Tag: smoking

LungVax vaccine uses DNA technology to prevent lung cancer

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Developed by scientists from the University of Oxford, the Francis Crick Institute and University College London, the LungVax vaccine uses technology similar to the highly successful Oxford/AstraZeneca COVID-19 vaccine.

The team will receive funding for the study over the next 2 years to support lab research and initial manufacturing of 3,000 doses of the vaccine at the Oxford Clinical BioManufacturing Facility.

Lung cancer cells look different from normal cells due to having “red flag” proteins called neoantigens. Neoantigens appear on the surface of the cell because of cancer-causing mutations within the cell’s DNA.

The LungVax vaccine will carry a strand of DNA which trains the immune system to recognize these neoantigens on abnormal lung cells. The LungVax vaccine will then activate the immune system to kill these cells and stop lung cancer.

In this study, the scientists are developing this vaccine in the lab to show that it successfully triggers an immune response. If this work is successful, the vaccine will move straight into a clinical trial. If the subsequent early trial delivers promising results, the vaccine could then be scaled up to bigger trials for people at high risk of lung cancer. This could include people aged 55-74 who are current smokers, or have previously smoked, and currently qualify for targeted lung health checks in some parts of the UK.

There are around 48,500 cases of lung cancer every year in the UK. 72% of lung cancers are caused by smoking, which is the biggest preventable cause of cancer worldwide.

Kidani Professor of Immuno-oncology at the University of Oxford and research lead for the LungVax project, Professor Tim Elliott, said:

“Cancer is a disease of our own bodies and it’s hard for the immune system to distinguish between what’s normal and what’s cancer. Getting the immune system to recognize and attack cancer is one of the biggest challenges in cancer research today.

“This research could deliver an off-the-shelf vaccine based on Oxford’s vaccine technology, which proved itself in the COVID-19 pandemic. If we can replicate the kind of success seen in trials during the pandemic, we could save the lives of tens of thousands of people every year in the UK alone.”

When given to people with cancer at its earliest stages, anti-cancer treatments are more likely to be successful.

We are developing a vaccine to stop the formation of lung cancer in people at high risk. This is an important step forward in preventing this devastating disease.”

Professor Sarah Blagden, Professor of Experimental Oncology at the University of Oxford and founder of the LungVax project

Professor Mariam Jamal-Hanjani of University College London and the Francis Crick Institute, who will be leading the LungVax clinical trial, said:

“Fewer than 10% of people with lung cancer survive their disease for 10 years or more. That must change. This research complements existing efforts through lung health checks to detect lung cancer earlier in people who are at greatest risk.

“We think the vaccine could cover around 90% of all lung cancers, based on our computer models and previous research, and this funding will allow us to take the vital first steps towards trials in patients.

“LungVax will not replace stopping smoking as the best way to reduce your risk of lung cancer. But it could offer a viable route to preventing some of the earliest stage cancers from emerging in the first place.”

Chief Executive of Cancer Research UK, Michelle Mitchell, said:

“The science that successfully steered the world out of the pandemic could soon be guiding us toward a future where people can live longer, better lives free from the fear of cancer.

“Projects like LungVax are a really important step forward into an exciting future, where cancer is much more preventable. We’re in a golden age of research and this is one of many projects which we hope will transform lung cancer survival.”

President of CRIS Cancer Foundation, Lola Manterola, said:

“We are at a crucial moment in the history of cancer research and treatment. For the first time, technology and knowledge of the immune system are allowing us to take the first steps towards preventing cancer.

“This groundbreaking study represents a firm step in that direction, and we at CRIS consider it essential to support it.”

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March 22, 2024
Smoking linked to increased abdominal fat

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The worry of gaining weight is a common excuse for smokers not to quit. A new study published today in the scientific journal Addiction has found that both starting smoking and lifetime smoking may increase abdominal fat, especially visceral fat: the unhealthy fat deep inside the abdomen that is linked to a higher risk of heart disease, diabetes, stroke, and dementia.

Smokers tend to have lower body weights than non-smokers, but they also have more abdominal fat, and more abdominal visceral fat. Visceral fat is hard to see; you can have a flat stomach and still have unhealthy amounts of it, raising your risk of serious illness. This new study offers supportive evidence that smoking may cause that type of fat to increase.

Researchers at the NNF Center for Basic Metabolic Research, University of Copenhagen used a form of statistical analysis called Mendelian randomization (MR) to determine whether smoking causes an increase in abdominal fat. MR combines the results from different genetic studies to look for causal relationships between an exposure (in this case, smoking) and outcome (increased abdominal fat). This new study combined multiple genetic results from European ancestry studies of smoking exposures and measures of body fat distribution (e.g., waist-hip ratio and waist and hip circumferences).

First, the researchers used previous genetic studies to identify which genes are linked to smoking habits and body fat distribution. Second, they used this genetic information to determine whether people with genes associated with smoking tend to have different body fat distributions. Finally, they accounted for other influences, such as alcohol consumption or socioeconomic background, to ensure that any connections they found between smoking and body fat distribution were truly due to smoking itself and not other factors.

This study found that starting to smoke and smoking over a lifetime might cause an increase in belly fat, as seen by measurements of waist-to-hip ratio. In a further analysis, we also found that the type of fat that increases is more likely the visceral fat, rather than the fat just under the skin.”

Dr. Germán D. Carrasquilla, Lead Author

“Previous studies have been prone to confounding, which happens when an independent variable affects the results. Because our study design uses genetic variations, it does a better job of reducing or controlling for those variables. The influence of smoking on belly fat seems to happen regardless of other factors such as socioeconomic status, alcohol use, ADHD, or how much of a risk-taker someone is.”

“From a public health point of view, these findings reinforce the importance of large-scale efforts to prevent and reduce smoking in the general population, as this may also help to reduce abdominal visceral fat and all the chronic diseases that are related to it. Reducing one major health risk in the population will, indirectly, reduce another major health risk.”

The researchers determined that excess abdominal fat in smokers was predominantly visceral fat by studying how DNA variants linked to smoking habits and belly fat relate to fat compartments in different parts of the body. The key finding is that these genetic factors are more strongly linked to increased visceral adipose tissue-;the deep fat that wraps around the abdominal organs-;than to subcutaneous fat that is stored under the skin.

The two underlying European ancestry studies were large in scale: the smoking study looked at 1.2 million people who started smoking and over 450,000 lifetime smokers, and the body fat distribution study included over 600,000 people.

Source:

Society for the Study of Addiction

Journal reference:

Carrasquilla, G. D., et al. (2024) Estimating causality between smoking and abdominal obesity by Mendelian randomization. Addiction. doi.org/10.1111/add.16454.

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March 21, 2024
Transforming cardiovascular health through diet and education

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In a recent study published in BMJ Nutrition, Prevention, and Health, researchers evaluated the effectiveness of the Get Heart Smart (GHS) program in improving cardiovascular health.

Study: Evaluation of a 4-week interdisciplinary primary care cardiovascular health programme: impact on knowledge, Mediterranean Diet adherence and biomarkers. Image Credit: Sven Hansche/Shutterstock.com

Background

Cardiovascular disease is Canada’s second-leading cause of mortality. Lifestyle changes can boost cardiovascular health by improving the lipid profile and blood pressure.

Limiting alcohol use, lowering stress, increasing physical activity, managing weight, stopping smoking, and eating a well-balanced, nutrient-dense diet, such as the Mediterranean diet, can optimize cardiovascular health.

The Mediterranean Diet promotes a high diet of unsaturated fats, fruits, leafy greens, wholegrain cereals, seeds, nuts, plant-origin proteins, moderate animal-based protein consumption, and minimal sweet intake.

A two-point rise in the Mediterranean Diet score is associated with better health, including lower mortality, CVD risk, neoplastic illness, and depression. Health education and motive planning can improve cardiovascular outcomes.

According to the Planned Behavior Theory, knowledge can robustly estimate involvement, which impacts intentions and subsequent behavior change.

About the study

In the present pragmatic, longitudinal cohort study, researchers explored the impact of the GHS program on cardiovascular outcomes.

The researchers enrolled 31 adults in the four-week GHS program formulated by the East Elgin Family Health Team dieticians based on referrals from healthcare practitioners or by themselves. Due to COVID-19, 16 participants attended the program virtually.

The program comprised four weekly educational sessions of 75 minutes each to improve participant awareness of BP and cholesterol management.

In addition, the program educated the participants on grocery store navigation from a cardiovascular perspective and reviewed diets that improve cardiovascular health [like the Mediterranean Diet, Portfolio Diet, and Dietary Approaches to Stopping Hypertension (DASH) diet].

In one session, a physician answered questions concerning cardiovascular medications. After each session, participants developed their SMART (specific, measurable, achievable, realistic, and timely) goals.

The team conducted in-person sessions between May 2019 and March 2020 and provided educational handouts to the participants.

They obtained blood samples from the participants for metabolic profile analysis and used the GHS knowledge questionnaire to assess participant awareness. The primary outcome was a change in Mediterranean Diet adherence after four weeks and six months of follow-up.

Secondary study outcomes included changes in glycated hemoglobin (HbA1c), blood pressure (BP), lipid profile [total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides], and an improved understanding of cardiovascular health after four weeks and six months.

In addition, the team compared cardiovascular outcomes between those attending in-person and virtually during COVID-19.

They performed two-way repeated-measures analyses of variance (RM-ANOVAs) to investigate GHS program effectiveness using data obtained between May 2019 and March 2023.

Results

The study population was primarily comprised of healthy female Caucasians, with a mean age of 61 years. GHS program participation was strong, with participants attending an average of 3.5 out of 4 sessions, with no significant differences between in-person and virtual attendance.

Knowledge ratings differed significantly between groups at baseline and after four weeks. Over six months, the team noted significantly higher Mediterranean Diet adherence and knowledge ratings in the in-person, virtual, and pooled samples. None of the biomarker alterations, except triglycerides, were statistically significant.

Following the four-week GHS course, the virtual group’s Mediterranean Diet adherence improved significantly. After a six-month follow-up, adherence to the Mediterranean Diet was remarkably higher in the virtual and in-person groups.

The effect on Mediterranean Diet adherence increased considerably with time (partial eta squared for time: 0.4).

After four-week and six-month follow-ups, the pooled, virtual, and in-person groups showed significantly higher knowledge scores than at study initiation.

After four weeks, knowledge levels differed considerably between the virtual and in-person groups; however, the team found no statistically significant difference between groups after six months. As time passed, they found a considerable influence on participant knowledge (partial eta squared for time, 0.5).

The study found that the four-week cardiovascular health program significantly increased Mediterranean diet adherence, as seen by an increase in the mean Mediterranean Diet score from 7.0 to 9.2 after six months.

Significant gains in knowledge ratings were observed in both the virtual and in-person groups, showing the adoption of virtual programs.

Future research, however, must assess the program’s effectiveness in larger sample sizes with higher gender and ethnic diversity and poor cardiovascular health to increase the generalizability and validity of the study findings.

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March 21, 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
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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March 20, 2024
Cannabis vaping liquids contain lead and other toxic metals

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Cannabis vape pens can contain unsafe levels of heavy metals

Richard Vogel/AP/ Alamy

Cannabis vape liquids contain toxic heavy metals that do not come from the device itself. In both legal and illegal products, the concentration of nano-sized metal particles exceeds the safe limits for metal intake.

Vaping is touted as a healthier alternative to smoking because heating a drug into an inhalable vapor, rather than burning it, releases lower levels of toxic chemicals. However, vaping liquid does contain other dangerous additives such as benzene, a carcinogen also found in car exhaust. Research…

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March 19, 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
Socioeconomic status shapes the gut microbiome in diverse U.S. population
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Previous studies have reported an association between socioeconomic status (SES) and the gut microbiome, with various biological mechanisms potentially contributing to this relationship. A recent npj biofilms and microbiome study investigates how SES impacts the gut microbiome.

Study: Sociobiome – Individual and neighborhood socioeconomic status influence the gut microbiome in a multi-ethnic population in the US. Image Credit: Maciej Bledowski / Shutterstock.com

Background

There is a positive correlation between lower SES and mortality that is related to chronic diseases, including cardiovascular disease, cancer, and diabetes. However, the biological mechanisms involved in SES-related health disparities remain unclear.

Low SES is often associated with unhealthy eating behaviors, smoking, consumption of alcohol, and reduced access to medical services. These unhealthy SES-associated behaviors have implications for the development of chronic diseases and influence the gut microbiome.

Ample evidence exists regarding the impact of maternal and family SES on the infant and childhood gut microbiome. Furthermore, twins who experience a different SES during adulthood exhibit differences in the composition of their gut microbiome. Nevertheless, these data have typically been obtained from small cohorts, thus necessitating the need for larger samples with information on area-related measures from racially diverse populations to confirm these findings.

About the study

Data on 825 participants of diverse nativity and racial backgrounds were obtained from the Food and Microbiome Longitudinal Investigation (FAMiLI) study. SES was inferred by noting individual and neighborhood characteristics.

The researchers were primarily interested in determining whether low SES was associated with overall gut microbiota diversity and composition. Heterogeneity analyses were conducted to explore the role of race/ethnicity and nativity in the development of the gut microbiome.

Study findings

Within the study cohort, 36.7% were male, and the mean age was 59.6 years. About 38% of the participants were non-Hispanic White, 34.8% non-Hispanic Asian, 10.8% non-Hispanic Black, and 16.7% Hispanic.

Approximately 48% of the cohort were foreign-born, whereas 25% had completed high school or less education. Neighborhood- and individual-level SES were correlated with race/ethnicity and nativity.

A greater association was observed between lower individual educational attainment and microbial α-diversity, which was represented by the number of within-sample phylogenetic tree units. Participants from more deprived neighborhoods did not exhibit significant α-diversity. Moreover, β-diversity or overall composition differentials in gut microbiome correlated with neighborhood- and individual-level SES indicators.

Ten bacterial species were differentially present by SES indicators. Some taxa associated with low SES included Collinsella sp000434535, Catenibacterium sp000437715, Prevotella copri, Prevotella stercorea, and Dorea_A formigenerans.

Monoglobus pectinilyticus, Lawsonibacter asaccharolyticus, Dysosmobacter welbionis, and Frisingicoccus caecimuris were associated with high SES. Comparatively, Dorea_A formicigenerans, Catenibacterium sp000437715, and Prevotella copri were associated with social deprivation index (SDI) scores and neighborhood income. Occupation and SDI scores were associated with Dysosmobacter welbionis.

The abundance of Bacteroides and Prevotella, both of which are known biomarkers for diet and lifestyle, was compared. Consistent with previous reports, a higher abundance of Prevotella and a lower abundance of Bacteroides were associated with low SES. These differences could be attributed to varying dietary habits that entail a high consumption of animal products relative to carbohydrates.

Prior research has reported the potential role of Dysosmobacter welbionis in preventing diet-induced diabetes, obesity, and metabolic disorders in mice. In the present study, a reduced abundance of Dysosmobacter welbionis was observed among low SES participants, which could explain adverse health outcomes, such as diabetes and metabolic disorders, in this group.

Hispanic and Black participants were more likely to have lower SES, as reflected by parameters relating to education, occupation, neighborhood income, and deprivation. United States-born participants had higher SES as compared to foreign-born participants. Concerning race/ethnicity, none of the SES indicators showed marked heterogeneity. However, β-diversity varied significantly between ethnic/racial groups.

Conclusions

A significant association was observed between the gut microbiome and SES across a diverse population. Differences in the SES were associated with the abundance of bacterial species, α-diversity, β-diversity, and microbial functions. Taken together, the study findings emphasize the important role of SES in influencing the gut microbiome composition.

The term “sociobiome” describes the gut microbiota composition of residents of a particular geographic location. Socially minoritized populations are more prone to experiencing adverse health outcomes and environmental conditions. Future studies should consider the broader social context, aside from SES, while identifying microbial factors that influence health inequalities.

Despite the relatively large size of the study cohort, there was an unequal distribution of SES across ethnic/racial groups. Furthermore, the population distribution did not reflect the general American population with regard to the percentages of White, Asian, Black, and Hispanic individuals; therefore, the study findings should be generalized with caution. Residual confounding may have also been present, despite controlling for a wide array of key lifestyle variables.
Journal reference:

Kwak, S., Usyk, M., Beggs, D., et al. (2024). Sociobiome – Individual and neighborhood socioeconomic status influence the gut microbiome in a multi-ethnic population in the US. Npj Biofilms and Microbiomes 10(1);1-10. doi:10.1038/s41522-024-00491-y
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March 14, 2024
New analysis sheds light on cancer incidence and mortality trends in the UK

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In a recent study published in BMJ, researchers investigated trends in cancer incidence and deaths in the United Kingdom (UK) among individuals aged between 35 and 69 years.

Study: 25 year trends in cancer incidence and mortality among adults aged 35-69 years in the UK, 1993-2018: retrospective secondary analysis. Image Credit: Image Point Fr/Shutterstock.com

Background

Over the last 25 years, the UK has seen remarkable improvements in cancer risk factors, including a decline in smoking prevalence as a result of tariff rises, advertising restrictions, and smoke-free laws. Diet and exercise are leading to an increase in the number of overweight or obese individuals.

Between 1993 and 2018, three screening programs for cervical, breast, and bowel cancer were implemented, with the ability to detect non-harmful cases. However, there is limited recent research on cancer incidences and deaths among those aged 35 to 69.

About the study

In the present study, researchers examined changes in cancer incidences and deaths in the United Kingdom between 1993 and 2018 for individuals aged 35 to 69 years.

The researchers examined cancer registration, deaths, and nationwide population-level data from the Public Health Wales, Office for National Statistics (ONS), North Ireland Cancer Registry, Public Health Scotland, the General Register Office for North Ireland, and National Health Service (NHS) England.

They investigated 23 cancer locations in the United Kingdom to determine cancer incidence and deaths among individuals aged 35 to 69 who received cancer diagnoses or died from cancers between 1993 and 2018.

The team used the International Classification of Diseases, Tenth Revision (ICD-10) codes to diagnose cancers. The primary outcomes were changes in cancer incidences and deaths based on age across time.

Sex-specific cancer groups were evaluated without breast and prostate cancers to examine general trends in the absence of the most prevalent cancer site for each gender.

Mesothelioma was a new particular code released in ICD-10, and there were no credible mortality statistics available for this site before 2001; hence, the researchers did not include this kind of malignancy.

They included non-malignant brain and spinal cord tumor codes, despite their benign character, because their presence in the cranial cavity can lead to death.

The researchers omitted non-melanoma skin cancer from the incidence statistics due to incomplete documentation of these tumors, making the data unreliable. To account for yearly volatility in low-case sites, the researchers estimated three-year rolling average age-standardized rates per 100,000 population. They used generalized linear modeling for analysis.

Results

Cancer incidence among individuals aged 35 to 69 years increased by 57% (86,297 from 55,014) for males and 48% (88,970 from 60,187) for women, with an average yearly growth of 0.80% for both genders.

Between 2003 and 2013, prostate and breast cancers grew in both sexes, with the male age-standardized incidence rate falling before 2000 and rising among women. Less frequent malignancies, such as melanoma, skin, liver, mouth, and kidney, have also shown alarming rises.

For males aged 35 to 69 years, the highest mean yearly percentage elevations were for malignancies of hepatic tissues (4.70%), prostate (4.20%), and skin melanomas (4.20%). The highest yearly declines were for stomach (4.2%), bladder (4.10%), and lung (2.10%) cancers.

For females, the highest average yearly percentage increases were for the liver (3.90%), skin melanomas (3.50%), and mouth (3.30%) cancers, whereas the highest annual declines were for bladder (3.60%) and stomach (3.10%).

Over the past 25 years, cancer fatalities were reduced by 20% (26,322 from 32,878) in men and 17% (23,719 from 28,516) in women. Age-standardized mortality rates for all malignancies were decreased by 37% (2.0% each year) in men and 33% (1.6% per year) in women.

The study discovered that after omitting prostate cancer from mortality trends, men’s death rates fell considerably, whereas women’s mortality decreased by 1.3% each year. The highest decline in mortality happened before 2000, with 14% in males and 11% in females.

The most significant declines were shown in bladder, mesothelioma, and stomach malignancies in males, as well as stomach, cervical, and non-Hodgkin lymphoma in women.

For males, the cancers with mean yearly percentage decreases in death rates of ≥1.0% per year were stomach (5.10%), mesothelioma (4.20%), bladder (3.20%), lung (3.10%), non-Hodgkin lymphoma (2.90%), testis (2.80%), Hodgkin lymphoma (2.60%), larynx (2.50%), bowel (2.50%), prostate (1.80%), myeloma (1.70%), and leukemia (1.60%).

For females, the cancers with mean yearly reductions in death rates of ≥1.0% were of the stomach (4.20%), cervix (3.60%), non-Hodgkin lymphomas (3.20%), ovaries (2.80%), breast (2.80%), myeloma (2.30%), bowel (2.20%), mesothelioma (2.0%), laryngeal tissues (2.0%), leukemia (2.0%), bladder (1.60%), esophagus (1.20%), and kidneys (1.00%).

In both sexes, liver (2.70%) and mouth (1.20%) malignancies had mean yearly mortality increases of ≥1.0%.

Conclusion

The study findings showed that cancer mortality in males and females aged 35 to 69 years decreased significantly over the last 25 years, primarily due to cancer prevention, early diagnosis, improved diagnostic testing, and successful treatment.

However, an increase in nonsmoking risk factors may result in a rise in some malignancies. The research provides a baseline for the coming years, assessing the influence of coronavirus disease 2019 (COVID-19) on cancer incidences and outcomes.

There are increased concerns regarding specific cancer sites, with the highest concern being the need to expedite the decline in female lung cancer.

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March 14, 2024
What coping strategies are most effective?
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In a recent review article published in the Journal of Clinical Medicine, researchers summarized the results of a systematic review that explored the impact of different coping strategies for people living with inflammatory bowel disease (IBD).

Study: Coping Strategies and Inflammatory Bowel Disease: A Narrative Review. Image Credit: PeopleImages.com – Yuri A/Shutterstock.com

Background

Through keyword searches, they identified 57 articles published in English in medical databases such as the Cochrane Library, PubMed, EBSCOhost, and EMBASE, concluding that personalized interventions can help diverse populations with IBD rehabilitation and management.

Challenges treating IBD

The two forms of IBD, namely ulcerative colitis (UC) and Crohn’s disease (CD), are thought to occur as a result of mucosal barrier dysfunctions, gastrointestinal microbiome disturbances, immune response dysregulation, genetic background, and environmental risk factors including smoking, air pollution, diet, and stress.

As many as four in 10 IBD patients show no response to biological therapy, though patient education regarding risk factors can improve the management of the disease.

Since IBD can be chronic, it has significant psychosocial effects and can affect work and quality of life.

Patients may cope with these stresses through adaptive strategies that could mitigate their psychological burden, while maladaptive strategies like denial or avoidance could lead to worsening symptoms.

Effects of coping mechanisms

Researchers identified active coping strategies in which individuals act directly to solve problems and address stressors, known as problem-focused coping.

This could include actively monitoring the disease and its symptoms to identify triggers, changes, and patterns. However, becoming overly focused on monitoring can increase stress.

Another form of emotion-focused coping involves reframing thoughts, regulating emotions, and seeking support systems. While these strategies can improve mental well-being, they can also reduce adherence to treatment and lead to individuals delaying seeking medical care.

Disease severity, complications, and activity influence the health-related quality of life (HRQoL) of people living with IBD. However, effectively managing stress, seeking support, being physically active, and adhering to medicine can improve their symptomology and overall well-being.

Adaptive coping mechanisms can lead to perceiving the illness more positively and reduce distress. People with IBD often show resilience by adapting to the side effects of treatments, psychosocial stressors, and symptom flares with problem-solving skills and psychological flexibility.

Individuals may experience reduced psychological resilience after being diagnosed with IBD, but mindfulness can be an effective form of therapy.

Maladaptive coping strategies that are negatively associated with HRQoL include negative religious coping, acceptance-resignation, catastrophizing, low acceptance, passive coping, decreased cognitive flexibility, emotion-focused coping, and perceived control.

Some strategies are also correlated with higher levels of anxiety and depression and lower work productivity.

Researchers have found differences in coping strategies between people with UC and CD. People with CD may experience higher levels of psychological distress and neuroticism while being more likely to adopt maladaptive coping strategies.

In another study, people with UC were more likely to cope by modifying meal content, sleeping more, and seeking medical care.

People with CD, however, adopted strategies like skipping meals or switching to elemental diets as they perceived these as more useful.

Interventions for IBD patients

Educational programs can reduce disease-related anxiety and depression while improving knowledge and the use of adaptive coping strategies. Notably, these improvements have been observed despite disease activity remaining similar.

This suggests that uncertainty around IBD can lead to worse outcomes and that individuals who know more about their condition benefit from this understanding.

Cognitive behavioral therapy (CBT) has also been shown to improve symptoms of depression and anxiety, while interventions focusing on mind-body relaxation additionally improved symptoms and reduced expression of genes directly linked to inflammatory processes.

Another study found that transcranial direct current stimulation reduced pain in the short term, but the effects faded after one week.

People with inactive IBD show a higher inclination to participate in treatment; they also experience lower depression and a higher quality of life.

Some patients with IBD may also experience joint and back pain; they show greater adaptability and flexibility but are less likely to perceive medical interventions as effective.

Conclusions

Individuals living with IBD experience severe challenges to their health and quality of life. As the prevalence of this condition increases, effective coping strategies must be identified to improve the treatment and management of this disease.

The review indicates that patients adopt a multitude of coping mechanisms, some adaptive and some maladaptive.

Their experience of the disease in terms of duration and severity modifies their coping strategies, and these strategies may also affect their condition.

Understanding these complex interplays can help health professionals tailor interventions to groups of people who have specific needs, providing the necessary level of social support and promoting resilience and treatment adherence.
Journal reference:

Popa, S.L., Stanculete, M.F., Grad, S., Brata, V.D., Duse, T., Badulescu, A., Dragan, R., Bottalico, P., Pop, C., Ismaiel, A., Turtoi, D., Dumitrascu, D.I., Pojoga, C., Gherman, C., David, L. (2024) Coping strategies and inflammatory bowel disease: a narrative review. Journal of Clinical Medicine. doi: https://doi.org/10.3390/jcm13061630. https://www.mdpi.com/2077-0383/13/6/1630
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March 14, 2024