University of Southampton researchers have found that the link between smoking at the start of pregnancy and having a smaller baby may extend to future pregnancies.
The research team studied data between 2003 and 2018 for nearly 17 000 mothers who received antenatal care for their first two pregnancies.
The findings, published in PLOS One, showed that, compared to non-smokers, women who smoked at the start of their first pregnancy were more likely to have a baby born smaller than expected in their second pregnancy. This held true even where they quit by the start of their second pregnancy.
The link between smoking during a pregnancy and that baby’s birth weight is well established. However, until now there has been limited evidence on the impact of maternal smoking on following pregnancies.
This study found that for women who smoked but did not smoke at the start of either pregnancy, there was no extra risk of a small for gestational age (SGA) baby in the second pregnancy compared to non-smokers. A mother who smoked ten or more cigarettes a day at the start of both of her first two pregnancies had the highest odds of SGA birth.
Study leader Dr Nisreen Alwan, Associate Professor at the University of Southampton, said: “It is important to encourage women to quit smoking before pregnancy and to not resume smoking after the baby is born. Resources that support mothers to quit and maintain smoking cessation are needed.”
First author Elizabeth Taylor said: “Women who smoke between pregnancies can reduce the risk of having a SGA baby by stopping smoking before the start of their next pregnancy. The period between pregnancies is when most mothers have close contact with health and care professionals and may require support to stop smoking.”
It is hoped that these findings and future research will encourage healthcare professionals and commissioners to provide better support to women before and between pregnancies, helping them to quit smoking, leading to better health for both mothers and children.
A large study has found that women smoke fewer cigarettes than men but are less likely to quit.
Study author Ms Ingrid Allagbe, PhD student at the University of Burgundy, said: “In our study, women who used smoking cessation services had higher rates of overweight or obesity, depression, and anxiety compared to men and kicked the habit less often. Our findings highlight the need to provide smoking cessation interventions tailored to the needs of women.”
This study, presented at ESC Congress 2021, compared characteristics and abstinence rates of men and women visiting smoking cessation services between 2001 and 2018 in France, obtained from a nationwide database. The participants were smokers with at least one additional risk factor for cardiovascular disease: overweight/obese (body mass index [BMI] 25 kg/m² or above); high cholesterol; diabetes; high blood pressure; history of stroke, heart attack or angina.
Participants were classified as having mild, moderate, or severe nicotine dependence. Smoking abstinence (at least 28 consecutive days) was self-reported and confirmed by measurement of exhaled carbon monoxide less than 10 parts per million (ppm).
Participant height, weight, age, education level, chronic conditions, and number of cigarettes smoked each day were recorded. Participants were classified as having anxiety and depression symptoms or not according to their medical history, use of anti-anxiety medication or antidepressants, and the Hospital Anxiety and Depression Scale (HADS).
A total of 37 949 smokers were included in the study, of whom 43.5% were women. The average age of women in the study was 48 years, while the average age of men was 51 years. More women (55%) reported a bachelor’s degree level of education or higher compared to men (45%).
Both men and women had a high burden of cardiovascular risk factors. High cholesterol was more common in men (33%) than women (30%), as was high blood pressure (26% vs 23%, respectively) and diabetes (13% vs 10%, respectively).
Women were more likely (27%) to be overweight or obese compared to men (20%), and more likely (37.5%) to have symptoms of anxiety or depression than men (26.5%). Chronic obstructive pulmonary disease was more common in women (24%) compared to men (21%) as was asthma (16% vs 9%, respectively).
However, women smoked fewer cigarettes per day (23) than men (27). Severe nicotine dependence was less common, 56% of women compared to 60% of men, and abstinence was less common in women (52%) than men (55%).
Ms Allagbe said: “The findings suggest that despite smoking fewer cigarettes and being less nicotine dependent than men, women find it more difficult to quit. Possible contributors could be the higher prevalence of anxiety, depression and overweight or obesity among women. It has previously been reported that women may face different barriers to smoking cessation related to fear of weight gain, sex hormones, and mood.”
She concluded: “The results indicate that comprehensive smoking cessation programmes are needed for women that offer a multidisciplinary approach involving a psychologist, dietitian, and physical activity specialist.”
A new study has shown that, while parental history is a contributing factor, young heart attack victims are more likely to be smokers, obese, and have high blood pressure or diabetes compared to their peers.
“The findings underline the importance of preventing smoking and overweight in children and adolescents in order to reduce the likelihood of heart disease later in life,” said study author Professor Harm Wienbergen of the Bremen Institute for Heart and Circulation Research.
“Understanding the reasons for heart attacks in young adults is important from a societal perspective due to their employment and family responsibilities,” he continued. “However, there are limited data on the predictors of heart events in this group.”
The researchers compared the clinical characteristics of consecutive patients admitted to hospital with acute myocardial infarction at 45 years of age or younger against randomly selected individuals from the German population. Cases and controls were matched according to age and gender. The case-control study enrolled a total of 522 patients with 1191 matched controls from a national database.
The researchers found that the proportion of active smokers was more than three-fold higher in the young heart attack group compared to the general population (82.4% vs 24.1%). Patients were more likely to have high blood pressure (25.1% vs 0.5%), diabetes (11.7% vs 1.7%) and a parental history of premature heart attack (27.6% vs 8.1%) compared to their peers. Patients were more often obese, with a median body mass index (BMI) of 28.4 kg/m2 compared to 25.5 kg/m2 for controls. In contrast, the proportion consuming alcohol at least four times a week was higher in the general population (11.2%) compared to heart patients (7.1%).
The researchers analysed the independent risk factors for the occurrence of acute myocardial infarction at 45 years of age or younger. The analysis was adjusted for age, sex, high blood pressure, diabetes, active smoking, body mass index, alcohol consumption, years of school education, and birth in Germany.
Hypertension was associated with an 85-fold odds of a heart attack aged 45 or under. The corresponding odds of a premature heart attack associated with active smoking, diabetes mellitus, parental history and obesity (BMI 30 kg/m2 or above) were 12, 5, 3 and 2. Alcohol consumption was associated with a lower odds of heart attack at a young age with an odds ratio of 0.3.
Prof Wienbergen said: “Our study shows that smoking and metabolic factors, such as hypertension, diabetes and obesity, are strongly associated with an increased likelihood of premature acute myocardial infarction. A protective effect of moderate alcohol consumption has been described by other studies and is confirmed in the present analysis of young patients.”
He concluded: “Our study suggests that family history is not the only predisposing factor for early heart attacks. The findings add impetus to the argument that young people should be educated about why it is important to avoid smoking and have a healthy body weight.”
In a new study, parental smoking was linked to an elevated risk of children developing rheumatoid arthritis when they reach adulthood.
Drawing on data for 90 923 participants in the Nurses’ Health Study II (which included female registered nurses aged 25–42 years in 1989), the researchers found that 532 developed rheumatoid arthritis during a median follow-up of 27.7 years. Parental smoking when the participants were children was associated with a 75% higher risk of developing rheumatoid arthritis, even after controlling for personal smoking when the participants were adults. Among participants who went on to smoke as adults, this risk was even greater.
“These results suggest that early life inhalant exposures such as passive smoking may predispose individuals to develop rheumatoid arthritis later in life,” said senior author Jeffrey A. Sparks, MD, MMSc, of Brigham and Women’s Hospital.
“We used advanced statistical methods that allowed us to decipher the potential direct harm of early-life passive smoking experience on rheumatoid arthritis risk, while also taking into account factors occurring throughout adulthood,” added lead author Kazuki Yoshida, MD, ScD.
In addition to the well-documented risks of smoking and vaping, a new UCLA study has revealed that a short vaping session can affect the cells of even healthy younger nonsmokers.
According to their study, published in JAMA Pediatrics, a single 30-minute vaping session can significantly increase cellular oxidative stress, which occurs when the body has an imbalance between free radicals, and the antioxidants which neutralise them.
“Over time, this imbalance can play a significant role in causing certain illnesses, including cardiovascular, pulmonary and neurological diseases, as well as cancer,” said the study’s senior author, Dr Holly Middlekauff, a professor of cardiology and physiology at the David Geffen School of Medicine at UCLA.
E-cigarettes, devices that deliver nicotine with flavouring and other chemicals in a vapour rather than smoke, are popularly seen as a safer cigarette alternative, but research by Prof Middlekauff and others has demonstrated that vaping is associated with a number of adverse changes in the body that can presage future health problems.
For the present study, 32 male and female study participants, aged 21 to 33, were split into three groups: 11 nonsmokers, nine regular tobacco cigarette smokers and 12 regular e-cigarette smokers. The researchers collected immune cells from each individual before and after a 30-minute vaping session to measure and compare changes in oxidative stress among the groups.
The researchers repeated this with a control session where participants spent 30 minutes “sham-vaping,” or puffing on an empty straw.
In nonsmokers, oxidative stress levels were found to be two to four times higher after the vaping session than before. Among the regular cigarette and e-cigarette smokers, the same 30-minute exposure did not lead to an increase in oxidative stress, the researchers noted, most likely because their baseline levels of oxidative stress were already increased. “We were surprised by the gravity of the effect that one vaping session can have on healthy young people,” Prof Middlekauff said. “This brief vaping session was not dissimilar to what they may experience at a party, yet the effects were dramatic.”
The researchers noted that these results are especially troubling due to the increasing popularity of vaping, particularly among the youth. In a 2020 study, nearly a third of high school students reported e-cigarette use during the previous month.
There is still more to be understood about what exactly causes the changes in oxidative stress levels, whether it is caused by the nicotine or non-nicotine elements in e-cigarettes, which will be the subject of future research.
“While there’s a perception that e-cigarettes are safer than tobacco cigarettes, these findings show clearly and definitively that there is no safe level of vaping,” Prof Middlekauff said. “The results are clear, unambiguous and concerning.”
Giving the means to quit smoking to patients with depression could save as many as 125 000 lives over the next 80 years, researchers estimate. This number could be as high as 203 000 if people with depression who are not yet in mental health care settings are included.
The study, led by the Yale School of Public Health, shows the potential benefits that smoking cessation could have in a population suffering disproportionately from tobacco-related disease and death. Smokers with depression already find it harder to quit, and experience more negative withdrawal symptoms if they do, including increased depression. The study is also the first to estimate the population health effects of integrating smoking cessation treatments with standard mental health care. Using more than a decade of data from the National Survey on Drug Use and Health, the researchers made a model to project the effectiveness of smoking-cessation treatments into the future. They assessed how the benefits varied based on different rates of treatment adoption over the next 80 years.
Simulating the health benefits reveals that, at least 32 000 deaths could be prevented by 2100 if a significant number of patients with depression adopted any kind of cessation treatment. Assuming 100% mental health service utilisation and pharmacological cessation treatment, the number of potential lives saved could rise to 203 000.
“We’ve known for a long time that people with depression smoke more than the general population, and that mental health care settings often don’t have cessation treatment as part of standard care. Our study asks: what is that missed opportunity? What do we have to gain when mental health care and smoking cessation treatment are fully integrated,” said lead author and assistant professor Jamie Tam, PhD. The findings are published in the American Journal of Preventive Medicine.
Such high benefits would be a best-case scenario, the researchers cautioned. Even so, the model’s results match public health experts’ long-standing predictions of the results of smoking-cessation treatment becoming a routine part of mental health care. The findings show that even less-optimal cessation treatments would greatly impact both quality and length of life for patients living with depression.
“Beyond reducing the risk of early death, smoking cessation improves quality of life and increases productivity,” Tam added. “Decision makers should remove barriers to mental health care and smoking cessation treatments for people with mental health conditions.”
The researchers concluded that while existing treatments, such as nicotine replacement therapy, varenicline, and bupropion, can raise cessation rates by nearly 60%, in the future there would be even larger health gains if there were better cessation treatments.
A new study has developed a new model for examining the genetic risk for nicotine dependence.
Tobacco smoking carries undeniable health risks, and being unable to quit or moderate smoking draws out the problem. While some people may be casual smokers and can easily quit, others become heavy smokers who struggle to quit. This risk for nicotine dependence comes from a complex mix of environmental, behavioural, and genetic factors.
Twins studies indicate that 40 to 70 percent of the risk factors are heritable. Until recently, however, studies have only explained about 1 percent of the observed variation in liability to nicotine dependence, using a genetic score based on how many cigarettes a person smokes per day.
The new study led by psychologists at Emory University leveraged genome-wide association studies for a range of different traits and disorders correlated with nicotine dependence and explained 3.6 percent of the variation in nicotine dependence. The findings were reported in the journal Nicotine & Tobacco Research.
Higher polygenetic scores for a risk for schizophrenia, depression, neuroticism, self-reported risk-taking, a high body mass index, alcohol use disorder, along with more cigarettes smoked a day were all indicators of a higher risk for nicotine dependence, the researchers found. Meanwhile, the results showed that polygenetic scores associated with higher education attainment lowered the risk for nicotine dependence.
Senior author Rohan Palmer, assistant professor, Behavioral Genetics of Addiction Laboratory, Emory University explained: “If you look at the joint effect of all of these characteristics, our model accounts for nearly 4 percent of the variation in nicotine dependence, or nearly four times as much as what we learn when relying solely on a genetic index for the number of cigarettes someone smokes daily,”
“What we’re finding,” Prof Palmer added, “is that to better leverage genetic information, we need to go beyond individual human traits and disorders and think about how risk for different behaviors and traits are interrelated. This broader approach can give us a much better measure for whether someone is at risk for a mental disorder, such as nicotine dependence.”
“All of the traits and diseases we looked at are polygenic, involving multiple genes,” added first author Victoria Risner, who did the work as an Emory undergraduate majoring in neuroscience and behavioural biology. “That means that millions of genetic variants likely go into a complete picture for all of the heritable risks for nicotine dependence.”
The researchers hope that others will build on their multi-trait, polygenetic model and continue to boost the understanding of the risk for such complex disorders. “The more we learn, the closer we can get to one day having a genetic test that clinicians can use to inform their assessment of someone’s risk for nicotine dependence,” Prof Palmer said.
Though smoking hazards are well known, about 14 percent of Americans use tobacco daily. Around half a million people die each year in the US from smoking or exposure to smoke, and another 16 million have serious illnesses caused by tobacco use, including cancer, cardiovascular disease, and pulmonary disease. While chemicals produced during smoking and vaping cause the health impacts, nicotine hooks people on these habits.
Risner worked on this paper for her Honours thesis. “Nicotine dependence was interesting to me because the vaping scene was just arriving while I was an undergraduate,” she says. “I saw some of my own friends who were into vaping quickly becoming dependent on it, while some others who were using the same products didn’t. I was curious about the genetic underpinnings of this difference.” Risner is now in medical school at University of North Carolina.
The work made use of genome-wide association studies for a range of traits and disorders. The researchers then sought matching variants in genetic data from a nationally representative sample of Americans with nicotine dependence. Polygenetic scores for the different traits and disorders either raised or lowered the risk for that dependence. The strongest predictors were number of cigarettes smoked per day, self-perceived risk-taking, and educational attainment.
The multi-variant, polygenetic model offers a path forward. For instance, a clearer picture of heritability for nicotine dependence, may be gained by adding more risk associations to the model (such as nicotine metabolism) and clusters of polygenic traits (such as anxiety along with neuroticism).
“As we continue to zero in on who is most at risk for becoming nicotine dependent, and what inter-related factors, whether genetic or environmental, may raise their risk, that could help determine what intervention might work best for an individual,” Prof Palmer said.
“Just a few decades ago, it was not well understood that nicotine dependence could have a genetic component,” Risner said. “Genetic studies may help reduce some of the stigma society has against substance use disorders, while also making treatment more accessible.”
A survey in the US has shown that cannabis users are often asthmatic, and some have allergies from cannabis smoking or its second-hand smoke.
Cannabis allergies can potentially cause respiratory symptoms, contact urticaria, angioedema, and uncommonly anaphylaxis. Inhalation of cannabis may also manifest in allergic rhinitis, conjunctivitis, wheezing, and throat oedema. Given the widespread legal use of cannabis, more information is needed on the effects of cannabis use, particularly smoking, on individuals with asthma and allergies.
The anonymous survey, conducted in concert with the Allergy & Asthma Network, consisted of 489 participants, 18% of whom reported cannabis use. A surprising 60% were asthmatic, and 40% had uncontrolled asthma.
Inhalation routes were the most popular way of taking cannabis. About half of users smoked cannabis, while a third vaped it. Only 40% reported being asked by their physician about cannabis use, and about the same proportion of participants were willing to talk to a physician about their cannabis use, said study co-author and cannabis allergy expert, William Silvers, MD.
“In order to more completely manage their allergy/asthma patients, allergists should increase their knowledge about cannabis and inquire about cannabis use including types of cannabinoid, route of use, reasons for use, and adverse effects,” said Dr Silvers. “As with cigarette smoking, efforts should be made to reduce smoking of cannabis, and recommend other potentially safer routes such as edibles and sublingual tinctures.”
Reported positive effects of cannabis use (eg, reduced pain, calm, improved sleep) were more frequent than adverse effects (eg, cough, increased appetite, anxiety). Approximately 20% of survey respondents reported coughing from cannabis, which was associated with smoking cannabis; this was cause for concern as it may indicate smoking risks for cannabis users.
“It surprised me that over half of the cannabis users in this study who have asthma were smoking it,” said principal investigator Joanna Zeiger, PhD. “And further, of those with uncontrolled asthma, half reported smoking cannabis. We also found that people with asthma are not routinely being asked or advised by their physician about cannabis and how they are consuming it.”
The researchers commented that further research into the relationship of cannabis and allergies is warranted. “We look forward to future studies of larger, more diverse cohorts to better explore more deeply the effect of cannabis use on asthma and other allergic disorders,” said Dr Zeiger.
Journal information: Zeiger, J. S., et al. (2021) Cannabis attitudes and patterns of use among followers of the Allergy & Asthma Network. Annals of Allergy, Asthma & Immunology.doi.org/10.1016/j.anai.2021.01.014.
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