Substance Abuse News

Quitting smoking is never easy. However, when you’re poor and uneducated, kicking the habit for good is doubly hard, according to a new study by a tobacco dependence researcher at The City College of New York (CCNY).

Christine Sheffer, associate medical professor at CCNY’s Sophie Davis School of Biomedical Education, tracked smokers from different socioeconomic backgrounds after they had completed a statewide smoking cessation program in Arkansas.

Whether rich or poor, participants managed to quit at about the same rate upon completing a program of cognitive behavioral therapy, either with or without nicotine patches. But as time went on, a disparity between the groups appeared and widened.

Hardest Time With Cravings

Those with the fewest social and financial resources had the hardest time staving off cravings over the long run. “The poorer they are, the worse it gets,” said Professor Sheffer, who directed the program and was an assistant professor with the University of Arkansas for Medical Sciences at the time.

She found that smokers on the lowest rungs of the socioeconomic ladder were 55 percent more likely than those at the upper end to start smoking again three months after treatment. By six months post-quitting, the probability of their going back to cigarettes jumped to two-and-a-half times that of the more affluent smokers. The research will be published in the March 2012 issue of the “American Journal of Public Health” and will appear ahead-of-print online under the journal’s “First Look” section.

More Poor People Smoke

In their study, Professor Sheffer and her colleagues noted that overall, Americans with household incomes of $15,000 or less smoke at nearly three times the rate of those with incomes of $50,000 or greater. The consequences are bleak. “Smoking is still the greatest cause of preventable death and disease in the United States today,” noted Professor Sheffer. “And it’s a growing problem in developing countries.”

Professor Sheffer suggested reasons it may be harder for some to give up tobacco forever.

Smoking relieves stress for those fighting nicotine addiction, so it is life’s difficulties that often make them reach for the cigarette pack again. Unfortunately, those on the lower end of the socioeconomic scale suffer more hardships than those at the top – in the form of financial difficulties, discrimination, and job insecurity, to name a few. And for those smokers who started as teenagers, they may have never learned other ways to manage stress, said Professor Sheffer.

For people with lower socioeconomic status (SES), it can be tougher to avoid temptation as well. “Lower SES groups, with lower paying jobs, aren’t as protected by smoke-free laws,” said Sheffer, so individuals who have quit can find themselves back at work and surrounded by smokers. Also fewer of them have no-smoking policies in their homes.

Not Addressed in Treatment

These factors are rarely addressed in standard treatment programs. “The evidence-based treatments that are around have been developed for middle-class patients,” Professor Sheffer pointed out. “So (in therapy) we talk about middle-class problems.”

Further research would help determine how the standard six sessions of therapy might be altered or augmented to help. “Our next plan is to take the results of this and other studies and apply what we learned to revise the approach, in order to better meet the needs of poor folks,” she said. “Maybe there is a better arrangement, like giving ‘booster sessions’. Not everybody can predict in six weeks all the stresses they will have later on down the road.”

“Some people say [quitting] is the most difficult thing in their life to do,” said Sheffer. “If we better prepare people with more limited resources to manage the types of stress they have in their lives, we’d get better results. “

The research was funded by National Institutes of Health National Cancer Institute (R03 CA141995–01A1) and the National Center for Research Resources (RR 020146). The treatment program was funded by the Arkansas Department of Health.

A study by the University of Liverpool has found that a decrease in smoking rapidly reduces mortality rates in individuals and entire populations within six months.

Research by Professor Simon Capewell and Dr Martin O’Flaherty at the Institute of Psychology, Health and Well-being, examined evidence from clinical trials and natural experiments. They found that a reduction in smoking has a positive impact on mortality rates in both individuals and populations within six months. Likewise, dietary improvements get very positive results within one to three years.

Benefits Happen Quickly

Professor Capewell said:”Our research found that smoking bans and diet improvements powerfully and rapidly reduce chronic disease in both individuals and in the wider population. This actually happens quickly, within a far shorter timescale than had previously been assumed; within months and years rather than decades. This discovery means that policies such as smoking bans or reducing saturated fats are effective at improving health and would save the NHS millions very rapidly.”

The study found that policies that reduce smoking consistently have a rapidly positive effect on mortality rates and hospital admissions in countries and communities around the world. After smoke-free legislation was introduced in Scotland in 2006, hospital admissions for acute coronary syndrome decreased by 17% with a 6% decrease in out-of-hospital cardiac deaths.

Similarly, when smoke-free legislation was introduced in Helena, an isolated community in the US, it resulted in a 40% drop in admission rates for acute coronary syndrome within six months in one hospital. When the law was repealed the coronary admissions returned to previous levels within six months.

Diet Changes Help Too

Changes to diet also have a rapid and positive impact on the reduction of mortality rates for coronary heart disease. Coronary death rates rose steadily during the 20th Century, peaking in the 1970s in the UK, US and Western Europe. However, closer scrutiny of national trends revealed a notch in the early 1940s. This has been attributed to sudden decreases in dietary meat and animal fats due to food rationing during the Second World War.

More recently, a study of coronary disease in Poland found that death rates from heart disease had been rising steadily. From 1990, however, they quickly dropped by 25% after meat and animal fat subsidies from the communist countries ceased and cheap vegetable oils and fruit flooded the market. A study of other central European countries confirmed very similar trends.

Current cigarette smokers have a higher risk of bladder cancer than previously reported, and the risk in women is now comparable to that in men, according to a study by scientists from the National Cancer Institute (NCI), part of the National Institutes of Health. The report was published on Aug. 16, 2011, in the Journal of the American Medical Association.

This latest study uses data from over 450,000 participants in the NIH-AARP Diet and Health Study, a questionnaire-based study that was initiated in 1995, with follow-up through the end of 2006.

Female Bladder Cancer Link

While previous studies showed that only 20 to 30 percent of bladder cancer cases in women were caused by smoking, these new data indicate that smoking is responsible for about half of female bladder cancer cases – similar to the proportion found in men in current and previous studies. The increase in the proportion of smoking-attributable bladder cancer cases among women may be a result of the increased prevalence of smoking by women, so that men and women are about equally likely to smoke, as observed in the current study and in the U.S. population overall, according to surveillance by the CDC. The majority of the earlier studies were conducted at time periods or in geographic regions where smoking was much less common among women.

The researchers found that the amount of risk brought on by smoking, called excess risk, was higher in this study than in previously reported. “Current smokers in our study had a fourfold excess risk of developing bladder cancer, compared to a threefold excess risk in previous studies. The stronger association between smoking and bladder cancer is possibly due to changes in cigarette composition or smoking habits over the years,” said study author Neal Freedman, Ph.D., in NCI’s Division of Cancer Epidemiology and Genetics (DCEG). “Incidence rates of bladder cancer in the United States have been relatively stable over the past 30 years, despite the fact that smoking rates have decreased overall. The higher risk, as compared to studies reported in the mid-to-late 1990s, may explain why bladder cancer rates haven’t declined.”

Increase in Carcinogens

Although there have been reductions in the concentrations of tar and nicotine in cigarette smoke, there have been apparent increases in the concentrations of certain carcinogens associated with bladder cancer. A 2009 NCI/DCEG study was the first to suggest a higher risk for smoking-induced bladder cancer than previously reported. That report, based on data from the New England Bladder Cancer Study, found that the association between cigarette smoking and risk of bladder cancer appeared to be stronger than it was in the mid-1990s. The results of the new study confirm the 2009 report.

In the current study, former smokers were twice as likely to develop bladder cancer as never smokers, and current smokers were four times more likely than those who never smoked. As with many other smoking-related cancers, smoking cessation was associated with reduced bladder cancer risk. Participants who had been smoke-free for at least 10 years had a lower incidence of bladder cancer compared to those who quit for shorter periods of time or who still smoked.

20 Percent Still Smoke

“Our findings provide additional evidence of the importance of preventing smoking initiation and promoting cessation for both men and women,” said senior author Christian Abnet, Ph.D., also from DCEG. “Although the prevalence of cigarette smoking has declined, about 20 percent of the U.S. adult population continues to smoke.”

Even though smoking carries the same risk for men and women, men are still about four times more likely to be diagnosed with bladder cancer. These results, as well as those from previous studies, suggest that difference in smoking rates explain only part of the higher incidence rates in American men. The researchers suggest that occupational exposures, as well as physiologic differences, may contribute to the gender disparity.

In 2011, approximately 69,250 people will be diagnosed with bladder cancer in the United States, and 14,990 will die from the disease.

Two new studies have found that smokers who tend to take their first cigarette soon after they wake up in the morning may have a higher risk of developing lung and head and neck cancers than smokers who refrain from lighting up right away. Published early online in Cancer, a peer-reviewed journal of the American Cancer Society, the results may help identify smokers who have an especially high risk of developing cancer and would benefit from targeted smoking interventions to reduce their risk.

Cigarette smoking increases one’s likelihood of developing various types of cancers. But why do only some smokers get cancer? Joshua Muscat, PhD, of the Penn State College of Medicine in Hershey, and his colleagues investigated whether nicotine dependence as characterized by the time to first cigarette after waking affects smokers’ risk of lung and head and neck cancers independent of cigarette smoking frequency and duration.

More Likely to Develop Cancer

The lung cancer analysis included 4,775 lung cancer cases and 2,835 controls, all of whom were regular cigarette smokers. Compared with individuals who smoked more than 60 minutes after waking, individuals who smoked 31 to 60 minutes after waking were 1.31 times as likely to develop lung cancer, and those who smoked within 30 minutes were 1.79 times as likely to develop lung cancer.

The head and neck cancer analysis included 1,055 head and neck cancer cases and 795 controls, all with a history of cigarette smoking. Compared with individuals who smoked more than 60 minutes after waking, individuals who smoked 31 to 60 minutes after waking were 1.42 times as likely to develop head and neck cancer, and those who smoked within 30 minutes were 1.59 times as likely to develop head and neck cancer.

Higher Levels of Nicotine

These findings indicate that the need to smoke right after waking in the morning may increase smokers’ likelihood of getting cancer. “These smokers have higher levels of nicotine and possibly other tobacco toxins in their body, and they may be more addicted than smokers who refrain from smoking for a half hour or more,” said Dr. Muscat. “It may be a combination of genetic and personal factors that cause a higher dependence to nicotine.”

According to the authors, because smokers who light up first thing in the morning are a group that is at high risk of developing cancer, they would benefit from targeted smoking cessation programs. Such interventions could help reduce tobacco’s negative health effects as well as the costs associated with its use.

To dispel any uncertainty about the serious harm caused by smoking to babies and pregnant women, the first-ever comprehensive systematic review of all studies over the past 50 years has established clearly that maternal smoking causes a range of serious birth defects including heart defects, missing/deformed limbs, clubfoot, gastrointestinal disorders, and facial disorders (for example, of the eyes and cleft lip/palate).

Smoking during pregnancy is also a risk factor for premature birth, says Dr. Michael Katz, senior Vice President for Research and Global Programs of the March of Dimes. He says the March of Dimes urges all women planning a pregnancy or who are pregnant to quit smoking now to reduce their chance of having a baby born prematurely or with a serious birth defect.

Serious Health Problems

Babies who survive being born prematurely and at low birthweight are at risk of other serious health problems, Dr. Katz notes, including lifelong disabilities such as cerebral palsy, intellectual disabilities and learning problems. Smoking also can make it harder to get pregnant, and increases the risk of stillbirth.

About 20 percent of women in the United States reported smoking in 2009. Around the world, about 250 million women use tobacco every day and this number is increasing rapidly, according to data presented at the 2009 14th World Conference on Tobacco or Health in Mumbai.

The new study, “Maternal smoking in pregnancy and birth defects: a systematic review based on 173,687 malformed cases and 11.7 million controls,” by a team led by Allan Hackshaw, Cancer Research UK & UCL Cancer Trials Centre, University College London, will be published online today in Human Reproduction Update from the European Society of Human Reproduction and Embryology.

Dangerous Chemicals

When women smoke during pregnancy, the unborn baby is exposed to dangerous chemicals like nicotine, carbon monoxide and tar, Dr. Katz says. These chemicals can deprive the baby of oxygen needed for healthy growth and development.

During pregnancy, smoking can cause problems for a woman’s own health, including:

• ectopic pregnancy;
• vaginal bleeding;
• placental abruption, in which the placenta peels away, partially or almost completely, from the uterine wall before delivery;
• placenta previa, a low-lying placenta that covers part or all of the opening of the uterus.

Smoking is also known to cause cancer, heart disease, stroke, gum disease and eye diseases that can lead to blindness.

Tobacco companies increased the advertising and lowered the sale price of menthol cigarettes in stores near California high schools with larger populations of African-American students, according to a new study from the Stanford School of Medicine.

Although cigarette makers have denied using race or ethnicity to target customers, the lead researcher for the study said the data shows a “predatory” marketing pattern geared to luring young African Americans into becoming smokers.

Racial Targeting Denied

“The tobacco companies went out of their way to argue to the Food & Drug Administration that they don’t use racial targeting,” said Lisa Henriksen, PhD, senior research scientist at the Stanford Prevention Research Center. “This evidence is not consistent with those claims.”

Henriksen is the first author of this study, which will be published online June 24 in Nicotine & Tobacco Research.

The study comes at a time when the FDA is gathering information on whether to ban menthol as a flavoring agent in cigarettes. A federal law passed in 2008 banned 13 candy flavorings in cigarettes but allowed for the continued use of menthol. Menthol makes the smoke from tobacco smoother and less harsh; even non- menthol cigarettes often have low levels of the substance.

A draft report by the Tobacco Products Scientific Advisory Committee, which the FDA asked to investigate the harms from the use and marketing of menthol cigarettes, found that the use of menthol cigarettes is highest among minorities, teenagers and low-income populations. Advertisements often tout the “freshness” of menthol cigarettes, and the report said many smokers mistakenly believe that the addition of menthol makes cigarettes less of a health risk.

The committee’s report says that “removal of menthol cigarettes from the marketplace would benefit public health in the United States,” but the FDA doesn’t have to follow the group’s recommendation. The committee is scheduled to meet July 21 in Rockville, Md., to discuss final changes to the document. An FDA spokesman said the edited version of the report will be posted soon on the agency’s website, but there is no timeline yet as to when the FDA will make a decision on menthol.

“The committee was charged with considering a broad definition of harm to smokers and other populations, particularly youth,” said Henriksen. “We think our study, which shows the predatory marketing in school neighborhoods with higher concentrations of youth and African-American students, fits a broad definition of harm.”

Preference for Menthol Cigarettes

In the Stanford study, Henriksen and her colleagues note that the preference for menthol cigarettes among teenage smokers increased from 43.4 percent in 2004 to 48.3 percent in 2008. Menthol cigarettes were also most popular among African-American smokers ages 12-17 (71.9 percent), compared to Hispanics (47 percent) and non-Hispanic whites (41 percent) of the same ages.

To find out how the leading brands of menthol and non-menthol cigarettes were promoted near California high schools, the researchers randomly selected convenience stores, small markets and other tobacco retailers within easy walking distance of 91 schools. The researchers then rated how the cigarettes were marketed in those stores. The data were collected in 2006.

The researchers found that for every 10-percentage-point increase in the proportion of African-American students at a school, the proportion of advertisements for menthol cigarettes increased by 5.9 percentage points. Additionally, the odds of an advertised discount for Newport, the leading brand of menthol cigarettes, were 1.5 times greater.

When it came to price, the average per-pack price for Newport was $4.37 at the time of the study, with Marlboro – the leading non-menthol brand – averaging $3.99. It also found that for every 10-percentage-point increase in the proportion of African-American students at the nearby school, the per-pack price for Newport was 12 cents lower. Advertised discounts and prices for Marlboro, however, were unrelated to school or neighborhood demographics.

“That’s important because lower prices tend to lead to increased cigarette use,” Henriksen said.

In addition, the study found that for each 10-percentage-point increase in the proportion of neighborhood residents ages 10-17, the proportion of menthol advertisements increased by 11.6 percentage points, and the odds of an advertised discount for Newport was 5.3 times greater.

Although the study was limited to California high schools, the authors believe the findings would be similar throughout the country.

Advertising Targets Teens

“When kids are exposed to more cigarette advertising they are more likely to start smoking, which will undoubtedly lead to dire health consequences,” said senior author Stephen Fortmann, MD, a professor emeritus of medicine at Stanford who is now a senior investigator at Kaiser Permanente Center for Health Research in Portland, Ore. “Our study finds that tobacco companies are trying to make smoking more attractive to teens, when we as a society should be doing just the opposite.”

Given previous research that young smokers and African-American smokers are more sensitive to prices than other groups, Fortmann and Henriksen said they believe this study clearly shows how tobacco companies are trying to target black teens in marketing menthol cigarettes.

“Adding menthol to cigarettes makes it easier to smoke and harder to quit, so the public health community strongly supports an FDA ban on menthol flavoring,” Fortmann said.

Parents shouldn’t let up when it comes to discouraging their kids from smoking.

That’s the message of a study to be presented Monday, May 2, at the Pediatric Academic Societies (PAS) annual meeting in Denver.

Previous research has shown that parents can deter adolescents from smoking by monitoring them and enforcing anti-smoking practices at home. Researchers, led by E. Melinda Mahabee-Gittens, MD, an emergency medicine physician at Cincinnati Children’s Hospital Medical Center, sought to determine if family factors continue to protect adolescents as they grow older and whether these factors affect youths of varying racial/ethnic backgrounds differently.

Family Factors in Smoking

Investigators studied 3,473 pairs of white, black and Hispanic parents and nonsmoking youths who participated in the National Survey of Parents and Youth in November 1999-June 2001 (Time 1) and again in July 2002-June 2003 (Time 2). They looked at whether youths remained nonsmokers throughout the study period, and they assessed changes in family factors thought to protect against smoking initiation over time.

Results showed no differences in the rate of smoking initiation between Time 1 and Time 2 by race. In addition, youths in all three racial/ethnic groups reported associating more with peers who smoked at Time 2 than at Time 1.

The levels of protective family factors decreased significantly from Time 1 to Time 2 across all racial/ethnic groups in both smokers and nonsmokers. However, levels of protective factors were consistently higher in nonsmoking youths compared to smokers. Continued, higher levels of connectedness and monitoring by parents decreased the risk of smoking initiation by as much as 30 percent in both whites and Hispanics.

Increased Risk of Smoking

Meanwhile, decreases in the following family factors from Time 1 to Time 2 were associated with an increased risk that youths would start smoking: 1) punishment: up to 43 percent increased risk in all three racial/ethnic groups; 2) monitoring: 42 percent increased risk in blacks only; and 3) connectedness: up to 26 percent increased risk in both blacks and Hispanics.

“Even though the level of protective family factors decreased as youth grew older, they remained important in continuing to protect against smoking initiation,” said Dr. Mahabee-Gittens, who is also associate professor of pediatrics at the University of Cincinnati. “These findings support smoking prevention interventions that encourage parents of all three racial/ethnic groups to enforce consistent consequences of smoking behavior, and encourage continued monitoring and connectedness in minority groups.”

Many brain imaging studies have reported that tobacco smoking is associated with large-scale and wide-spread structural brain abnormalities.

The cerebral cortex is a specific area of the brain responsible for many important higher-order functions, including language, information processing, and memory. Reduced cortical thickness has been associated with normal aging, reduced intelligence, and impaired cognition.

Smoking and Cortical Thickness

However, prior research had not described the impact of smoking upon cortical thickness. A new study, published in the current issue of Biological Psychiatry, now reports concerning findings about the impact of smoking.

Researchers compared cortical thickness in volunteers, both smokers and never-smokers, who were without medical or psychiatric illnesses.

Smokers exhibited cortical thinning in the left medial orbitofrontal cortex. In addition, their cortical thickness measures negatively correlated with the amount of cigarettes smoked per day and the magnitude of lifetime exposure to tobacco smoke. In other words, heavier smoking was associated with more pronounced thinning of cortical tissue.

The orbitofrontal cortex has frequently been implicated in drug addiction. The current findings suggest that smoking-related cortical thinning may increase the risk for addictions, including smoking.

Could Explain Addiction

“Since the brain region in which we found the smoking-associated thinning has been related to impulse control, reward processing and decision making, this might explain how nicotine addiction comes about,” explained Dr. Simone Kühn. “In a follow-up study, we plan to explore the rehabilitative effects of quitting smoking on the brain.”

“The current findings suggest that smoking may have a cumulative effect on the brain,” noted John Krystal, M.D., Editor of Biological Psychiatry and Professor and Chair of Psychiatry at Yale University. “This concerning finding highlights the importance of targeting young smokers for antismoking interventions.”

For now, this study adds to a long and ever-growing list of reasons that smokers should consider quitting.

The percentage of substance abuse treatment facilities offering nicotine replacement therapy to clients gradually increased by about 6 percentage points from 2006 to 2009, according to a new Spotlight report issued by the Substance Abuse and Mental Health Services Administration (SAMHSA) released in conjunction with the “Great American Smokeout.” The report showed that in 2009, 2,613 (19 percent) of 13,513 facilities surveyed were offering nicotine replacement therapy up from 13 percent in 2006.

Tobacco use remains the single most preventable cause of death — causing about 440,000 deaths per year in the United States. Almost half of these deaths occur among people with mental and substance use disorders.

Effective Smoking Cessation

According to the Spotlight report, nicotine replacement therapy including patches, gum and lozenges is a safe and effective way of promoting smoking cessation. The report noted that smokers who use nicotine replacement therapy are twice as likely as nonusers to quit smoking.

“The report shows that substance abuse programs are increasingly recognizing the need to address nicotine addiction as part of treating the whole person. Including nicotine replacement therapy as part of addiction treatment can make a life-saving difference to people who are also often addicted to tobacco and tobacco products,” said SAMHSA Administrator Pamela S. Hyde, J.D. “These efforts are critically important because individuals in substance abuse treatment are more likely to smoke cigarettes than the general population. By helping individuals in treatment say no to cigarettes — we are helping them to take an important step towards a healthier, more productive life.”

The study provided details on what type of treatment facilities were more likely to offer smoking cessation services. Hospital inpatient facilities were much more likely than residential or outpatient facilities to provide nicotine replacement therapies (ranging from 79 percent of hospitals to only16 percent of outpatient programs).

Helping Smokers Quit

In light of this report, SAMHSA encourages all substance abuse treatment facilities to observe the 35th Great American Smokeout each year by instituting their own plans to help smokers quit smoking. (The American Cancer Society sponsors the annual event)

The SAMHSA Data Spotlight was developed as part of the agency’s strategic initiative on data, outcomes, and quality — an effort to inform policymakers and service providers on the nature and scope of behavioral health issues. It is based on SAMHSA’s National Survey of Substance Abuse Treatment Services (NSSATS).

Texting while driving can be a deadly combination for anyone. Yet, new data released today reveal that the dangers of excessive texting among teens are not limited to the road. Hyper-texting and hyper-networking are now giving rise to a new health risk category for this age group.

Scott Frank, MD, MS, lead researcher on the study and director of the Case Western Reserve School of Medicine Master of Public Health program, presented the findings today at the American Public Health Association’s 138th Annual Meeting & Exposition in Denver. Researchers surveyed a cross section of high school students from an urban Midwestern County and assessed whether use of communication technology could be associated with poor health behaviors, including smoking, drinking and sexual activity.

According to the research, hyper-texting, defined as texting more than 120 messages per school day, was reported by 19.8 percent of teens surveyed, many of whom were female, from lower socioeconomic status, minority and had no father in the home.

Hyper-Texters

Drawing from the data, teens who are hyper-texters are 40 percent more likely to have tried cigarettes, two times more likely to have tried alcohol, 43 percent more likely to be binge drinkers, 41 percent more likely to have used illicit drugs, 55 percent more likely to have been in a physical fight, nearly three-and-a-half times more likely to have had sex and 90 percent more likely to report four or more sexual partners.

“The startling results of this study suggest that when left unchecked texting and other widely popular methods of staying connected can have dangerous health effects on teenagers,” said Frank. “This should be a wake-up call for parents to not only help their children stay safe by not texting and driving, but by discouraging excessive use of the cell phone or social websites in general.”

Depression, Suicide

Additionally, hyper-networking, defined as spending more than three hours per school day on social networking websites, was reported by 11.5 percent of students and associated with higher odds ratios for stress, depression, suicide, substance use, fighting, poor sleep, poor academics, television watching and parental permissiveness.

Teens who are hyper-networkers are 62 percent more likely to have tried cigarettes, 79 percent more likely to have tried alcohol, 69 percent more likely to be binge drinkers, 84 percent more likely to have used illicit drugs, 94 percent more likely to have been in a physical fight, 69 percent more likely to have had sex and 60 percent more likely to report four or more sexual partners.