TAG: "Tobacco"

Tech tool will support smokers’ efforts to quit


Great American Smokeout is Nov. 20.

UCLA is marking the Great American Smokeout on Nov. 20 by introducing a new technology tool to help smokers who are seen in the UCLA Health System quit for good.

Health care providers in the UCLA Health System will soon be able to send an “eReferral” for tobacco cessation through CareConnect, the patients’ electronic health record, to the California Smokers’ Helpline.

The helpline, based at UC San Diego, offers free telephone counseling and follow-up support that doubles the chances of long-term quitting. Referred patients cared for in the UCLA Health System as inpatients or  outpatients will then receive a call from a helpline counselor within one to two business days. The ordering provider will, in turn, receive a CareConnect results message from the helpline about the interaction with the patient.

The eReferral is just one more tool for health professionals to support a patient’s desire to join the unhooked generation. The helpline’s 1-800-NO-BUTTS number has been around for over 20 years, but eReferral ensures that the helpline will connect with a referred patient and that the ordering provider will be  kept informed.

“I am thrilled that patients suffering from nicotine addiction will get the help that they need to support their quit efforts,” said Linda Sarna, acting dean for the UCLA School of Nursing and one of the UCLA champions of the tobacco-free campus movement. “This eReferral is part of the UC Quits project led by Dr. Elisa Tong from UC Davis, and is supported by the UC Center for Health Quality and Innovation. This ambitious project involves all five of the health science campuses to ensure that every smoker receives support at every encounter. This systemwide collaboration is a historic change in how health care providers can ensure that smokers can get help to quit smoking by using the electronic health care record.”

Tobacco use remains the single largest preventable cause of disease and premature death in the U.S. Yet about 42 million Americans still smoke cigarettes — a bit under one in every five adults — and too few get the help they need to quit. In California, more than 3 million people still smoke cigarettes.

The UC Quits champions at the UCLA campus are Drs. Timothy Fong, Alison Diamont and Estebes Hernandez and nurses Cait Walsh, Elizabeth Bailey and Sarna. On Nov. 20, UCLA’s Tobacco-Free Task Force will host a table in Bruin Plaza from 10 a.m. to 2 p,m. Bruins can learn more about resources to help them, their friends or family members quit.

Learn more about UC Quits at www.ucquits.com, the California Smokers’ Helpline at www.nobutts.org, and UCLA’s Smoke and Tobacco-Free Policy at healthy.ucla.edu/pod/breathe_well.

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Nonsmokers in cars can be exposed to significant secondhand smoke


UCSF researchers find elevated carcinogen markers for first time in car passengers.

Nonsmokers sitting in an automobile with a smoker for one hour had markers of significantly increased levels of carcinogens and other toxins in their urine, indicating that secondhand smoke in motor vehicles poses a potentially major health risk according to a groundbreaking study led by UC San Francisco researchers.

The nonsmoking passengers showed elevated levels of butadiene, acrylonitrile, benzene, methylating agents and ethylene oxide. This group of toxic chemicals is “thought to be the most important among the thousands in tobacco smoke that cause smoking-related disease,” said senior investigator Neal L. Benowitz, M.D., a UCSF professor of medicine and bioengineering and therapeutic sciences and chief of the division of clinical pharmacology at San Francisco General Hospital and Trauma Center.

“Ours is the first study to measure exposure to these particular chemicals in people exposed to secondhand smoke,” said Benowitz. “This indicates that when simply sitting in cars with smokers, nonsmokers breathe in a host of potentially dangerous compounds from tobacco smoke that are associated with cancer, heart disease and lung disease.”

The scientists published their results today (Nov. 14) in the journal Cancer, Epidemiology, Biomarkers & Prevention, published by the American Association for Cancer Research.

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Thirdhand smoke: Toxic airborne pollutants remain long after smoke clears


Researchers assess health impacts of inhalable constituents of thirdhand tobacco smoke.

Berkeley Lab researchers Lara Gundel and Hugo Destaillats found that thirdhand smoke continues to be harmful for hours after a cigarette has been extinguished.

Ever walked into a hotel room and smelled old cigarette smoke? While the last smoker may have left the room hours or even days ago, the lingering odors — resulting from noxious residue that clings to walls, carpets, furniture, or dust particles — are thanks to thirdhand smoke.

Scientists at the U.S. Department of Energy’s Lawrence Berkeley National Laboratory (Berkeley Lab), who have made important findings on the dangers of thirdhand smoke and how it adsorbs strongly onto indoor surfaces, have published a new study assessing the health effects of thirdhand smoke constituents present in indoor air. Looking at levels of more than 50 volatile organic compounds (VOCs) and airborne particles for 18 hours after smoking had taken place, they found that thirdhand smoke continues to have harmful health impacts for many hours after a cigarette has been extinguished.

“In the U.S., the home is now where nonsmokers are most exposed to second- and thirdhand smoke. The goal of our study is to provide information supporting effective protective measures in the home. The amount of harm is measurable even several hours after smoking ends,” said chemist Hugo Destaillats, lead author of the study. “Many smokers know secondhand smoke is harmful, so they don’t smoke when their kids are present. But if, for example, they stop smoking at 2 p.m. and the kids come home at 4 p.m., our work shows that up to 60 percent of the harm from inhaling thirdhand smoke remains.”

Their study, “Inhalable Constituents of Thirdhand Tobacco Smoke: Chemical Characterization and Health Impact Considerations,” has been published online in the journal Environmental Science & Technology. Other co-authors were Berkeley Lab scientists Mohamad Sleiman, Jennifer Logue, and Lara Gundel, and Portland State University professor James F. Pankow and researcher Wentai Luo.

The Berkeley Lab team has done previous studies establishing the formation of harmful thirdhand smoke constituents by reaction of nicotine with indoor nitrous acid, showing that nicotine can react with ozone to form potentially harmful ultrafine particles, and finding that thirdhand smoke can cause genetic damage in human cells. These studies focused primarily on chemical contaminants adsorbed to indoor surfaces, entering the human body through dermal uptake or ingestion of dust. The new study focuses on a third type of exposure, inhalation. The study shows that this route of exposure, even after the smoke dissipates, is also significant.

The team collected data from two environments: one was a room-sized chamber at Berkeley Lab where six cigarettes were machine-smoked and levels of particulate matter and 58 VOCs were monitored during an aging period of 18 hours; the second was a smoker’s home, where field measurements were made eight hours after the last cigarette was smoked. Logue led the health analysis, using an impact assessment approach that she has used for studying indoor air pollutants.

Berkeley Lab researcher Jennifer Logue

Health data was available for only about half of the measured chemicals. For those Logue used a metric called DALY, or disability-adjusted life year, to quantify the health impact. The DALY is commonly used by the World Health Organization (WHO) and others in the public health field as a way to combine loss of life with loss of quality of life in a single metric.

Looking at DALYs lost as a function of time, the study found that the total integrated harm rises sharply in the first five hours after a cigarette has been smoked, continues to rise for another five hours, and doesn’t start to level off until after 10 hours.

“We ranked the health damage due to each of the pollutants for which we had data,” Logue said. “We found that particulate matter, or PM2.5, accounted for 90 percent of the health damage.”

PM2.5, or particles that are less than 2.5 micrometers in diameter, can be inhaled deeply into the lungs and cause serious health problems. The study identified also those tobacco VOCs with the highest health impacts, some of which exceeded concentrations considered harmful by the state of California over the entire 18-hour period.

The researchers caution that this was an initial scoping study, in which they had to rely on health data available for outdoor air particles. Common outdoor sources include vehicle exhaust, forest fires, and burning of fuels. “Tobacco particles have a different composition than outdoor air particles, but there are chemical similarities,” Gundel said. “This is a first-order approximation.”

Another purpose of the study was to better understand the transition between secondhand smoke and thirdhand smoke. Depending on the criteria used, the predicted health damage caused by thirdhand smoke could range from 5 percent to 60 percent of the total harm. “A lot of the harm attributed to secondhand smoke could be due to thirdhand smoke,” Gundel said. “Because there’s a gradual transition from one to the other, we don’t really know yet what the chronic effects of thirdhand smoke are.”

The study is part of a research agenda developed by the California Consortium on Thirdhand Smoke, which was established in 2011 largely as a result of work published in 2010 by Destaillats, Gundel, Sleiman and others. The consortium, which includes researchers from Berkeley Lab, UC San Francisco, UC Riverside, the University of Southern California and San Diego State University, is funded by the Tobacco-Related Disease Research Program, managed by the University of California. Its goals are better understanding the health effects of thirdhand smoke, identifying the most effective control policies and practices to protect nonsmokers, and developing methods to remediate indoor environments contaminated with thirdhand smoke.

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Smoking’s $18B toll on California


Despite declines in numbers of smokers, related diseases account for 1 in 7 deaths in state.

Read the full report (click image to view)

By Carolyn McMillan, UC Newsroom

Fewer Californians smoke today than 10 years ago, yet smoking continues to take an enormous toll on the state and its residents, triggering $18.1 billion in health care costs and lost productivity from illness and premature death.

In the first comprehensive analysis of the financial and health impacts of tobacco in more than a decade, UC San Francisco researchers found that smoking accounted for 1 in 7 deaths in the state — more than from AIDS, influenza, diabetes, or many other causes.

While the number of smokers in California declined from a decade ago, nearly 4 million people still smoke, including an estimated 146,000 adolescents, the UCSF study found.

Far too many smoking deaths

“We found that while the California tobacco control program has led to reductions in tobacco use in the state over the last decade, smoking is still far too prevalent and results in far too many deaths and high health care costs,” said principal investigator Wendy Max, Ph.D., professor of health economics at the UCSF School of Nursing and director of the UCSF Institute for Health & Aging.

The research was conducted at the institute, with grant funding from the Tobacco-Related Disease Research Program of the University of California’s Office of the President.

The findings offer a snapshot of tobacco use throughout the state drawn from 2009 data, the most recent available when the study began.

UCSF researchers profiled each of the state’s 58 counties with total costs, costs per resident and per smoker, expenditures for each type of health care, smoking prevalence and mortality measures. The same investigators conducted similar statewide studies in 1999 and 1989.

The report found that smoking prevalence was higher in some parts of the state than others, and that males — whether teens or adults — were far more likely to smoke than females.

“This kind of detailed data helps us target our limited smoking cessation resources where they are needed most,” said Dr. Michael Ong, chair of the California Tobacco Education and Research Oversight Committee and a UCLA physician. “We also see clearly from this report that tobacco — despite declines in its prevalence — remains a major threat to public health and a drain on health care resources.”

An extraordinary economic burden

The cost to California, its counties and its residents from smoke-related diseases remains significant. In Los Angeles County, for example, smoking carried a $4.4 billion price tag in 2009 — the highest of any county in the state. That total included $2.3 billion in direct health care costs and $2.1 billion for indirect costs, of which $1.7 billion was due to premature deaths.

“Smoking exacts an extraordinary economic burden on our county,” said Dr. Paul Simon, director of the LA County Public Health’s division of Chronic Disease and Injury Prevention. “The dollar amount is staggering, and it does not take into account the untold emotional costs on family members and friends.”

UC President Janet Napolitano said the study exemplifies the ways in which university research informs the work of public health offices around the state. UC campuses conduct a wide range of research each year aimed at improving the lives of Californians and people around the world — often in partnership with state and federal agencies looking to understand and address important health issues.

“In partnership with the state, we’ve made great strides in educating people about the risks of smoking, but as this important study shows, there is much more to do,” Napolitano said.

As the former Arizona attorney general, Napolitano was heavily involved in implementing the Master Settlement Agreement and represented the nation’s attorneys general on the Board of the Legacy Foundation, the largest national nonprofit public health organization devoted to tobacco control.

Statewide, smoking represented $6.8 billion in lost productivity and about 587,000 years of potential life lost from 34,363 deaths, or 17.1 years per death, the researchers found.

More deaths than AIDS, diabetes or Alzheimer’s

Smoking also was found to be a leading cause of death in 2009. The 34,363 total deaths from smoking were 17 times the number from AIDS; five times the deaths from diabetes, influenza and pneumonia; and three times the number of deaths from Alzheimer’s disease and unintentional injuries.

Cancer was the primary cause of smoking-attributable death, accounting for 13,514 deaths, followed by cardiovascular disease with 10,490 deaths, and respiratory diseases with 10,331. Pediatric disease accounted for 27 deaths, and secondhand smoke exposure was attributed to 794 adult deaths.

The direct health care costs of smoking accounted for 54.4 percent of the total $18.1 billion cost of smoking, or $9.8 billion. Lost productivity due to illness comprised 7.9 percent ($1.4 billion), and lost productivity from premature death comprised 37.6 percent ($6.8 billion).

Hospital care of current and former smokers cost $4.3 billion of the $9.8 billion total health care costs of smoking. Ambulatory care services were $2.1 billion; nursing home care, $1.5 billion; prescription drugs, $1.1 billion; and home health care, $794 million.

The report found that the state’s tobacco control efforts have been effective in reducing smoking-attributable deaths, reducing the prevalence of smoking and cutting the real costs of smoking, as compared to a decade ago.

Nonetheless, costs remain high and the wide variation in smoking costs across the counties suggests that many geographic areas would benefit from targeted efforts to reduce smoking.

“County-level estimates of the costs of smoking help to identify geographic disparities in the economic burden of tobacco use. These data are useful for local governments and policy makers to develop more effective tobacco control policies at the local level,” said co-author Hai-Yen Sung, Ph.D., professor of health economics at the UCSF School of Nursing and the UCSF Institute for Health & Aging.

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Why it’s so hard to quit smoking


Findings suggest that nicotine withdrawal significantly impacts brain’s response to reward.

Efforts to quit smoking tend to end in failure. Almost half of smokers attempt to quit each year, but only 4 to 7 percent succeed on any given attempt without medicines or assistance, according to the American Cancer Society, and less than 25 percent of smokers who use medicines remain smoke-free for more than six months. Relapse is especially common within 48 hours of quitting when nicotine withdrawal symptoms are most acute.

In a set of novel experiments involving both humans and rats, researchers at the UC San Diego School of Medicine, Florida Atlantic University (FAU), University of Pittsburgh, Washington University and Harvard Medical School report that the brain’s response to reward – its ability to recognize and derive pleasure from natural stimuli such as food, money or sex – is measurably reduced after nicotine withdrawal.

The findings, published this week online in JAMA Psychiatry, suggest that nicotine withdrawal significantly impacts the ability to modulate behavioral choices based on the expectancy of reward. This deficit is seen often in people who suffer from depression.

“What we saw in both humans and rats was decreased responsiveness to reward,” said Athina Markou, Ph.D., professor and vice chair of research in the Department of Psychiatry at UC San Diego. “During acute nicotine withdrawal, both people and animals attended less to positive rewards. That’s a hallmark of depression. And there is evidence that people who already express depressive symptoms and quit smoking are more likely to become clinically depressed and stay that way. These findings have an obvious bearing on how we approach cessation treatment.”

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How California measures up in fight against cancer


Ahead of other states in some areas, behind in smoking-related policies.

UC Davis' Elisa Tong (left) , Elizabeth David (right) and Lori Bremner from ACS CAN give a media briefing on ACS CAN's 2014 cancer progress report.

In a media briefing at the UC Davis Comprehensive Cancer Center today (Aug. 21), the American Cancer Society Cancer Action Network (ACS CAN) released How Do You Measure Up?, an annual report that scores each state on how they are doing in the fight against cancer.

The 2014 report shows California is ahead of other states in breast and cervical cancer screening programs, protecting young people from tanning devices and broadening Medicare eligibility. The Golden State, however, is falling far behind in smoking-related policies, which are crucial to preventing deaths from certain cancers.

“Tobacco-related cancers continue to lead to the vast majority of cancer deaths we see in the state,” said Elizabeth David, thoracic and cancer surgeon at UC Davis. “We know that 85 percent of lung cancers are caused by cigarette smoking. This year, about 16,000 people in California will be diagnosed with lung cancer and about 35 Californians will die each day from the disease.”

Smoking also increases the risk of many other cancers such as head and neck, esophageal, pancreatic, uterine, cervical, ovarian, kidney, bladder, stomach, colorectal and leukemias, she said.

Lori Bremner, board member with the ACS CAN and 37-year leukemia survivor, said California is failing in comprehensive tobacco control, which should include increasing the price of all tobacco products, implementing comprehensive smoke-free policies and fully funding and sustaining state-wide tobacco-prevention cessation programs.

“Evidence clearly shows that raising tobacco prices through taxes encourages users to quit or cut down and, most importantly, it prevents kids from ever starting,” Bremner said. “California is woefully underfunded in tobacco-prevention programs compared to what’s recommended by the U.S. Centers for Disease Control and Prevention.”

Elisa Tong, an associate professor of internal medicine who conducts research on tobacco control, said California has more than 4 million smokers, which cost the state $9 billion a year in health care expenses.

“In Sacramento, we actually have the highest smoking prevalence rate among California’s urban areas,” said Tong, who said smoke-free policies are crucial for cancer prevention and to help people quit smoking.

“We can address tobacco-cessation at a patient level, but with comprehensive smoke-free policies, we can address the whole environment the patient lives in,” she added.

In 2014, it is estimated that more than 1.6 million people in the United States will be diagnosed with cancer and more than 580,000 people will die from the disease. In California this year, an estimated 155,920 will be diagnosed with cancer and a predicted 153 people will perish daily from the disease.

To view the complete How Do You Measure Up? report, visit www.acscan.org.

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Many young smokers aren’t aware of hookah dangers


Survey finds many young adults believe that smoking hookah is not harmful to their health.

In a UCLA survey, 60 percent of respondents said hookah smoking is a trendy way of socializing. (Photo by Fredler Brave)

Despite warnings from the Centers for Disease Control and Prevention that hookah smoking can be just as dangerous as cigarettes, many young adults believe that using the water pipes is not harmful to their health, according to a UCLA School of Nursing study.

Researchers visited three Southern California hookah lounges and asked patrons between the ages of 18 and 30, “Do you believe smoking hookah is harmful to your health?” Fifty-seven percent said they thought that it was not. When asked why they thought hookahs were not harmful, 47 percent of the participants said they believed that the smoke gets filtered through water, and 35 percent said they thought that fruit used to flavor the tobacco detoxify tobacco’s harmful chemicals. Still others, 16 percent, said they assumed hookahs are not harmful because the tobacco is not addictive and does not contain nicotine.

Unfortunately, none of those beliefs is true.

“With hookah smoking on the rise, particularly among young adults, our goal was to identify factors influencing perceptions, attitudes and preferences toward hookah smoking,” said Mary Rezk-Hanna, a UCLA nursing doctoral student and lead researcher for the study, which was published in the July–August issue of the journal Nursing Research.

Other recent studies have shown that even as cigarette use continues to decline, hookah smoking is increasing, especially among college students. It is the only form of tobacco use that is not regulated in the United States, and its exemption from clean indoor air legislation, such as the California Clean Air Act, is contributing to its rapidly growing popularity. In California alone, there are more than 2,000 shops that sell hookah tobacco and related products, in addition to 175 hookah lounges and cafes, and a disproportionate number of them are in Los Angeles, near universities and colleges.

When asked why hookah smoking is more attractive than cigarette smoking, 60 percent of the participants in the UCLA study said it is a trendy way of socializing. And although 43 percent of hookah smokers said they believe the practice is indeed harmful, “socializing with friends appeared to outweigh health concerns,” Rezk-Hanna said.

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Survey finds e-cigarette online market filled with many brands


Hundreds of brands, thousands of flavors available online.

A survey finds that there are currently 446 e-cigarettes brands online.

Researchers at the UC San Diego School of Medicine have completed the first comprehensive survey of e-cigarettes for sale online and the results, they believe, underscore the complexity in regulating the rapidly growing market for the electronic nicotine delivery devices.

The survey, published in a special supplement today (June 16) of the journal Tobacco Control, found that 10 new e-cigarette brands entered the Internet marketplace every month, on average, from 2012 to 2014, and that there are currently 466 e-cigarette brands online, offering more than 7,700 flavors, including candy flavors such as gummy bear and marshmallow, that may appeal to children. In contrast, traditional cigarettes sold in the United States can be marketed in just two flavors: tobacco and menthol.

The scientists also documented a shift in the marketing of e-cigarettes, with newer brands selling customizable e-cigarettes that might look nothing like an old-fashioned tobacco cigarette. For example, some resemble pens, flashlights, even a violin.

The marketing messages also change with the products: Older brands were more likely to claim that e-cigarettes were healthier or cheaper than smoking, or that e-cigarettes could help people quit smoking. Newer brands are less inclined to making these claims. Instead, their marketing is focused on consumer choice, such as flavors or models.

“It almost seems that newer brands don’t want to be compared to cigarettes, which are associated with the image of cancer,” said lead author Shu-Hong Zhu, Ph.D., professor of family and preventive medicine and director of the Center for Research and Interventions in Tobacco Control at UC San Diego.

Smoking-related diseases are the leading cause of preventable death worldwide, estimated to be responsible for 6 million deaths annually. Although smoking rates among American adults have declined by more than half, from 42 percent in 1965 to 18 percent in 2012, tobacco use in the United States is still responsible for nearly 1 in 5 deaths, according to the American Cancer Society. E-cigarettes vaporize nicotine, the addictive ingredient in tobacco products. They first became available in the U.S. in 2007 and have since stoked controversy about whether they improve or worsen public health by reducing tobacco cigarette consumption or provide an alternative way to consume nicotine.

“Some consider them promising products to help smokers quit traditional cigarettes, while others believe they will re-normalize smoking, which will keep more people smoking,” Zhu said.

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Poor health, lifestyle factors linked to memory complaints


Early complaints often precursors to significant decline in later life, UCLA/Gallup study says.

Gary Small, UCLA

If you’re depressed, don’t get enough exercise or have high blood pressure, you may find yourself complaining more about memory problems, even if you’re a young adult, according to a new UCLA study.

UCLA researchers and the Gallup organization polled more than 18,000 people about their memory and a variety of lifestyle and health factors previously shown to increase the risk of Alzheimer’s disease and dementia. They found that many of these risk factors increased the likelihood of self-perceived memory complaints across all adult age groups.

The findings, published in today’s (June 4) edition of the journal PLOS ONE, may help scientists better identify how early lifestyle and health choices impact memory later in life. Examining these potential relationships, researchers say, could also help to pinpoint interventions aimed at lowering the risk of memory issues.

The 18,552 individuals polled ranged in age from 18 to 99. The known risk factors the researchers focused on included depression, lower education levels, physical inactivity, high blood pressure, diabetes, obesity and smoking. They were surprised by the prevalence of memory issues among younger adults, said the study’s senior author, Dr. Gary Small, UCLA’s Parlow–Solomon Professor on Aging and director of the UCLA Longevity Center.

“In this study, for the first time, we determined these risk factors may also be indicative of early memory complaints, which are often precursors to more significant memory decline later in life,” said Small, who is also a professor of psychiatry and biobehavioral sciences at the Semel Institute for Neuroscience and Human Behavior at UCLA.

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UCSF e-cigarette study shows industry health claims unsupported by data


E-cigarettes should be regulated, according to UCSF scientists.

Stanton Glantz, UC San Francisco

In a major scientific review of research on e-cigarettes, UC San Francisco scientists found that industry claims about the devices are unsupported by the evidence to date, including claims that e-cigarettes help smokers quit.

The review marks the first comprehensive assessment of peer-reviewed published research into the relatively new phenomenon of electronic cigarettes.

The devices, which are rapidly gaining a foothold in popular culture particularly among youth, are marketed as a healthier alternative to tobacco smoking, as an effective tool to stop smoking, and as a way to circumvent smoke-free laws by allowing users to “smoke anywhere.” Often the ads stress that e-cigarettes produce only “harmless water vapor.”

But in their analysis of the marketing, health and behavioral effects of the products, which are unregulated, the UCSF scientists found that e-cigarette use is associated with significantly lower odds of quitting cigarettes. They also found that while the data are still limited, e-cigarette emissions “are not merely ‘harmless water vapor,’ as is frequently claimed, and can be a source of indoor air pollution.

Neal Benowitz, UC San Francisco

The long-term biological effects of use are still unknown, the authors said.

In tackling the question of whether e-cigarette use is helping or harming the nation’s tobacco control efforts, the authors analyzed 84 research studies on e-cigarettes and other related scientific materials.

They concluded that e-cigarettes should be prohibited wherever tobacco cigarettes are prohibited and should be subject to the same marketing restrictions as conventional cigarettes.

The paper is published May 12 in the American Heart Association’s journal Circulation.

E-cigarettes deliver a nicotine-containing aerosol popularly called “vapor” to users by heating a solution commonly consisting of glycerin, nicotine and flavoring agents. E-liquids are flavored, including tobacco, menthol, coffee, candy, fruit and alcohol flavorings.

Despite many unanswered questions about e-cigarette safety, the impact on public health, and whether the products are effective at reducing tobacco smoking, e-cigarettes have swiftly penetrated the marketplace in the United States and abroad in both awareness and use. Sold by the major multinational tobacco and other companies, the devices are aggressively marketed in print, television and the Internet with messages similar to cigarette marketing in the 1950s and 1960s, even in the U.S. and other countries that have long banned advertising for cigarettes and other tobacco products.

Rachel Grana, UC San Francisco

In one indication of the swiftness by which the devices have been embraced, in the U.S. youth “ever use” of the devices rose from 3.3 percent in 2011 to 6.8 percent the following year; in Korea, youth “ever use” of e-cigarettes rose from 0.5 percent in 2008 to 9.4 percent in 2011. “Ever use” means whether one has smoked the product even just once.

Furthermore, most adults and youths who use e-cigarettes are engaging in “dual use” – smoking both e-cigarettes and conventional cigarettes.

While most youth using e-cigarettes are dual users, up to a third of adolescent e-cigarette users have never smoked a conventional cigarette, indicating that some youth are starting use of the addictive drug nicotine with e-cigarettes.

The report also tackles secondhand exposure.

“E-cigarettes do not burn or smolder the way conventional cigarettes do, so they do not emit side-stream smoke; however, bystanders are exposed to aerosol exhaled by the user,” said the authors. Toxins and nicotine have been measured in that aerosol, such as formaldehyde, acetaldehyde, acetic acid and other toxins emitted into the air, though at lower levels compared to conventional cigarette emissions.

One study of e-cigarettes was conducted to resemble a smoky bar: the researchers found that markers of nicotine in nonsmokers who sat nearby was similar for both cigarette smoke and e-cigarette aerosol exposure. Short-term exposure studies of e-cigarette use show a negative impact on lung function and bystanders absorb nicotine from passive exposure to e-cigarette aerosol, the authors report.

While early research found that e-cigarettes resulted in lower levels of plasma nicotine than conventional cigarettes, more recent research demonstrated that experienced users can attain nicotine absorption similar to that with conventional cigarettes.

When UCSF scientists pooled the results of five population-based studies of smokers, they found that smokers who used e-cigarettes were about a third less likely to quit smoking than those who did not use e-cigarettes. Whether e-cigarette use prevents attempts to quit or whether people who choose to use e-cigarettes are more highly dependent and therefore have a harder time quitting remains to be determined.

The scientists said their research illustrates the need for product regulation.

“While it is reasonable to assume that, if existing smokers switched completely from conventional cigarettes (with no other changes in use patterns) to e-cigarettes, there would be a lower disease burden caused by nicotine addiction, the evidence available at this time, although limited, points to high levels of dual use of e-cigarettes with conventional cigarettes, no proven cessation benefits, and rapidly increasing youth initiation with e-cigarettes,” the authors wrote.

“Furthermore, high rates of dual use may result in greater total public health burden and possibly increased individual risk if a smoker maintains an even low-level tobacco cigarette addiction for many years instead of quitting.”

The authors are Rachel Grana, Ph.D., M.P.H., a postdoctoral fellow at the UCSF Center for Tobacco Control Research and Education (CTCRE); Neal Benowitz, M.D., a UCSF professor of medicine and bioengineering and therapeutic sciences and chief of the division of clinical pharmacology at San Francisco General Hospital and Trauma Center; and Stanton Glantz, Ph.D., professor of medicine at UCSF, director of the CTCRE and the American Legacy Foundation Distinguished Professor in Tobacco Control.

The same authors have previously published general information on e-cigarettes.

The paper is a condensed and updated version of a longer report by Grana, Benowitz and Glantz with the support of the World Health Organization. Additional support came from the University of California Tobacco Related Disease Research Program and the National Cancer Institute and Food and Drug Administration Center for Tobacco Products.

Benowitz is a consultant to several pharmaceutical companies that market smoking cessation medications and has been a paid expert witness in litigation against tobacco companies.

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E-cigarettes and mental health


People with mental health conditions found more likely to use nicotine-delivery devices.

Researchers at the UC San Diego School of Medicine report that people living with depression, anxiety or other mental health conditions are twice as likely to have tried e-cigarettes and three times as likely to be current users of the controversial battery-powered nicotine-delivery devices, as people without mental health disorders.

They are also more susceptible to trying e-cigarettes in the future in the belief that doing so will help them quit, the scientists said. The FDA has not approved e-cigarettes as a smoking cessation aid.

The study will be published in today’s (May 13) online issue of Tobacco Control.

“The faces of smokers in America in the 1960s were the ‘Mad Men’ in business suits,” said lead author Sharon Cummins, Ph.D., assistant professor in the Department of Family and Preventive Medicine. “They were fashionable and had disposable income. Those with a smoking habit today are poorer, have less education, and, as this study shows, have higher rates of mental health conditions.”

By some estimates, people with psychiatric disorders consume approximately 30 to 50 percent of all cigarettes sold annually in the U.S.

“Since the safety of e-cigarettes is still unknown, their use by nonsmokers could put them at risk,” Cummins said. Another concern is that the widespread use of e-cigarettes could reverse the social norms that have made smoking largely socially unacceptable.

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Taxpayer donations give boost to cancer research


Checking a box can help save lives.

By Wallace Ravven

Nobody looks forward to the April 15 tax-filing deadline, but it’s not all gloom. Every year, thousands of Californians brighten the outlook for cancer prevention and treatment by using tax time to make a donation to research and community-based education.

Donations help support a wide range of programs, from leading-edge research aimed at early detection of lung cancer to exploring with teens the toxins found in everyday beauty products.

Taxpayers can support research and community education through the California Breast Cancer Research Program (CBCRP) with a check-off on line 405 of California Tax Form 540. Line 413 furthers projects funded by the Tobacco-Related Disease Research Program (TRDRP), which focuses on cancer and other diseases caused by tobacco products.

The University of California administers both programs, and puts a priority on projects aimed at communities that are disproportionately at risk for cancer.

Reducing breast cancer risk among young Latinas

An innovative community health partnership in East Salinas, for example, teaches young Latinas about the potential breast cancer risk posed by the chemicals that are found in some cosmetics, shampoos and other personal care products.

Funded by the CBCRP, the project has brought together UC Berkeley public health professor Kim Harley with Kimberly Parra at the Clinica de Salud del Valle de Salinas to carry out cancer-risk research and offer health education and practical training to teens.

Harley focuses her work on chemicals that can act as endocrine disrupters, meaning they mimic or block the normal effects of hormones such as estrogen. Endocrine disrupters are suspected of being a key factor in the development of breast cancer.

Young girls and minority women tend to have higher levels of the chemicals in their blood than non-Hispanic whites.

Sixteen local youths have been trained to design and carry out research to determine what products local teens use, the amount of endocrine disrupters they are exposed to in these products, and whether switching to low-chemical alternatives will decrease their exposure.

“Working with teens in this community has been really rewarding,” Harley says.  “We have watched them learn that science can be accessible and fun, and relevant to their lives.

“At the same time, we have learned from them about what environmental health issues are important to them. It has really helped us conduct effective, appropriate research that can affect change among youth.”

The prevention message is spreading beyond the teens involved: Two local TV news stations — one English-language, the other Spanish-language — have reported on the project. And both the teen researchers and their subjects are sharing what they learn about endocrine disrupters with friends and family.

Targeting cancer in the brain

Prevention holds the greatest promise for reducing cancer illness and death, but treatment forms the crucial second line of defense.

When breast cancer cells spread to the brain, the disease becomes particularly difficult to treat. The body’s natural physiological buffer, known as the blood-brain barrier, prevents bacteria and other blood-borne invaders from entering the brain, but also closes the door to chemotherapy targeting the brain.

At the University of Southern California, Axel Schönthal is applying CBCRP tax check-off funds to developing a novel strategy that would allow chemotherapy drugs to reach the brain through inhalation.

The drug, commonly known as temozolomide, has been proven effective against particularly aggressive brain tumors, but it must be given orally and can cause severe side effects throughout the body.

Schönthal predicts that inhalation of the drug will increase effectiveness in destroying cancer cells in the brain while reducing side effects. He expects that the intranasal treatment can work well against many types of breast cancer that have metastasized to the brain, particularly cancers that have proved resistant to most other drugs.

Such difficult-to-treat cases, called triple-negative breast cancer, are particularly prevalent in African-American women.

As federal NIH budget cuts have increased, Schönthal says, the tax check-off contributions for CBCRP-funded projects have become a lifeline for research aimed at treating and curing a range of cancers.

He especially values the fact that patient advocates are often part of the team that evaluates CBCRP research proposals.

“It is important that funding focuses on research of importance to affected communities,” Schönthal says.

Early detection of cancer’s leading killer

Lung cancer is the leading cause of cancer death in both men and women in the U.S., and smoking accounts for more than 80 percent of lung cancer cases.  Many smokers contract a less familiar but debilitating disorder called chronic obstructive pulmonary disease, or COPD, before they are diagnosed with lung cancer.

Lung cancer and COPD don’t strike all smokers, and genetics almost certainly influences disease vulnerability.

Identifying the genetic underpinnings common to both lung cancer and COPD vulnerability may reveal the biological processes that are triggered by smoking — creating new avenues for early warnings and novel interventions.

Cancer epidemiologist Lori Sakoda at the Kaiser Permanente Division of Research has launched a study supported by TRDRP to search for genetic traits shared by people with either or both diseases.

Although resisting smoking or breaking the habit are the surest way to prevent cancer and COPD, “once lung cancer develops, it is potentially curable if it is caught before it metastasizes, so early diagnosis is crucial,” Sakoda says.

Low-dose CT scans have become an accepted early detection strategy, but like any screening test, it carries risks. Sakoda’s research seeks to identify genetic markers that might help clinicians zero in on which subgroup of chronic smokers is at highest risk for either or both diseases, and so, pinpoint them as strong candidates for CT screening.

The study focuses on former or current smokers from a large, ethnically diverse cohort of Kaiser Permanente Northern California members.

Lowering the dose

A second TRDRP-funded study aims to determine the lowest possible CT dose that can reliably detect small nodules that mark the early stages of lung cancer.

“We want to find just how far we can ‘dial down’ CT dose without losing critical sensitivity,” says UCLA’s Michael McNitt-Gray. Drawing on CT scans of patients that already show telltale cancer nodules, his team applies imaging software to simulate the clarity that would be provided by scanning with lower CT exposures.

“It’s like trying to see how low you can turn down the light in a room and still clearly see,” he says.

McNitt-Gray hopes the exposure can be reduced significantly beyond currently accepted methods for screening CT exams — “possibly by as much as 50 to 75 percent without sacrificing our ability to detect those small nodules.”

“Detecting lung cancer in its earliest stages can save lives,” says Bart Aoki, Ph.D., director of the Tobacco-Related Disease Research Program. “We are very pleased to be able to support projects that foster awareness in underserved communities as well as research by the outstanding scientific community in California.”

Both the Tobacco-Related Disease Research Program and California Breast Cancer Research Program receive financial support from a California tax on tobacco products. As smoking rates decline, so too, does their funding for these important projects.

“Reduced smoking is of course great news for improving public health, but it threatens our ability to fund significant research,” says Marion Kavanaugh-Lynch, M.D., MPH, director of the California Breast Cancer Program. “We depend on California taxpayers to help offset this decline by voluntary contributions on their tax returns.”

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