TAG: "Tobacco"

Smokers who use e-cigarettes less likely to quit


Study rebuts contention that the devices assist tobacco cessation.

By Yadira Galindo, UC San Diego

The rapid increase in use of e-cigarettes has led to heated debates between opponents who question the safety of these devices and proponents who claim the battery-operated products are a useful cessation tool. A study, published online today (April 16) in the American Journal of Public Health, suggests proponents are in error.

UC San Diego School of Medicine researchers found that smokers who used e-cigarettes were 49 percent less likely to decrease cigarette use and 59 percent less likely to quit smoking compared to smokers who never used e-cigarettes. The population-based study followed 1,000 California smokers over the course of one year.

“Based on the idea that smokers use e-cigarettes to quit smoking, we hypothesized that smokers who used these products would be more successful in quitting,” said Wael Al-Delaimy, M.D., Ph.D., professor and chief of the Division of Global Public Health in the Department of Family Medicine and Public Health. “But the research revealed the contrary. We need further studies to answer why they cannot quit. One hypothesis is that smokers are receiving an increase in nicotine dose by using e-cigarettes.”

Although e-cigarettes do not contain tobacco, users, known colloquially as “vapers,” exhale a mixture of volatile organic compounds, heavy metals and ultrafine particles that usually contain aerosolized nicotine in a cloud of vapor.

The findings show that daily smokers and women were more likely to have tried e-cigarettes. Al-Delaimy believes the study will inform the United States Food and Drug Administration and other regulators on the profile of e-cigarette usage among smokers as they create guidelines for e-cigarettes amid continued discussion about product safety and its attraction to people who have never used traditional cigarettes.

In January, the California Department of Public Health (CDPH) released the State Health Officer’s Report on E-Cigarettes, a health advisory that addressed the health risks posed by the marketing, sale and use of e-cigarettes.

“There is a lot of misinformation about e-cigarettes,” said CDPH director and state health officer, Ron Chapman, M.D., M.P.H. “That is why, as the state’s health officer, I am advising Californians to avoid the use of e-cigarettes and keep them away from children of all ages.”

Co-authors include Eric C. Leas and David R. Strong, UCSD; Mark G. Myers, UCSD and Veterans Affairs San Diego Healthcare System; and C. Richard Hofstetter, San Diego State University.

Funding for this research came, in part, from the California Department of Public Health (12-10046).

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Cigarette smoke makes superbugs more aggressive


In experiments, cigarette smoke helps drug-resistant bacteria fight off the immune system.

By Heather Buschman, UC San Diego

Methicillin-resistant Staphylococcus aureus (MRSA), an antibiotic-resistant superbug, can cause life-threatening skin, bloodstream and surgical site infections or pneumonia. Researchers at the UC San Diego School of Medicine now report that cigarette smoke may make matters worse. The study, published March 30 by Infection and Immunity, shows that MRSA bacteria exposed to cigarette smoke become even more resistant to killing by the immune system.

“We already know that smoking cigarettes harms human respiratory and immune cells, and now we’ve shown that, on the flipside, smoke can also stress out invasive bacteria and make them more aggressive,” said senior author Laura E. Crotty Alexander, M.D., assistant clinical professor of medicine at UC San Diego and staff physician at the Veterans Affairs San Diego Healthcare System.

Crotty Alexander is a pulmonologist who sees many patients who smoke cigarettes. She also sees many MRSA infections, and that got her wondering if one might influence the other. To test the hypothesis, Crotty Alexander and her team infected macrophages, immune cells that engulf pathogens, with MRSA. Some of the bacteria were grown normally and some were grown with cigarette smoke extract. They found that while the macrophages were equally able to take up the two bacterial populations, they had a harder time killing the MRSA that had been exposed to cigarette smoke extract.

To better understand why, the Crotty Alexander team tested the bacteria’s susceptibility to individual mechanisms macrophages typically employ to kill bacteria. Once inside macrophages, smoke-exposed MRSA were more resistant to killing by reactive oxygen species, the chemical burst that macrophages use to destroy their microbial meals. The team also discovered that smoke-exposed MRSA were more resistant to killing by antimicrobial peptides, small protein pieces the immune system uses to poke holes in bacterial cells and trigger inflammation. The effect was dose-dependent, meaning that the more smoke extract they used, the more resistant the MRSA became.

MRSA treated with cigarette smoke extract were also better at sticking to and invading human cells grown in the lab. In a mouse model, MRSA exposed to cigarette smoke survived better and caused pneumonia with a higher mortality rate.

The data suggest that cigarette smoke strengthens MRSA bacteria by altering their cell walls in such a way that they are better able to repel antimicrobial peptides and other charged particles.

“Cigarette smokers are known to be more susceptible to infectious diseases. Now we have evidence that cigarette smoke-induced resistance in MRSA may be an additional contributing factor,” Crotty Alexander said.

Study co-authors include Elisa K. McEachern, John H. Hwang, Katherine M. Sladewski, UC San Diego and Veterans Affairs San Diego Healthcare System; Shari Nicatia, UC San Diego, Veterans Affairs San Diego Healthcare System and Utrecht University; Carola Dewitz, UC San Diego, Veterans Affairs San Diego Healthcare System and University of Veterinary Medicine, Hannover, Germany; Denzil P. Mathew, Veterans Affairs San Diego Healthcare System; and Victor Nizet, UC San Diego.

This research was funded, in part, by the U.S. Department of Veterans Affairs.

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New spotlight on smoking at the movies


Launch of revamped UCSF website ranks actors, directors, top 10 movies by use of tobacco.

By Elizabeth Fernandez, UC San Francisco

UC San Francisco is launching a revamped Smokefree Movies website that offers the public unusual insight into Hollywood’s role in the global tobacco epidemic, projected to kill one billion people this century.

Updated every week, the site ranks film producers, directors, writers and actors by their on-screen tobacco footprint based on a database of more than 2,000 films released since 2002.

The site currently lists the five “smokiest” actors, directors, and producers since 2002 as:

Additionally, the website’s “Now Showing” feature reveals the tobacco content of the top ten movies in theaters and on DVD each week. It also provides information about film companies. For example in the last three years, Time Warner accounted for 22 percent of all the tobacco impressions in top grossing films. That was the same amount for independent producer-distributors (22 percent), followed by Sony (17 percent), Fox (14 percent), Viacom (Paramount) (11 percent), Comcast (Universal) (8 percent), and Disney (6 percent). Smoking in movies, encouraged for decades by tobacco company cross-promotions and product placements, leads to thousands of new young smokers every year, according to federal health officials.

“The major media companies and the Hollywood studios they own have known since at least 2002 that smoking in movies causes kids to smoke and eventually die from a long list of tobacco diseases,” says Stanton Glantz, Ph.D., director of the UCSF Center for Tobacco Control Research and Education, which created the movie website. “By looking at top-grossing movies and putting all the key health information in one place, the website gives everyone from parents and public officials to film critics and Wall Street analysts an inside look at the tobacco choices Hollywood producers are making now.”

The website:

  • Traces the history of commercial collaboration by U.S. tobacco and film industries;
  • Summarizes scientific research in a dozen countries supporting the U.S. Surgeon General’s conclusion that exposure to on-screen smoking causes kids to smoke;
  • Offers evidence-based policy solutions based by the World Health Organization, the U.S. Centers for Disease Control and Prevention (CDC), and other leading health authorities;
  • Monitors in real time the progress or failure of specific media companies and their movie studio subsidiaries to safeguard young audiences worldwide by reserving smoking for their R-rated films.

U.S public health officials for years have warned that exposure to on-screen smoking causes young people to start smoking. The CDC has decried the movie industry’s failure to protect impressionable young viewers, and in 2012 the Surgeon General reported that because of the onscreen exposure, “6.4 million children alive today will become smokers, and 2 million of these children will die prematurely from diseases caused by smoking.”

A significant number of the movies depicting smoking were rated PG-13, the surgeon general reported.

“The CDC reports that R-ratings on movies with smoking can prevent a million future tobacco deaths among American kids alone,” Glantz says. “The media company chiefs could easily direct their trade group, the Motion Picture Association of America, to add smoking to the voluntary R-rating standard, alongside the non-lethal content it already rates R. The longer they delay, the more kids worldwide will be addicted to cigarettes by the smoking in the movies Hollywood makes and exports.”

The Smokefree Movies website uses data collected by UCSF partner Thumbs Up! Thumbs Down!, an ongoing project of Breathe California of Sacramento-Emigrant Trails. Since 1995, more than a thousand volunteers between the ages of 14 and 22 have been trained to analyze tobacco content in all films grossing more than $1 million in the domestic market.

Historical resources for the Smokefree Movies website include the 82 million-page Legacy Tobacco Documents Library housed at UCSF. Other information is gathered from film industry sources. UCSF’s Smoke Free Movies receives foundation support for its policy research and education projects.

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Curing cancer, one tax return at a time


Check a box and fund two UC-administered cancer research projects.

California taxpayers fund a number of health programs — some administered by UC — by designating a portion of their tax refund.

By Kate Rix, UC Newsroom

Those contribution lines on your 540 State Income Tax Return where you can fill in donation amounts for nearly 30 different California-based funds? Those are just nickel-and-dime funds without much impact, right?

Wrong.

Last year California taxpayers contributed more than $4 million to an inspiring range of worthy health, environmental and educational funds. Among the funds that get an important boost around tax time are the California Breast Cancer Research Program and the California Cancer Research Fund. Both funds are administered by the University of California, which distributes the money as direct grants to California researchers working on the cutting edge.

In other words, those contributions have a tangible impact in the fight against cancer, supporting work that ranges from personalized support for young cancer survivors to new low-radiation screening tools.

Protecting fertility for young cancer survivors

As treatments for breast cancer improve, the number of young women surviving the disease has grown. Of the 2.8 million cancer survivors in the U.S., 10 percent are under 45 at diagnosis. After enduring cancer therapies and one of the most frightening experiences of their lives, survivors often find themselves faced with a variety of worrisome long-term health issues.

During chemotherapy, menstrual periods often stop, and it is not uncommon for women — even very young women — to experience the symptoms of menopause, including hot flashes and vaginal dryness. Cancer fears become compounded by worries that they may never be able to have children and that their bodies will never be the same.

“Young breast cancer survivors and their health care providers want to learn about how to manage reproductive health after cancer,” said Dr. Irene Su, an assistant professor in the Division of Reproductive Endocrinology and Infertility at the UC San Diego School of Medicine.

Closing the knowledge gap

“There hasn’t been an emphasis on providing reproductive health information to young survivors,” Su said. Also, because many health care providers may not see that many young women with cancer, they may face knowledge gaps on providing reproductive health care for this population.

“Right now, there is a dearth of resources for disseminating reproductive health care information to patients and providers.”

Su is leading a project, funded by the California Breast Cancer Research Program, to help women and their medical providers — no matter where they are located — have access to up-to-date, evidence-based information to treat estrogen deprivation symptoms, improve sexual function and monitor fertility potential after cancer. CBCRP received nearly $400,000 through the tax check-off program last year.

With a grant of more than $750,000 over three years, the project will generate the Reproductive Survivorship Care Plan (SCP-R), a Web-based tool that offers the best current research on managing hot flashes, sexual problems, fertility concerns and contraception to young breast cancer patients and their providers. Information can be tailored to the patient, and focuses on specific issues. The SCP-R will be tested in a randomized controlled trial that launches this summer.

The resource is being developed with the participation of patients and caregivers recruited across the country and with the oversight of a stakeholder panel of clinicians, researchers and breast cancer survivors.

Young women who survive breast cancer often have questions about fertility. It isn’t unusual, for example, for a young woman’s periods to stop when she undergoes chemotherapy. Women who have not completed their families may worry that not menstruating means that they are infertile. “The SCP-R will provide relevant information on the natural course of ovarian recovery, when survivors usually get their periods back, types of blood tests that can help monitor ovarian function, and, equally importantly, what tests are not recommended and what we still don’t know,” Su said.

Women who have completed their families will need to consider effective contraception. In the United States, birth control pills are the most common reversible form of contraception. For a cancer survivor, however, it is crucial to keep estrogen levels low.

“The copper IUD is a great form of reversible birth control, because it is non-hormonal and highly effective,” said Su. “It would be great if a family practice physician or oncology provider had knowledge of how effective different birth controls are and what are recommended methods for breast cancer survivors.”

Lung cancer screenings as safe as chest X-rays

Lung cancer is the most deadly form of cancer in the U.S. While patients with other forms of cancer are living longer than before, the five-year survival rate for lung cancers hasn’t improved much in recent decades. More people die from lung cancer than from the next four cancers combined (including breast and prostate cancer). And while smoking is a leading cause of lung cancer, up to 15 percent of lung cancers have no relation to smoking; even smokers who quit smoking up to 15 years previously are still at risk of lung cancer.

One obstacle has been the lack of any screening test to detect lung cancer at an early stage. While imaging technology held some promise, it was unproven and there were some risks associated with being screened. But just a few years ago, a national lung screening trial found that at-risk patients who were screened using low-dose CT scanning technology had a 15-20 percent lower chance of dying of lung cancer than those who received a standard chest X-ray.

These results showed promise for a new tool, with dramatically reduced radiation, to detect the most deadly form of cancer.

With funding from the California Cancer Research Fund (administered by UC’s Tobacco-Related Disease Research Program), a team at UCLA is working to bring the level of radiation in an ultra-low-dose CT scan even lower. The TRDRP received nearly $445,000 through the tax check-off program last year.

“We know how to do the screening and the technology is pretty good,” said Michael McNitt-Gray, a professor of radiology at the UCLA School of Medicine. “We want to push that dose even lower. We’d like to get the same level as a single chest X-ray.”

Shorter times, improved images

Several aspects of CT scanning technology have improved dramatically. While low-dose CT screenings have been possible for nearly 20 years, technical limits have made them difficult to use effectively.

For example, an accurate image used to take up to 60 seconds to capture. Patients had to hold their breath during that entire time, something that most smokers can’t do.

The improvements being made at UCLA make the process faster — the actual scan takes just 5 seconds — and can allow finer detail in the image, showing suspicious objects in the lung as small as 5 mm.

The timing of the UCLA project couldn’t be better. Last year, private insurers began covering the cost of ultra-low-dose CT scans. In February, Medicare announced that it also would cover the screening, making the early detection tool available to the elderly and disabled who may be at risk of developing lung cancer.

“The test itself is very quick,” says McNitt-Gray. “The patient lies down, puts their arms above their head, and does some practice breathing. Based upon a planning view, the scanner adjusts to the patient’s anatomy so that just enough of the radiation dose is used to provide the necessary image quality to detect anything suspicious in the lungs.”

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Twitter helps smokers kick the habit


Hybrid approach combines automated messages with social media platform.

By Anne Warde, UC Irvine

When subjects in a smoking cessation program tweet each other regularly, they’re more successful at kicking the habit, according to a study by UC Irvine and Stanford University researchers. Specifically, daily “automessages” that encourage and direct the social media exchanges may be more effective than traditional social media interventions for quitting smoking.

Cornelia Pechmann, professor of marketing at UCI’s Paul Merage School of Business, and Judith J. Prochaska, associate professor of medicine at Stanford, found that overall engagement in two consecutive Tweet2Quit groups was high, with 78 percent of members tweeting their fellow study subjects at least once during the 100-day study.

The average number of tweets per person was 72, and 60 percent tweeted past the 30-day mark. Group No. 1 had a smoking cessation rate of 42 percent. Using lessons gleaned from that trial, researchers tweaked the automessaging process, and Group No. 2 had a success rate of 75 percent.

The findings were published recently in the Journal of Medical Internet Research.

“Our results indicate that incorporating social media-delivered automessages from trained counselors was effective in promoting smoking cessation,” Pechmann said. “The twice-daily messages encouraged people to tweet their group members, which made them more accountable for quitting.”

Members of the Tweet2Quit’s two closed, 20-person groups communicated online via Twitter for 100 days. Participants each received a free supply of nicotine patches, along with daily automated text messages. They were encouraged to use a Web-based guide to develop a cessation plan and were asked to tweet their group at least once a day about their progress.

There were no expert facilitators in the groups; the smokers themselves supported one another. However, the daily automessages encouraged and directed peer-to-peer discussions, and distinct tweeting spikes occurred when the messages were sent, at 9 a.m. and 5 p.m.

“The Twitter environment created a sort of party dynamic,” Pechmann said. “That’s especially important for social smokers. In addition, group leaders naturally emerged, facilitating the online conversations. These leaders played a critical role in keeping people engaged.”

Several types of tweets related positively to smoking abstinence. The more people shared about setting a quit date, using nicotine patches, countering roadblocks, utilizing self-rewards, believing in themselves and feeling pride, the more likely they were to remain smoke-free.

Support, accountability, advice and bragging rights are a few of the benefits that make social media a promising platform for self-help groups, Pechmann noted. However, while health-related online forums, blogs and websites can be informative, they lack the instantaneous interaction of Twitter.

Tweet2Quit’s hybrid approach combines automated messages with the social media element. The prompts are based on clinical guidelines for smoking cessation and employ positive, open-ended questions that encourage online discussion, such as “What will you do when you feel the urge to smoke?” On average, about 23 percent of tweets were in response to these automated texts, while 77 percent were spontaneous.

Pechmann and her team are currently working on a follow-up study involving Latino smokers. For more information on Tweet2Quit, visit tweet2quit.merage.uci.edu.

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E-cigarettes: Consumers increasingly face companies’ creative smoke and mirrors


The acceptance and popularity of e-cigarettes is rapidly growing.

Heavily marketed as a safer, healthful alternative to smoking, electronic cigarettes are under fire from California health officials who have declared “vaping” a public health threat, hoping to head off the type of deceptive manipulation that tobacco companies succeeded with for decades, according to new research from UC Davis.

“The e-cigarette industry has proven to be very creative in their product marketing,” says Greta Hsu, an associate professor at the UC Davis Graduate School of Management. “There’s a great deal of ambiguity about product content in the largely unregulated e-cigarette industry right now, and considerable debate over the safety, long-term risks, and effects of secondhand smoke exposure. At the same time, acceptance and popularity of e-cigarettes is rapidly growing, creating a market where consumers are vulnerable.”

Organizational sociologists Hsu and co-author Stine Grodal, an assistant professor at Boston University’s School of Management, say e-cigarettes may be just one of many markets where firms strategically decouple the actual features of products from the features expected by their customers.

“For example, as labels such as ‘low fat’ and ‘low sugar’ became increasingly taken-for-granted shortcuts for the notion of ‘healthy’ food, there is some evidence that companies increasingly manipulated underlying product characteristics to make them more palatable, such as adding more sugar or fat and adjusting the serving size to mask the increase,” says Grodal. “It’s scope creep, and it’s deceiving.”

In their new study, published in the February issue of the American Sociological Review, Hsu and Grodal investigated how it was possible for the tobacco industry to ratchet up the levels of tar and nicotine in “light” cigarettes for decades without a regulatory crackdown. This happened despite mounting proof of health hazards.

Looking at history of tobacco regulation

Starting in the early 1960s, in the face of increasing public scrutiny, U.S. tobacco firms marketed “lights” as a new, safer type of cigarette due to their low tar and nicotine content. By the 1990s, a number of light brands exceeded their full-flavor counterparts in deliveries of both components.

Using evidence from tobacco firm internal documents, Hsu and Grodal found that consumers decreased their scrutiny of the tar and nicotine levels of light cigarette brands as they became increasingly familiar with the light category. Tobacco firms in turn strategically used this lack of scrutiny to increase the tar and nicotine deliveries of both new and established light cigarette brands. It wasn’t until 2009 that the federal government finally stepped in to regulate tobacco products with the Family Smoking Prevention and Tobacco Control Act.

“While one may be tempted to regard cigarettes as an extreme case due to its links with addiction, we believe this kind of widespread manipulation of shared categorical understandings takes place in a variety of markets,” the authors wrote.

Hsu and Grodal point out that researchers and the media have highlighted the potential for manipulation in several growing market categories, including organic produce, “green” products such as hybrid cars and energy-saving appliances, nontoxic beauty products, and sectors defined around craft techniques, personnel, or ingredients such as microbrews, wild fishing, and Greek yogurt.

“In such cases, without the presence of regulatory watchdogs setting and upholding clear standards, the opportunities for and likelihood of manipulations are expected to increase,” Hsu says. “One lesson is that monitoring must be done by a trusted source.”

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Tobacco-smoking parents increase diabetes risk for children exposed in utero


“Smoking of parents is by itself a risk factor for diabetes, independent of obesity or birth weight.”

Credit: iStock

By Michele La Merrill and Kat Kerlin, UC Davis

Children exposed to tobacco smoke from their parents while in the womb are predisposed to developing diabetes as adults, according to a study from the University of California, Davis, and the Berkeley nonprofit Public Health Institute.

In the study, published today (Feb. 9) in the Journal of Developmental Origins of Health and Disease, women whose mothers smoked while pregnant were two to three times as likely to be diabetic as adults. Dads who smoked while their daughter was in utero also contributed to an increased diabetes risk for their child, but more research is needed to establish the extent of that risk.

“Our findings are consistent with the idea that gestational environmental chemical exposures can contribute to the development of health and disease,” said lead author Michele La Merrill, an assistant professor of environmental toxicology at UC Davis.

The study analyzed data from 1,800 daughters of women who had participated in the Child Health and Development Studies, an ongoing project of the Public Health Institute. The CHDS recruited women who sought obstetric care through Kaiser Permanente Foundation Health Plan in the San Francisco Bay Area between 1959 and 1967. The data was originally collected by PHI to study early risk of breast cancer, which is why sons were not considered in this current study.

In previous studies, fetal exposure to cigarette smoke has also been linked to higher rates of obesity and low birth weight. This study found that birth weight did not affect whether the daughters of smoking parents developed diabetes.

“We found that smoking of parents is by itself a risk factor for diabetes, independent of obesity or birth weight,” said La Merrill. “If a parent smokes, you’re not protected from diabetes just because you’re lean.”

The study was supported through funding from the National Institute of Environmental Health Sciences, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the California Breast Cancer Research Program Special Research Initiative.

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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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