM and proximal epithelial hyperM sets, as cigarette smoking. It must be noted that only cigarette smokers exhibited changes in DNAme at immune hypoM sites. Proximal epithelial hypermethylation was robustly associated with lung cancer progression and cervical cancer.

    Conclusions

    In sum, the results presented here shed light on cell type-specific epigenetic changes following cigarette smoking. Some of these changes, which could also predict lung cancer, are similar to e-cigarette users.

    A key limitation of this study was the use of pathway analysis based on gene names, which limited the investigation to cis genes alone. In the future, scientists must perform multi-omics profiling to investigate the association between methylation changes and gene transcription function more comprehensively. 

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  • Second-hand vape smoke linked to more asthma symptoms in kids

    Second-hand vape smoke linked to more asthma symptoms in kids

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    In a recent study published in the journal Children, researchers retrospectively investigated the impacts of second-hand e-cigarette smoke exposure on childhood asthma, especially in home environments. They carried out a pilot, monocenter, observational study of 54 young asthma patients, half of whom experienced second-hand exposure (SHE) to second-hand aerosols (SHAs).

    Study: Association between Second-Hand Exposure to E-Cigarettes at Home and Exacerbations in Children with Asthma. Image Credit: Prostock-studio / ShutterstockStudy: Association between Second-Hand Exposure to E-Cigarettes at Home and Exacerbations in Children with Asthma. Image Credit: Prostock-studio / Shutterstock

    Despite finding no statistically significant association between electronic nicotine delivery systems (ENDSs) and asthma exacerbations (no difference in the number of patients requiring clinical intervention step-up), this study suggests that asthmatic children exposed to elevated levels of second-hand e-cigarette smoke may experience increases in their number of asthma symptomatic days. This highlights the need for heightened awareness, both amongst adolescents and their parents, of the psychological harms of the ‘safe’ vape.

    The ENDs pandemic and what this means for asthma patients

    Extensive research and medical reports highlight tobacco smoking as the single most preventable cause of global mortality and morbidity, with the habit associated with significant increases in the risks of numerous cancers, cardiovascular diseases (CVDs), respiratory ailments, and psychiatric disorders. Long-term global efforts have resulted in substantial reductions in tobacco use prevalence amongst adults and adolescents, representing one of the most noteworthy accomplishments of modern public health.

    Unfortunately, in recent years, tobacco smoking has been replaced by the use of electronic nicotine delivery systems (ENDSs). Commonly called ‘vapes,’ these devices are marketed as low- or no-risk alternatives to conventional smoking. While they are devoid of tar and a majority of the heavy metal components that make tobacco smoke harmful, recent research presents a growing body of evidence suggesting that ENDs are not as safe as we may think. Even non-smokers who take up vaping have been shown to develop adverse and often chronic respiratory symptoms, including bronchoconstriction and severe cough.

    Asthma is a respiratory condition characterized by difficulty breathing, chest pain, cough, and wheezing, which in severe cases may lead to life-threatening suffocation. Caused by the inflammation or narrowing of a patient’s airways or excessive mucus secretions along the respiratory tract, the condition is most common in young children. It presents the most common pediatric disease worldwide. Unfortunately, while a few studies have investigated the associations between e-cigarette exposure and asthma in adults and found that the former can exacerbate the latter, the impacts of second-hand exposure on pediatric asthma have hitherto remained unexplored.

    “Establishing evidence of adverse health effects caused by second-hand nicotine vaping exposure could represent a valid motivation for minimizing household exposure and imposing restrictions on vaping in public spaces.”

    About the study

    Aerosols produced by ENDs are known to contain volatile aldehydes and oxidant metals, some of which have been shown to produce adverse outcomes in adult patients’ lungs, both asthmatic and non-asthmatic. Unfortunately, the effects of these volatile organic compounds (VOCs) on children’s lungs remain unknown. The present study aims to fill this knowledge gap by retrospectively elucidating the associations between childhood ENDs exposure and asthma symptom progression.

    The observational study was carried out between January and May 2023 at “Gaetano Martino” Hospital, University of Messina, Italy, and comprised children or adolescents aged five to 17 with medically confirmed asthma. Data collection included demographics (age, sex, gender, and race), clinical (comorbidities), parents’ socioeconomic status, and the education levels of both parents and children. Additionally, ENDs exposure was recorded in terms of presence (yes/no) and frequency. All data was collected using a custom-designed questionnaire.

    The Asthma Control Test (ACT) and the children-Asthma Control Test (c-ACT were administered at the time of initial study enrolment. Patients were assigned to asthma or no-asthma cohorts (n = 27 per cohort), with analyses stratified to account for age – two age cohorts (5-11 [n = 65%] and 12-17 [n = 35%]). Continuous data variables were analyzed using descriptive statistics (expressed as means and standard deviations [SDs]), while ordinary variables were expressed as percentages. Fisher’s tests were used to compare cohorts qualitatively, while independent t-tests computed differences between continuous variables across cohorts.

    Study findings and conclusions

    The total sample size for the present study was 54, equally divided between children whose parents indulge in e-cigarette consumption at home and those whose parents do not. Of these, 39 were diagnosed with intermittent, nine with moderate, and six with severe asthma, respectively.

    While the dataset was too small to provide statistically significant differences between asthma and non-asthma cohorts, descriptive statistics reveal that ENDs had more profound impacts on younger children (Group A – 5 to 11 years) compared to their older counterparts (Group B – 12 to 17 years) with the former group needing six times more rescue therapy and 15% more therapeutic step-up than the former. These results are in concordance with the conventional assumption that younger children are at higher risk of asthma contraction due to their undeveloped immune systems and narrower respiratory passages.

    Despite not yielding statistically significant results, the proceeds of this study highlight the risk posed by household END usage to children. While not as harmful as conventional tobacco smoke, vaporization of e-liquids is known to release significant qualities of aldehydes, including formaldehyde, known for being respiratory irritants and carcinogens. Previous research comparing harmful aerosol concentrations in home environments raises cause for concern – ultrafine particulate matter produced by e-cigarettes matches. It sometimes exceeds that produced by an equivalent amount of tobacco smoke.

    “…our data highlight the importance of the prevention of the vaping epidemic and passive exposure to e-cigarettes, even among children and adolescents. Implementing educational programs to increase awareness about the risks of vaping among children and emphasizing the potential impact on respiratory health, especially for those with asthma, should be a priority. Launching targeted campaigns to inform parents about the dangers of vaping and its specific implications for children with asthma should be strengthened.”

    Journal reference:

    • Costantino, S., Torre, A., Foti Randazzese, S., Mollica, S. A., Motta, F., Busceti, D., Ferrante, F., Caminiti, L., Crisafulli, G., & Manti, S. (2024). Association between Second-Hand Exposure to E-Cigarettes at Home and Exacerbations in Children with Asthma. Children, 11(3), 356, DOI – 10.3390/children11030356,  https://www.mdpi.com/2227-9067/11/3/356

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  • E-cigarette users experience similar DNA changes to specific cheek cells as smokers

    E-cigarette users experience similar DNA changes to specific cheek cells as smokers

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    E-cigarette users with a limited smoking history experience similar DNA changes to specific cheek cells as smokers, finds a new study led by researchers at UCL (University College London) and University of Innsbruck.

    This study is an incremental step in helping researchers to build a deeper understanding of the long-term effects of e-cigarettes on health. Although it does not show that e-cigarettes cause cancer, studies with long-term follow up are important to assess whether e-cigarettes have harmful effects and, if so, what they are.

    The study, published in Cancer Research, analysed the epigenetic effects of tobacco and e-cigarettes on DNA methylation in over 3,500 samples, to investigate the impact on cells that are directly exposed to tobacco (e.g. in the mouth) and those that are not directly exposed (e.g. in blood or cervical cells).

    The epigenome refers to an extra layer of information that is superimposed on our genetic material – the DNA. While DNA can be compared to the ‘hardware’ of a computer, epigenetics are comparable to the computer’s ‘software’ and define how, where and when the programs used by the computer are run.

    Epigenomes change throughout our lives and can be affected by a variety of genetic or nongenetic factors – including aging, our lifestyles, exposure to hormones, chemicals and environmental factors, and even stress and psychological trauma. One commonly studied type of epigenetic modification is called DNA methylation.

    The researchers found that epithelial cells (cells that typically line organs and are often the cells of origin for cancer) in the mouth showed substantial epigenomic changes in smokers. Importantly, these changes are further elevated in lung cancers or pre-cancers (abnormal cells or tissue that have the potential to develop into cancer), when compared to the normal lung tissue, supporting the idea that the epigenetic changes associated with smoking allow cells to grow more quickly.

    The publication also includes new data showing the similar epigenomic changes were likewise observed in the cells of e-cigarette users who had only ever smoked less than 100 tobacco cigarettes in their lives.

    First author, Dr Chiara Herzog (UCL EGA Institute for Women’s Health and University of Innsbruck), said: “This is the first study to investigate the impact of smoking and vaping on different kinds of cells – rather than just blood – and we’ve also strived to consider the longer-term health implications of using e-cigarettes.

    “We cannot say that e-cigarettes cause cancer based on our study, but we do observe e-cigarette users exhibit some similar epigenetic changes in buccal cells as smokers, and these changes are associated with future lung cancer development in smokers. Further studies will be required to investigate whether these features could be used to individually predict cancer in smokers and e-cigarette users.

    “While the scientific consensus is that e-cigarettes are safer than smoking tobacco, we cannot assume they are completely safe to use and it is important to explore their potential long-term risks and links to cancer.

    “We hope this study may help form part of a wider discussion into e-cigarette usage – especially in people who have never previously smoked tobacco.”

    Through their computational analysis of the samples, the researchers also found that some smoking-related epigenetic changes remain more stable than others after giving up smoking, including smoking-related epigenetic changes in cervical samples – something that has not previously been studied.

    Senior author, Professor Martin Widschwendter (UCL EGA Institute for Women’s Health and University of Innsbruck), said: “The epigenome allows us, on one side, to look back. It tells us about how our body responded to a previous environmental exposure like smoking. Likewise exploring the epigenome may also enable us to predict future health and disease. Changes that are observed in lung cancer tissue can also be measured in cheek cells from smokers who have not (yet) developed a cancer. Importantly, our research points to the fact that e-cigarette users exhibit the same changes, and these devices might not be as harmless as originally thought. Long-term studies of e-cigarettes are needed. We are grateful for the support the European Commission has provided to obtain these data.”

    Tobacco is well known as a modifiable contributor to adverse health outcomes, and it has been estimated to have caused 7.69 million deaths globally in 2019, with numbers expected to increase in the future. The NHS says e-cigarettes are substantially safer than smoking tobacco and smokers are recommended to switch to vaping to improve their health.

    The researchers involved in the latest study now hope to further investigate how epigenetic changes related to smoking in cheek swabs could be used for identifying individuals at highest risk of developing cancer and assess the long-term health risks of e-cigarettes. 

    This work was supported by funding from the European Union’s Horizon 2020 Research and Innovation programme, The Eve Appeal, and Cancer Research UK.

    This study contributes to our understanding of e-cigarettes, but it does not show that e-cigarettes cause cancer. Decades of research has proven the link between smoking and cancer, and studies have so far shown that e-cigarettes are far less harmful than smoking and can help people quit. This paper does however highlight that e-cigarettes are not risk-free, and so we need additional studies to uncover their potential longer-term impacts on human health.


    Smoking tobacco causes 150 cases of cancer every single day in the UK, which is why we look forward to seeing the Government’s age of sale legislation being presented in parliament. Nothing would have a bigger impact on reducing the number of preventable deaths in the UK than ending smoking, and this policy will take us one step closer to a smokefree future.”


    Dr Ian Walker, Cancer Research UK’s executive director of policy

    Source:

    University College London

    Journal reference:

    Herzog, C., et al. (2024) Cigarette smoking and e-cigarette use induce shared DNA methylation changes linked to carcinogenesis. Cancer Research. doi.org/10.1158/0008-5472.CAN-23-2957.

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  • Lesbian, gay and bisexual women respond more positively to tobacco marketing

    Lesbian, gay and bisexual women respond more positively to tobacco marketing

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    People who identify as lesbian, gay and bisexual – particularly women – respond more positively to tobacco marketing, are more inclined to smoke cigarettes daily and may have a more difficult time quitting, according to two studies by a Rutgers Health researcher.

    The studies, published in the Annals of LGBTQ Public and Population Health and Preventive Medicine Reports, investigated how some among the LGBTQ population respond to tobacco marketing, how they use tobacco and their history of quitting using two large national datasets, including the Population Assessment of Tobacco and Health Study and the National Survey on Drug Use and Health.

    Ollie Ganz, a faculty member at the Rutgers Institute for Nicotine and Tobacco Studies and an assistant professor at the Rutgers School of Public Health who is lead author of the studies, discussed the significance of the findings to future policy.

    Why is specifically studying how sexual minority populations receive tobacco marketing important?

    From previous studies, we know that sexual minority individuals are more likely to use tobacco products than heterosexual individuals. This may be because tobacco companies have targeted this population with advertising and promotions, but the impact of this has not been studied extensively. The main thing we wanted to understand in this study is, given that sexual minority individuals are exposed to more tobacco advertising than heterosexual individuals, are there also differences in terms of how receptive they are to the ads, such as having a positive response to the ads.

    What did your study find regarding tobacco marketing among sexual minority individuals?

    What was unique about our study is that we were able to look at subsets of the LGB population – gay men, bisexual men, lesbian/gay women and bisexual women – rather than looking at them as one group. By looking at these subgroups we discovered that lesbian/gay and bisexual women were more likely to be receptive to marketing for tobacco products overall, and that bisexual women – but not lesbian/gay women – were more likely to be receptive to marketing for cigarettes, cigars, e-cigarettes and smokeless tobacco, compared with heterosexual women.

    Among men, we discovered that gay men, but not bisexual men, were more likely to be receptive to cigar advertising compared with heterosexual men. We also found that gay and bisexual men were more likely to be receptive to e-cigarette advertising compared with heterosexual men.

    In the Preventive Medicine Reports study, you also looked at subsets of the LGB population, but focused on cigarette use behaviors. What were your findings?

    We discovered that sexual minority women – particularly bisexual women – are smoking at higher rates and are having a harder time quitting compared with heterosexual women. We also found that the differences in prevalence of cigarette smoking between lesbian/gay and bisexual women and heterosexual women was much greater than between the prevalence between sexual minority men and heterosexual men.

    These findings show that we need more support to specifically help sexual minority women quit smoking –particularly bisexual women. This population presents unique challenges, such as greater mental health problems, and there is a need for more resources and tailored interventions to support them in quitting smoking.

    How can these findings inform future policy?

    In order for tobacco control policies and regulations and public education campaigns to be effective, they need to be able to identify the populations that are at greatest risk for tobacco use. They also need a body of evidence that identifies the factors that are driving elevated use among those populations so effective messages and policies can be developed that directly address those factors.

    Source:

    Journal references:

    • Ganz, O., et al. (2024) Differences in Tobacco Advertising Receptivity Among Young Adults by Sexual Identity and Sex: Findings From the Population Assessment of Tobacco and Health Study. Annals of LGBTQ Public and Population Health. doi.org/10.1891/LGBTQ-2022-0036.
    • Ganz, O., et al. (2024). Cigarette Smoking Behaviors and Nicotine Dependence at the Intersection of Sexual Identity and Sex in the United States: Findings from the National Survey on Drug Use and Health. Preventive Medicine Reports. doi.org/10.1016/j.pmedr.2024.102593.

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  • Smokers’ views on e-cigarette harm worsen, matching or exceeding concerns for cigarettes

    Smokers’ views on e-cigarette harm worsen, matching or exceeding concerns for cigarettes

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    In a recent study published in JAMA Network Open, researchers examined trends in the perception of harm caused by electronic cigarettes (e-cigarettes) relative to combustible cigarettes among smokers in England.

    E-cigarettes are less harmful than cigarettes and can help people quit smoking. However, many adult smokers believe e-cigarettes to be as harmful as cigarettes. Various factors could have led to confusion regarding e-cigarettes. Media reporting has often exaggerated the risks of e-cigarettes, with evidence suggesting this might aggravate misperceptions.

    Study: Trends in Harm Perceptions of E-Cigarettes vs Cigarettes Among Adults Who Smoke in England, 2014-2023. Image Credit: Andrey_Popov / ShutterstockStudy: Trends in Harm Perceptions of E-Cigarettes vs Cigarettes Among Adults Who Smoke in England, 2014-2023. Image Credit: Andrey_Popov / Shutterstock

    Risk messages can also influence harm perceptions. For instance, an outbreak of acute lung injuries in 2019 was misattributed to vaping even before the cause was identified and was labeled as e-cigarette or vaping product use-associated lung injury (EVALI). Further, concerns emerged that e-cigarettes may increase the risk of coronavirus disease 2019 (COVID-19) and its severity, albeit there was little evidence.

    There have been short-term spikes in e-cigarette harm perceptions post-EVALI outbreak. Nevertheless, how harm perceptions of e-cigarettes evolved beyond 2020 and how the changes vary across population subgroups remains unclear. It is necessary to determine whether changes in perceptions have occurred over time among adult smokers because it has implications for accurate support and messaging.

    About the study

    In the present study, researchers explored the trends in harm perceptions of e-cigarettes in England relative to cigarettes. They obtained data from an ongoing cross-sectional survey of adults between November 2014 and June 2023. The sample was restricted to individuals aged 18 or older who were current smokers because the survey item assessing e-cigarette harm perceptions was limited to them.

    Smokers were asked to specify their perception of whether e-cigarettes were less, more, or equally harmful to health as cigarettes. The primary outcome was the proportion of smokers who thought e-cigarettes were less harmful. Secondary outcomes included the proportions responding more harmful, equally harmful, or do not know.

    Vaping status was determined with questions asking subjects if they used a vaping product or e-cigarette to quit or limit smoking or for other reasons. Those responding to e-cigarette use were deemed current vapers. The team applied logistic regression to evaluate associations between survey waves and perceptions of e-cigarettes.

    Findings

    Of over 169,400 individuals surveyed, 28,393 were current smokers, including 13,253 females. They were aged 43.5 on average, and 5,879 subjects were current vapers. Overall, 35.2% of smokers believed e-cigarettes were less harmful to health than cigarettes; 36.7% reported it as equally harmful, and 13.4% perceived it as more harmful, while 14.8% did not know.

    Further, the proportion who perceived it was less harmful than cigarettes was higher among current vapers and the 35-64 age group. Nearly a third of dual users, i.e., smokers and vapers, perceived e-cigarettes as more or equally harmful. Moreover, significant changes occurred over time in harm perceptions. Specifically, in November 2014, the most common perception was that e-cigarettes were less harmful (44.4%); however, this view declined by 40% by June 2023.

    The proportion of smokers who believed it was less harmful declined to 33.2% between November 2014 and July 2019, whereas the proportion who perceived it was equally harmful increased to 42.5%. Notably, there were marked shifts in perceptions in late 2019, with a sharp reduction in the proportion who believed it was harmful in the first quarter of 2020.

    Meanwhile, the proportion believing e-cigarettes are more or equally harmful increased to 50.6%. The decrease in the proportion of smokers viewing e-cigarettes as less harmful was similar across age groups. The increase in the proportion of people believing e-cigarettes were more harmful was the most pronounced in the youngest age group. The proportion who thought e-cigarettes were less harmful was consistently lower among non-vapers.

    Conclusions

    In sum, harm perceptions of e-cigarettes among adult smokers in England have substantially worsened over the past decade. While the most common perception in 2014 was that e-cigarettes were less harmful, the proportion with this view declined by 40% by June 2023. On the other hand, the proportion who thought e-cigarettes were more harmful had more than doubled. Overall, currently, most adults who smoke and do not vape do not believe e-cigarettes are less harmful than cigarettes.

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  • Exploring the epigenetic impact of smoking across racial and ethnic groups

    Exploring the epigenetic impact of smoking across racial and ethnic groups

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    Smoking changes the way genes are expressed, which later contributes to the development of lung cancer and other smoking-related illnesses. But the link between epigenetics (the study of mechanisms that impact gene expression) and smoking is not fully understood, especially in terms of differences across racial and ethnic groups.

    We know that smoking affects people differently based on their race and ethnicity, but identifying epigenetic signatures of smoking would help us better predict risk for smoking-related diseases.”


    Brian Huang, PhD, assistant professor, Department of population and public health sciences, Keck School of Medicine of USC and first author of the new study

    In a National Institutes of Health-funded effort, researchers from the Keck School of Medicine analyzed the link between smoking and DNA methylation, a specific type of epigenetic change that can alter a number of biological processes. The study included data from 2,728 people across six distinct racial and ethnic groups. Researchers found 408 DNA methylation markers (known as “CpG sites”) related to smoking, including two that differed depending on race or ethnicity. The results were published in the American Journal of Human Genetics.

    Most past research on smoking and epigenetics has looked at just one or two racial groups at a time, making the new effort one of the largest multiethnic studies yet. In addition, the researchers quantified smoking by calculating participants’ total nicotine equivalents (TNEs), a biological measure of nicotine uptake that measures levels of nicotine and several other metabolites of cigarette smoke with a urine sample. That enabled a more accurate calculation of smoking dose compared to much of the existing research, which relies on self-reported measures.

    “This study gives us some additional information about the mechanism by which smoking can affect health, and how that could differ across various populations,” Huang said. “Ultimately, that can lead to better prediction, early detection and treatment for smoking-related conditions.”

    Insights from the epigenome

    The research team conducted their primary analysis using data from the Multiethnic Cohort Study, a collaboration between USC and the University of Hawaii that includes African Americans, European Americans, Japanese Americans, Latinos and Native Hawaiians. Using biological samples from 1,994 participants, the researchers determined each person’s smoking dose (by measuring TNEs), as well as the levels of DNA methylation at CpG sites across the genome (through an epigenome-wide association study, or EWAS).

    Across the epigenome, smoking was linked to DNA methylation at 408 sites. That total includes 45 new sites that were not identified in previous studies that relied on self-reports of smoking behavior.

    “This gives us an indication that TNEs can provide more information beyond what we already know from self-reported measures of smoking,” Huang said.

    Of the 408 sites identified, two carried a significant risk difference depending on race or ethnicity. One site on the gene CYTH1 only showed changes in African American people who smoked; another site on MYO1G was more strongly linked with epigenetic changes in Latinos who smoked, compared to other racial and ethnic groups. Those genes perform functions that relate to cancer progression and other disease processes.

    The new insights could improve scientists’ understanding of why some populations face a higher lung cancer risk than others, Huang said. African Americans who smoke face a higher risk of lung cancer than non-Hispanic whites who smoke, while people of Hispanic origin may face a lower risk.

    To further confirm their findings, Huang and his team collected TNE and DNA methylation data from two other groups of participants: 340 people in the Singapore Chinese Health Study and 394 people in the Southern Community Cohort Study. The researchers identified many of the same CpG sites found in the Multiethnic Cohort Study, including the sites most strongly associated with TNEs. That provides evidence that the strongest epigenetic markers of smoking are consistent across multiple racial and ethnic groups, Huang said.

    Better prediction of disease risk

    In their next study, the researchers will conduct an EWAS of DNA methylation and lung cancer risk: How do epigenetic changes increase a person’s risk for lung cancer?

    “By conducting these joint studies, we can understand the mechanism by which DNA methylation acts as a mediator between smoking and lung cancer, which can in turn improve our ability to predict lung cancer risk,” Huang said.

    He and his team also have research underway to study epigenetic changes associated with additional biomarkers of smoking, including biological levels of cadmium, a heavy metal found in cigarette smoke.

    About this research

    In addition to Huang, the study’s other authors are Yesha Patel, Christopher Haiman, Kimberly Siegmund and Daniel Stram from the Department of Population and Public Health Sciences, Keck School of Medicine of USC; Alexandra Binder, Brandon Quon, Annette Lum-Jones, Maarit Tiirikainen, Lenora Loo, Lynne Wilkens, Loïc Le Marchand and Sungshim L. Park from the University of Hawaii Cancer Center; Sharon Murphy and Stephen Hecht from the Masonic Cancer Center, University of Minnesota; Alika Maunakea from the John. A. Burns School of Medicine, University of Hawaii; Woon-Puay Koh from the National University of Singapore; Woon-Puay Koh, William Blot and Melinda Aldrich from the Vanderbilt University Medical Center; and Jian-Min Yuan from the University of Pittsburgh.

    This work was supported by the National Institutes of Health/National Cancer Institute (NIH/NCI) [P01CA138338]. NIH also supported the Multiethnic Cohort Study [U01CA164973], the Singapore Chinese Health Study [R01CA129534, R01CA144034, UM1CA182876] and the Southern Community Cohort Study [U01CA202979, R01CA092447].

    Source:

    Keck School of Medicine of USC

    Journal reference:

    Huang, B. Z., et al. (2024). Epigenome-wide association study of total nicotine equivalents in multiethnic current smokers from three prospective cohorts. The American Journal of Human Genetics. doi.org/10.1016/j.ajhg.2024.01.012.

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  • Vaping increases susceptibility to COVID-19 infection, study finds

    Vaping increases susceptibility to COVID-19 infection, study finds

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    Vapers are susceptible to infection by SARS-CoV-2, the virus that spreads COVID-19 and continues to infect people around the world, a University of California, Riverside, study has found.

    The liquid used in electronic cigarettes, called e-liquid, typically contains nicotine, propylene glycol, vegetable glycerin, and flavor chemicals. The researchers found propylene glycol/vegetable glycerin alone or along with nicotine enhanced COVID-19 infection through different mechanisms.

    Study results appear in the American Journal of Physiology.

    The researchers also found that the addition of benzoic acid to e-liquids prevents the infection caused by propylene glycol, vegetable glycerin, and nicotine. 

    Users who vape aerosols produced from propylene glycol/vegetable glycerin alone or e-liquids with a neutral to basic pH are more likely to be infected by the virus, while users who vape aerosols made from e-liquids with benzoic acid -; an acidic pH -; will have the same viral susceptibility as individuals who do not vape.”


    Rattapol Phandthong, postdoctoral researcher, Department of Molecular, Cell and Systems Biology and research paper’s first author

    The researchers obtained airway stem cells from human donors to produce a 3D tissue model of human bronchial epithelium. They then exposed the tissues to JUUL and BLU electronic cigarette aerosols to study the effect on SARS-CoV-2 infection. They found all tissues showed an increase in the amount of ACE2, a host cell receptor for the SARS-CoV-2 virus. Further, TMPRSS2, an enzyme essential for the virus to infect cells, was found to show increased activity in tissues exposed to aerosols with nicotine.

    Prue Talbot, a professor of the graduate division and Phandthong’s advisor, said e-cigarette users should be cautious about vaping as some products will increase their susceptibility to SARs-CoV-2 infection. 

    “It would probably be best for vapers to quit vaping for the protection of their health and to stop nicotine dependency,” she said. “If they cannot stop vaping, it is better to vape aerosols produced from an e-liquid with acidic pH or with benzoic acid to prevent the enhanced SARS-CoV-2 infection caused by nicotine, propylene glycol, and vegetable glycerin. However, inhalation of benzoic acid has its own risk, and data is still limited on this topic.”

    The researchers acknowledge that the relationship between e-cigarettes and SARS-CoV-2 susceptibility is complex.

    “The complexity is attributed to a wide range of available e-liquids, the chemical composition of each e-liquid, and different models of e-cigarettes,” Phandthong said. “Our study only used Classic Tobacco Flavor JUUL e-cigarette and BLU Classic Tobacco e-cigarette. Even with just these two e-cigarettes, we found the aerosols and individual ingredients produced different effects on SARS-CoV-2 infection.” 

    Phandthong and Talbot hope the Food and Drug Administration will use their findings to implement regulatory laws on e-cigarette products.

    “Our findings could also help improve the design of clinical trials involving the use of tobacco products and SARS-CoV-2 infection,” Phandthong said. “In the meantime, it is worth bearing in mind that the scientific literature has shown that a vaper who contracted SARS-CoV-2 has more complications during the recovery period and is more likely to develop long COVID-19, which can be serious and last many months post-infection. We hope our findings encourage vapers to stop vaping and discourage non-users from starting to vape.”

    Phandthong acknowledged the team only investigated the initial stage of SARS-CoV-2 infection. 

    “There are many later stages involved in infection, such as viral replication,” he said. “It is likely that these additional stages can also be affected by inhalation of e-cigarette aerosols.” 

    Phandthong and Talbot were joined in the study by Man Wong, Ann Song, and Teresa Martinez.

    The research was funded by grants from the Tobacco-Related Disease Research Program, National Institute of Environmental Health Sciences, Center for Tobacco Products of the Food and Drug Administration, and California Institute of Regenerative Medicine.

    Source:

    University of California – Riverside

    Journal reference:

    Phandthong, R., et al. (2023). Does Vaping Increase the Likelihood of SARS-CoV-2 Infection? Paradoxically Yes and No. American Journal of Physiology-Lung Cellular and Molecular Physiology. doi.org/10.1152/ajplung.00300.2022.

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