Tag: Nicotine

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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April 23, 2024
Unraveling the mysteries of gastro-esophageal junction development

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The transition from the esophagus to the stomach is a delicate region from a medical point of view, often associated with pathological disorders leading to cancer. An international research team has now gained new insights into this region. These pave the way for new prevention and treatment options.

The meeting point of the stomach and esophagus, the so-called gastro-esophageal junction, is a region of the human body that is not well-suited to the modern lifestyle. Stress, alcohol, nicotine and severe obesity are often triggers for pathological changes to the mucosal membrane in this area, often resulting in esophageal cancer.

An international research team has now gained new insights into the development of the cells, their communication with each other, and their regulation at the junction of the esophagus and stomach. With the help of specially developed mini-organs, so-called organoids, and with techniques that make it possible to track and profile individual cells, they have been able to follow the development of the gastro-esophageal junction from embryonic to adult stage in detail using animal experiments.

New insights into the development of the gastrointestinal tract

Their results reveal the complex communication at the cellular level and the specific pathways that these cells use to communicate. They provide new insights into the development of the gastro-esophageal junction and thus have significant implications for the understanding, prevention and treatment of gastrointestinal diseases. At the same time, they present new starting points for medical research and the development of new therapies.

Cindrilla Chumduri is responsible for this study, which has now been published in the journal Nature Communications. Until recently, the infection and cancer biologist was a research group leader at the Department of Microbiology at Julius-Maximilians-Universität Würzburg (JMU); she is now an associate professor at Aarhus University (Denmark). Other participants came from Charité – Universitätsmedizin and the Max Planck Institute for Infection Biology in Berlin.

“This collaboration underlines the importance of different expertise to improve our understanding of the biology of the gastrointestinal tract,” says Chumduri.

She herself has many years of experience in research with organoids. Among other things, she has used mini-organs she developed to study how cells in the cervix degenerate and turn cancerous – another region where different types of mucosal cells collide.

Where different epithelia meet

The squamous epithelia of the esophagus and the columnar epithelia of the stomach meet at the gastroesophageal junction.”

Dr. Naveen Kumar Nirchal, one of the first authors of the study

The area is known as a “hotspot for the development of metaplasia” – the replacement of one type of cell by another.

Barrett’s esophagus, a precursor to esophageal cancer, often develops there, the number of cases of which has increased dramatically in the Western world over the past four decades. “Barrett’s esophagus is characterized by the replacement of the resident squamous epithelium of the esophagus by other cell types that are not normally found in this tissue,” says the scientist.

However, it is still unclear why this region is so susceptible to this process. In order to better understand this transformation, it is therefore first necessary to decipher the normal development process in detail – from embryo to mature adult. “This is the only way to determine the tissue changes that trigger the progression of the disease, explains Dr. Rajendra Kumar Gurumurthy, another researcher of the study.

A never-before-seen insight into the development of this region

This has now been achieved: By using a novel approach that combines organoid and mouse models with advanced single-cell transcriptome analyses over time and space, the research team has shed light on the complex developmental process of the gastroesophageal junction. “We were able to provide unprecedented insight into the development of this region from the embryonic stage to adulthood in mice and identify the intricate composition of the cells involved and how they develop,” explains Pon Ganish Prakash, another scientist involved in the study.

The work shows the sophisticated communication between different cell types within the gastroesophageal junction and the signaling pathways involved. “This understanding opens up new avenues for research into gastrointestinal diseases,” says Cindrilla Chumduri.

Above all, the precision of the single-cell analysis in their study opens new doors to understanding how pathological processes develop and to developing innovative treatments, the team writes in its study. The work will therefore be a “cornerstone for understanding the development of such diseases” and will significantly influence the approach to the early detection and treatment of diseases in this important part of the digestive system.

Source:

Julius-Maximilians-Universität Würzburg, JMU

Journal reference:

Kumar, N., et al. (2024). Decoding spatiotemporal transcriptional dynamics and epithelial fibroblast crosstalk during gastroesophageal junction development through single cell analysis. Nature Communications. doi.org/10.1038/s41467-024-47173-z.

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April 13, 2024
New research links social factors to cardiovascular risk in Asian American adults
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Having more unfavorable social determinants of health, such as being unemployed, uninsured or not having education beyond high school, was associated with an increased likelihood of having risk factors for cardiovascular disease among Asian American adults, according to new research published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.

The investigation also noted that the link between these unfavorable social determinants of health variables and cardiovascular disease risk factors varied widely among people in different Asian American subgroups in this study. An association does not mean that social determinants of health directly caused the risk factor.

Despite the perception that Asian Americans may be less impacted by social determinants of health compared to people in other racial/ethnic groups, our findings indicate unfavorable social factors are associated with higher prevalence of cardiovascular risk factors among Asian American adults.”

Eugene Yang, M.D., lead study author, professor of medicine at the University of Washington School of Medicine in Seattle

“The Asian American population is the fastest growing racial/ethnic group in the United States,” Yang said. “People of South Asian heritage have higher rates of premature heart disease globally, and they recently have been found to have higher cardiovascular mortality than non-Hispanic white people. Better understanding of why differences in cardiovascular risk exist among Asian subgroups is vital to reducing risk and improving outcomes.”

Researchers examined data from the National Health Interview Survey conducted in the U.S. from 2013 to 2018, which included 6,395 adults who self-identified as Asian.

Researchers rated 27 social determinants of health factors as favorable or unfavorable in six areas: economic stability (which included employment and income status); neighborhood and social cohesion (which gauged neighborhood trust and whether homes were owned or rented); psychological distress; food security; education; and health care utilization.

The analysis found a significant relationship between unfavorable social determinants of health and cardiovascular disease risk factors. This relationship varied among people in different Asian American subgroups. Among the findings:
- For all Asian groups included in the data, a higher unfavorable social determinants of health score by one standardized unit was associated with a 14% greater risk of high blood pressure; a 17% greater risk of poor sleep; and a 24% greater risk of Type 2 diabetes -; all of which increase the risk for developing cardiovascular disease.
- Specifically, more unfavorable social determinants were associated with:
  
  a 45% greater likelihood of Type 2 diabetes among Chinese adults and a 24% greater likelihood among Filipino adults;
  
  a 28% greater risk of high blood pressure among Filipino adults;
  
  a 42% increased likelihood of insufficient physical activity among Asian Indian adults, a 58% increased likelihood among Chinese adults and a 24% increased likelihood among Filipino adults;
  
  a 20% likelihood of suboptimal sleep among Asian Indian adults; and
  
  a 56% and 50% likelihood of nicotine exposure among Chinese adults and Filipino adults, respectively.
- Compared with other Asian American subgroups, adults who identified as Filipino reported the highest prevalence -; 4 out of 7 -; cardiovascular risk factors: poor sleep, high cholesterol, high blood pressure and obesity.
Yang said many social determinants of health are often interconnected, such as neighborhood cohesion, economic stability and use of the health care system.

“It is important to understand how different Asian subgroups are affected,” he said. “When Asian people are lumped together, higher risk groups like South Asian people may not be treated aggressively enough, while groups with lower risk, like people of Korean and Japanese descent, may be overtreated for blood pressure or cholesterol.”

Study background and details:
- The large, cross-sectional study reviewed data from 2013-2018 National Health Interview Surveys -; annual, nationally representative surveys of U.S. adults.
- Of the 6,395 Asian adults in the survey, about 22% self-identified as Filipino adults; 22% as Asian Indian adults; 21% as Chinese adults; and 36% as other Asian.
- The sample size of Asian American individuals in the national survey was too small to analyze several major Asian populations, including Japanese, Korean and Vietnamese people, as well as other smaller Asian subgroups.
- Nearly 56% of the group were women, and nearly 52% were between the ages of 18 and 44. About 77% of the participants were born outside the United States.
- Participants were assigned scores for social determinants of health by categorizing 27 variables as favorable or unfavorable.
- The cardiovascular risk factors were self-reported and were similar to the American Heart Association’s Life’s Essential 8 -; eight lifestyle metrics assessing ideal cardiovascular health. These eight metrics include: following a healthy diet, maintaining a healthy weight, getting regular exercise and enough quality sleep, avoiding nicotine exposure and maintaining healthy levels of blood pressure, glucose and cholesterol. However, healthy diet was not measured in this study. Reaching optimal levels of these eight metrics improves heart health and reduces the risk for heart disease and stroke.
Limitations of the study include that its small sample size did not allow for analysis of some Asian subgroups (Japanese, Korean, Vietnamese and other Asian people). In addition, it examined self-reported survey data on social factors and cardiovascular risk factors at a single point in time. Therefore, the analysis could not assess long-term social determinants of health patterns, and it could not prove that unfavorable social factors caused the development of cardiovascular disease risk factors. Furthermore, language barriers may have been a factor for some participants because the National Heath Interview Surveys were only conducted in English and Spanish.

Study authors noted that it is vital to include more Asian Americans in national surveys to reveal potential differences in optimal social determinants of health profiles and cardiovascular risk factor prevalence and outcomes.

Co-authors, disclosures and funding sources are listed in the manuscript.

Source:

American Heart Association

Journal reference:

Zhu, A. L., et al. (2024) Social Determinants of Cardiovascular Risk Factors Among Asian American Subgroups. Journal of the American Heart Association. doi.org/10.1161/JAHA.123.032509.
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April 3, 2024
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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April 2, 2024
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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March 27, 2024
Feedback loop involving estrogen linked to women’s higher propensity to nicotine addiction

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A newly discovered feedback loop involving estrogen may explain why women might become dependent on nicotine more quickly and with less nicotine exposure than men. The research could lead to new treatments for women who are having trouble quitting nicotine-containing products such as cigarettes.

Sally Pauss is a doctoral student at the University of Kentucky College of Medicine in Lexington. She led the project.

“Studies show that women have a higher propensity to develop addiction to nicotine than men and are less successful at quitting,” said Pauss, who is working under the supervision of Terry D. Hinds Jr., an associate professor. “Our work aims to understand what makes women more susceptible to nicotine use disorder to reduce the gender disparity in treating nicotine addiction.”

The researchers found that the sex hormone estrogen induces the expression of olfactomedins, proteins that are suppressed by nicotine in key areas of the brain involved in reward and addiction. The findings suggest that estrogen–nicotine–olfactomedin interactions could be targeted with therapies to help control nicotine consumption.

Pauss will present the research at Discover BMB, the annual meeting of the American Society for Biochemistry and Molecular Biology, which will be held March 23–26 in San Antonio.

Our research has the potential to better the lives and health of women struggling with substance use. If we can confirm that estrogen drives nicotine seeking and consumption through olfactomedins, we can design drugs that might block that effect by targeting the altered pathways. These drugs would hopefully make it easier for women to quit nicotine.”

Sally Pauss, doctoral student, University of Kentucky College of Medicine

For the new study, the researchers used large sequencing datasets of estrogen-induced genes to identify genes that are expressed in the brain and exhibit a hormone function. They found just one class of genes that met these criteria: those coding for olfactomedins. They then performed a series of studies with human uterine cells and rats to better understand the interactions between olfactomedins, estrogen and nicotine. The results suggested that estrogen activation of olfactomedins -; which is suppressed when nicotine is present -; might serve as a feedback loop for driving nicotine addiction processes by activating areas of the brain’s reward circuitry such as the nucleus accumbens.

The researchers are now working to replicate their findings and definitively determine the role of estrogen. This knowledge could be useful for those taking estrogen in the form of oral contraceptives or hormone replacement therapy, which might increase the risk of developing a nicotine use disorder.

The investigators also want to determine the exact olfactomedin-regulated signaling pathways that drive nicotine consumption and plan to conduct behavioral animal studies to find out how manipulation of the feedback loop affects nicotine consumption.

Source:

American Society for Biochemistry and Molecular Biology

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March 26, 2024
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 / 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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March 21, 2024
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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March 15, 2024
Fish oil’s significant role in cancer prevention

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In a recent study published in Scientific Reports, researchers used murine (A/J mice) models to evaluate the anti-cancer efficacy of different oils consumed as a part of ketogenic diets (KDs).

Specifically, they compared seven commonly consumed, fat-enriched KDs with Western-style diets and a 15% carbohydrate diet as controls.

Their results revealed that all ketonic diets proved better than Western-style and 15% carbohydrate diets at preventing nicotine-derived nitrosamine ketone (NNK)-induced lung cancer in mice.

Study: A ketogenic diet rich in fish oil is superior to other fats in preventing NNK-induced lung cancer in A/J mice. Image Credit: Natalia Klenova/Shutterstock.com

Background

This study highlights the anti-lung cancer potential of fish oils (FOs), which were found to increase plasma β-hydroxybutyrate (β-HB), reduce blood glucose, and attenuate fatty acid synthase (FAS) expression, thereby metabolically arresting lung tumor nodule formation.

Notably, to address KD-induced high plasma triglyceride (TG) and cholesterol levels, researchers further characterized the impacts of long-term ketogenic diets on lipid profiles and liver health and found that, not only did standard KDs not induce liver damage, FO-enhanced KDs were even less harmless to liver and lipid profiles, attesting to their safety.

What are ketogenic diets, and what makes them useful against cancers?

Ketogenic diets (KDs) are diets that were initially developed to treat intractable epilepsy in the 1920s. They are characterized by very high-fat contents and low carbohydrates (CHO), forcing the body to metabolize lipids for energy.

Most KDs are designed to supply 90% of total calories from fats, while only 2% are acquired from CHO. KDs acclimatize the body to depend on KD-derived ketone bodies instead of glucose.

Ketone bodies, in turn, have been the source of recent scientific excitement due to the inability of most cancerous tumors to utilize ketones as fuel sources.

Surprisingly, the systematic evaluation of KD-associated fats remains lacking. Still, scientists hypothesize that the differences in the fatty acid contents of these fats may result in vastly differing tumor cell proliferation profiles.

Previous work by the present research team has established that reductions in easily digestible CHO from 50% (typical CHO content of Western-style diets) to 15% significantly reduce nicotine-derived nitrosamine ketone (NNK)-induced tumor nodules in A/J mice, further supporting the need for an investigation of the benefits of alternative fat-rich, CHO-poor diets as preventive interventions against cancer.

“…saturated fatty acids like palmitic acid, the most common dietary fatty acid, are potent activators of Toll like receptor 4 (TLR4) signaling in macrophages, making them pro-inflammatory. As well, omega 6 fatty acids like arachidonic acid (AA) are known to be metabolized to prostaglandin E₂ (PGE₂), a prostanoid shown to help tumors grow, both directly and via suppression of anti-tumor immunity. Omega 3 fatty acids, on the other hand, have been shown to be anti-inflammatory, at least in part by inhibiting AA conversion to PGE_2.”

About the study

In the present study, researchers compared the anti-NKK-induced lung cancer efficacies of three different dietary regimes – the Western-style diet (50% CHO), the 15% amylose diet (developed in-house; 50% fat-based), and KDs (seven types, each with a different fat source).

The seven KDs comprised Western-type fats (standard KD), medium chain fatty acids (MCT-KD), milk fat (MF-KD), palm oil (PO-KD), olive oil (OO-KD), corn oil (CO-KD), and fish oil (FO-KD).

All experiments were conducted on 12-week-old female A/J mice. Data collection included blood glucose levels (measured during nocturnal feeding), biochemical blood and plasma analyses (Plasma β-hydroxybutyrate [β-HB], cholesterol, and alanine aminotransferase levels), and immunohistochemistry of excised and preserved lung and liver tissue.

Since the prolonged dependence on KDs has been hypothesized to alter lipid profiles and potentially damage the liver, researchers further investigated the liver health scores (via proxies and biomarkers) of the various KDs compared to Western and 15% amylose diets.

For liver health evaluations, the thiobarbituric acid substances (TBARS) assay was used to determine liver TBARS levels, enzyme-linked immunosorbent assays (ELISAs) were used for liver 8-OHdG determination, and whole liver sections were scored for non-alcoholic fatty liver disease (NAFLD).

Finally, in an attempt to unravel the mechanistic underpinnings of KDs’ (specifically, fats’) anti-cancer ability, mice fecal samples were used for microbiome analysis.

Study findings

The results of the five-month-long dietary interventions following NNK injections revealed that Western diets were the worst (mean nodule number = 18). In contrast, 15% of amylose diets only depicted ten nodules on average.

KDs (even the standard KD containing common Western diet fats) performed much better than both diets. FO-enriched KDs, in particular, were found to perform the best and were the only KD cohort to differ significantly in nodule number from standard KD.

Investigations into the mechanisms underpinning these observations revealed that FO-KD produced substantially more ketone bodies than other KD cohorts.

In parallel, KD was shown to downregulate, attenuate fatty acid synthase (FAS) expression, and increase CPT1a levels within the liver. Notably, fish oil enrichment further exuberated these results.

This suggests that ketosis improvements may contribute to FO-KD’s anti-cancer properties. FO-KDs were additionally observed to reduce the levels of inflammatory cytokines, including interleukin-6 (IL-6) and PGE₂, in mouse lungs.

“Interestingly, palm oil and corn oil-enriched KDs further lowered IL-6 levels, potentially challenging the long-held notion that palm oil and corn oil are pro-inflammatory. On the other hand, the PO-KD and CO-KD resulted in the highest levels of IFNγ and the lowest levels of IL-5 and IL-10 amongst the different KDs. Unexpectedly, even though the FO-KD was the most effective in preventing lung nodule formation, this diet had no unique impact on the pro-inflammatory cytokines/chemokines tested, other than a trend towards high IL-1β levels.”

Immunohistochemistry results validate these assays and suggest that FAS, substantially lower in KDs (and lowest in FO-KD) than Western diets, may play the most crucial role in NNK-induced lung pathology.

Encouragingly, liver health assays debunked previously hypothesized concerns, revealing that not only did KDs do no more damage than standard Western diets or the 15% amylose diet, but FO-KD and MCT-KD were found to cause even less liver damage than these.

In contrast, while standard KD did not significantly alter lipid profiles compared to Western and amylose diets, FO-KD and MCT-KD substantially increased low- (LDL) and very low-density lipoprotein (VLDL) levels in mice plasma.

Conclusions

The present study validates the long-term safety of KDs on liver health and validates their anti-lung cancer properties in A/J mice.

Fish oil was found to be the most effective of all tested KD fats and is assumed to confer anti-cancer protection through metabolic alterations, especially by reducing FAS levels.

These findings highlight FO-KD as a future intervention against lung cancer, but its cardiovascular safety must first be confirmed before these interventions can be implemented.

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March 11, 2024
Prenatal exposure to nicotine could increase risk of behavioral disorders in newborns, study finds

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Although several studies have linked smoking during pregnancy with neurodevelopmental disorders, the results of behavioral experiments in mice prenatally exposed to nicotine have been inconsistent. In a recent study, scientists from Japan developed a deep learning-based framework to automatically observe and classify mice behavior in such experiments, producing more accurate and unbiased results. They show that prenatal exposure to nicotine could increase the risk of autism spectrum- and attention deficit/hyperactivity disorders in newborns.

The fact that smoking is a risk factor for several diseases, including cancer, stroke, and diabetes, has been known for approximately half a century. However, over the past few decades, scientists have brought to light many of the detrimental effects of smoking during pregnancy, linking this habit to high infant mortality, failed delivery, and low body weight at birth. In addition, recent studies suggest that prenatal nicotine exposure (PNE) may be related to neurodevelopmental disorders, such as attention deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD).

For a long time now, scientists have used animal models (like rodents) to understand how PNE leads to neurodevelopmental disorders. By carefully analyzing the behavior of rodents, they can infer whether PNE is causing neurological changes and the brain regions affected by it; this can later be confirmed through histological analyses.

Unfortunately, thus far, studies on behavioral changes induced by PNE in mice have shown varied results, some of which are contradictory. Although there could be multiple reasons behind these discrepancies, human error and bias are prime suspects. In general, the assessment of complex animal behaviors, especially social interactions, relies on the efforts of human observers, which introduces a baseline level of subjectivity that is hard to dispel. But what if we can leverage artificial intelligence (AI) to produce more accurate and unbiased results from observations of PNE mice behavior?

In a recent study published in Cells on 1 February 2024, researchers from the Department of Molecular and Cellular Physiology at the Shinshu University School of Medicine, including graduate student Mengyun Zhou, Assistant Professor Takuma Mori, and Professor Katsuhiko Tabuchi, developed and trained a deep learning-based system to automatically analyze footage from behavioral experiments on mice. They used this tool to explore the behavioral changes induced by PNE in mice without observer biases, seeking to shed light on the link between nicotine and neurodevelopmental disorders.

The proposed AI-based framework relied on a combination of two well-established open-source toolkits, namely DeepLabCut and Simple Behavioral Analysis (SimBA). “AI tools can label the body parts of animals in a markerless video footage and precisely estimate their poses using supervised machine learning,” explains Prof. Tabuchi. “Since animal behaviors are defined as a specific arrangement of body parts over a short period of time, deep-learning toolkits like SimBA can use the pose estimations obtained with DeepLabCut to classify different types of animal behaviors.”

After reaching an optimal training protocol for their framework using manually labeled data, the researchers conducted several experiments using PNE and control mice, looking for indicators of ADHD- and ASD-like behaviors. First, they carried out cliff avoidance reaction tests, which are used to test impulsivity. In these tests, they placed the subject mouse on top of a slightly elevated platform and took note-;both manually and with the AI system-;of how long the mouse waited before jumping down the platform. The test results suggested that PNE mice are more impulsive, a behavioral feature of ADHD in humans.

They also tested the working memory of mice using a Y-shaped maze and counted the number of times each mouse spontaneously switched from one arm of the maze to another. “We observed a decrease in the spontaneous alteration in PNE mice, suggesting that their working memory was altered, which is another behavioral feature of ADHD,” comments Mengyun Zhou. “These results suggest prenatal exposure to nicotine may cause ADHD in mice, which is consistent with clinical reports in humans.“

Finally, the researchers conducted open-field and social-interaction experiments, which represented the main challenge for their AI-based system. In these experiments, the researchers observed either one or two mice behaving freely in a large enclosure and looked for indicators of anxiety and social behaviors, such as grooming and following. Interestingly, PNE mice exhibited social behavioral deficits and increased anxiety which are features of ASD. Subsequent histological analysis of hippocampal brain tissue confirmed decreased neurogenesis, a hallmark of ASD. Thus, it appears that smoking may not only increase the risk of ADHD, but also ASD.

Worth noting, the results obtained using the AI-based system were highly reliable, as Prof. Tabuchi highlights: “We validated the accuracy of our behavioral analysis framework by drawing a careful comparison between the results generated by the model and behavior assessments made by multiple human annotators, which is considered the gold standard.” These analyses cement the potential of the proposed approach and showcase its capabilities for many types of behavioral studies.

With any luck, further efforts will pave the way to a solid understanding of mechanisms behind neurodevelopmental disorders like ASD and ADHD, ultimately leading to better diagnostic tools and therapeutic methods.

Source:

Journal reference:

Zhou, M., et al. (2024). Deep-Learning-Based Analysis Reveals a Social Behavior Deficit in Mice Exposed Prenatally to Nicotine. Cells. doi.org/10.3390/cells13030275.

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March 6, 2024