Research digest June 2020

This page provides a non-exhaustive list of tobacco-related research articles identified weekly from PubMed by the ASH Scotland Information Service. 

Research period: 30/05 - 26/06

Research Trawl 20^th – 26^th June

Reactions to standardised cigarette packs with varying structural designs, and the association with smoking susceptibility: A post-implementation cross-sectional survey with never-smoking adolescents in Scotland

Published: 23/06/2020, Nicotine and Tobacco Research

Abstract: This article explores post-implementation reactions to standardised cigarette packaging among never smoking 12-17 year olds in Scotland. Results: The mean reaction scores for all four packs were mostly negative, however the shoulder box was consistently rated less negatively than the regular, slim, or bevelled-edge packs. Most participants (87%) said they would not select any of the four packs, although susceptible participants were more likely to select one than non-susceptible participants (25% vs. 7%; χ2=29.70; p=0.001). For all four packs, not finding them off-putting was associated with susceptibility

Questioning the regressivity of tobacco taxes: a distributional accounting impact model of increased tobacco taxation

Published: 23/06/2020, Tobacco Control

Background: Tobacco taxes, as with other ‘sin taxes’, are generally regarded as a highly cost-effective mechanism to reduce consumption but are often considered by policymakers to be regressive, undermining efforts to fully implement them at levels recommended by the WHO due to concerns of fairness. Conclusions Our findings question the doctrine that tobacco taxes are uniformly regressive from a standard income-share accounting view and point to the importance of the specific features of tax policy to shape a progressive approach to tobacco taxation: tobacco tax increases are less likely to be regressive when accompanied by a broad framework of demand-side measures that enhance the capacity of low-income smokers to quit tobacco use.

Tobacco excise taxes: a health and social justice measure?

Published: 23/06/2020,Tobacco Control

[Commentary on the article ‘Questioning the regressivity of tobacco taxes’]

Excerpt: Evidence shows that excise taxes do not having the same effects on all population groups, [particularly negatively affecting the most deprived] which raises important questions, as the consequences of rising tobacco prices affect those people who continue to smoke and also their families. In most jurisdictions, smokers currently receive little direct benefit from the increased excise tax they pay on tobacco products (other than an incentive to quit) and tobacco excise taxes become part of the Government’s general revenue. There are strong ethical arguments for reallocating funds to those people most affected by smoking and excise tax increases, but who have fewer resources to quit.

Philip Morris patents ‘harm reduction’ electronic waterpipe

Published: 25/06/2020, Tobacco Control

[Industry Watch] On 18 April 2019, a patent filed by Philip Morris Products SA was published entitled ‘Shisha device for heating a substrate without combustion’. The patent describes a waterpipe apparatus that contains a complex electric heating element with a cartridge containing an ‘aerosol-generating substrate’.1 The design appears to interchangeably accommodate solid or liquid substrates that may or may not contain tobacco, non-tobacco plant material or nicotine salts…

Prisoners and prison staff express increased support for prison smoking bans following implementation across Scotland: results from the Tobacco In Prisons study

Published: 25/06/2020, Tobacco Control

Outline: This novel analysis uses Tobacco In Prison Studies’ data to examine prisoners’ and prison staff’s opinions about prison smoking bans over the course of implementation. Conclusion There were notable opinion changes in both groups in the study period. We acknowledge possible sample bias, but suggest policymakers should be encouraged by these findings from Scotland which suggest support for prison smoking bans increases among prison staff and prisoners, following largely trouble-free implementation of such bans.

Voltage and e-liquid composition affect nicotine deposition within the oral cavity and carbonyl formation

Published: 25/06/2020, Tobacco Control

Conclusions Increasing voltage and composition of e-liquid can increase the exposure of the oral pharynx and bronchial airways to carbonyls that can react with DNA to generate adducts, induce oxidative stress, inflammation and cell death. The elevated nicotine and carbonyls readily enter the circulation where they can also cause cardiovascular stress. The growing popularity of higher voltage e-cigarette delivery devices will likely further elevate health risks from chronic exposure to these complex aerosols.

Mental Health and Smoking Cessation-A Population Survey in England

Published: 25/06/2020,BMC Medicine

Conclusions: Smokers with mental health problems were more likely to have attempted to quit because of health problems and were more likely to have used gold standard support (medication and behavioural support) than other smokers. E-cigarettes were strongly associated with increased success and were used similarly by those with and without mental health problems, indicating that improved uptake of e-cigarettes for smoking cessation among smokers with mental health problems could help address inequalities.

The Benefits of Smoking Cessation on Survival in Cancer Patients by Integrative Analysis of Multi-Omics Data

Published: 24/06/2020, Molecular Oncology

Conclusion According to our analyses, quitting smoking was the independent protective factor for overall survival in lung squamous cell carcinoma (LUSC). Comprehensive analysis of multi-component data across reformed and current smokers identified a total of 85 differential expressed genes (DEGs) affected by different modes of genetic and epigenetic regulation, potentially representing cancer drivers in smokers. In conclusion, this study demonstrates that quitting smoking at diagnosis decreases risk of death in cancer patients.

Pharmacological Approach to Smoking Cessation: An Updated Review for Daily Clinical Practice

Published: 23/06/2020, High Blood Pressure and Cardiovascular prevention

Outline: The present document aims to summarize the current viable pharmacological strategies for smoking cessation, also discussing the controversial issue regarding the use of alternative tobacco products, in order to provide useful practical indications to all physicians, mainly to those involved in cardiovascular prevention.

Parent Preferences for Pediatric Clinician Messaging to Promote Smoking Cessation Treatment

Published: 22/06/2020, Pediatrics

Conclusions: Parent smokers identified smoking cessation messages that emphasized the impact on their child, with outcomes focused on respiratory health, cancer, or general health, as most important. The clinical impact of these messages should be tested in future research.

Attention Deficit Hyperactivity Disorder Increases Nicotine Addiction Severity in Adults Seeking Treatment for Substance Use Disorders: The Role of Personality Disorders

Published: 19/06/2020, European Addiction Research

Conclusions: Substance Use Disorder (SUD) patients with comorbid ADHD show more severe nicotine addiction than those without, which is largely explained by comorbid impulsive personality disorders. In SUD patients, it is important to screen for adult ADHD and other psychiatric disorders, especially those with impulse control deficits such as ASP and BPD.

Effects of tobacco cigarettes, e-cigarettes, and waterpipe smoking on endothelial function and clinical outcomes

Published: 25/06/2020, European Heart Journal

[Review]

Research Trawl 13^th – 19^th June

Associations between cigarette prices and consumption in Europe 2004–2014

Published: 16/06/2020, Tobacco Control

Introduction Increases in tobacco price are known to reduce smoking prevalence, but these correlations may be blunted by the availability of budget cigarettes, promoted by the tobacco industry to maintain profits. Conclusion These analyses suggest that even in Europe, where tobacco taxes are relatively high compared with other regions, differential cigarette pricing strategies may undermine tobacco control. Further research is needed on links between tobacco price structures and consumption, and policy design to maximise the effectiveness of tobacco taxation.

How much of the future mortality toll of smoking can be avoided?

Published: 16/06/2020, Tobacco Control

Results: Under status-quo assumptions, smoking will claim 305 million LYL in the US from 2018 to 2100. If all smoking ceased at the end of 2017, past smoking would be responsible for 191.8 million LYL. Thus, avoidable LYL by 2100—the MPRPM—would be 113.2 million, 37% of the expected toll of smoking. A sensitivity analysis finds that were the annual smoking initiation rate 3% instead of 7.8%, the MPRPM would be 13-14% lower. Were the annual permanent smoking cessation rate twice our status-quo estimate of 4.35%, the MPRPM would be 38-39% lower.

Acute Effects of a Heat-Not-Burn Tobacco Product on Pulmonary Function

Published: 12/06/2020, Medicina

Conclusions: IQOS had an impact on exhaled CO, SaO2%, and airways function immediately after use. Even though these changes were rather small to be considered of major clinical importance, they should raise concerns regarding the long-term safety of this product. Further research is needed for the short- and long-term effects of IQOS, especially in patients with respiratory disease.

Association of the US Outbreak of Vaping-Associated Lung Injury With Perceived Harm of e-Cigarettes Compared With Cigarettes

Published: 15/06/2020, JAMA Network Open

Results: Of the 3215 current smokers surveyed in 2019, 1833 were interviewed before the outbreak  and 1382 were interviewed after. The proportion who perceived e-cigarettes as less harmful than combustible cigarettes decreased significantly from 37.0% before to 30.9% after the outbreak, and significantly fewer smokers reported not knowing which product was more harmful. Conversely, there were significant increases in the proportion of individuals who perceived e-cigarettes as equally harmful or more harmful than cigarettes.

Inequalities, Harm Reduction and Non-Combustible Nicotine Products: A Meta-Ethnography of Qualitative Evidence

Published: 15/06/2020, BMC Public Health

Results: The review only identified studies exploring the attitudes of socioeconomically disadvantaged smokers towards NCNP for harm reduction or cessation purposes (i.e. we did not identify any relevant studies of more advantaged socioeconomic groups). Using a lines-of-argument meta-ethnographic approach, we identified a predominantly pessimistic attitude to NCNP for harm reduction or cessation of smoking due to: wider circumstances of socioeconomic disadvantage; lack of a perceived advantage of alternative products over smoking; and a perceived lack of information about relative harms of NCNP compared to smoking. Optimistic findings, although fewer, suggested the potential of NCNP being taken up among smokers experiencing socioeconomic disadvantage.

Tobacco Use and Associated Health Risk Behaviours Among University Students in 27 Countries

Published: 08/06/2020, International Journal of Adolescent Medicine and Health

A cross-sectional study the sample included 23,396 university students from 27 countries in Africa, Asia and the Americas. Conclusions: Compared to non-tobacco users, less than daily and/or daily tobacco users had significantly higher overweight or obesity, dietary risk behaviour, addictive behaviour, sleep risk behaviours and other health risk behaviour. These associations may be taken into account in health promotion strategies targeting multiple health compromising behaviours.

Has the Time Come to Focus on (Young Adult) Smoking Uptake Prevention?

Published: 11/06/2020, Nicotine and Tobacco Research

[Editorial]

Research Trawl 6^th – 12^th June

Association of Socioeconomic Position With e-Cigarette Use Among Individuals Who Quit Smoking in England, 2014 to 2019

Published: 05/06/2020, JAMA Network Open

Conclusions and Relevance: In this study, e-cigarette use increased among all participants from 2014 to 2019 but was highest among those with lower socioeconomic position. Continued monitoring of this socioeconomic patterning is important because if e-cigarettes do not confer the public health benefit of protection against relapse to smoking, then equity-negative disadvantages of long-term usage are more likely.

Association of Electronic Nicotine Delivery System Use With Cigarette Smoking Relapse Among Former Smokers in the United States

Published: 05/06/2020, JAMA Network Open

Conclusions and Relevance: In this study, use of ENDS and other tobacco products was associated with increased risk of cigarette smoking relapse among former cigarette smokers who did not use any tobacco product at wave 1 of the PATH Study. For clinicians treating former smokers who have successfully quit all nicotine products, the implications are that use of ENDS products should be discouraged, just as use of all other tobacco products is discouraged.

A genetically informed study on the association of cannabis, alcohol, and tobacco smoking with suicide attempt

Published: 08/06/2020, Nature Molecular Psychiatry

… In conclusion, evidence from this quasi-experimental study based on genetic data from large-scale GWASs are consistent with a causal role of cannabis, alcohol, and tobacco smoking on suicide attempt.

Associations of Flavored e-Cigarette Uptake With Subsequent Smoking Initiation and Cessation

Published: 05/06/2020, JAMA Network Open

Conclusions and Relevance: In this study, adults who began vaping nontobacco-flavored e-cigarettes were more likely to quit smoking than those who vaped tobacco flavors. More research is needed to establish the relationship between e-cigarette flavors and smoking and to guide related policy.

New Insights From MRI and Cell Biology Into the Acute Vascular-Metabolic Implications of Electronic Cigarette Vaping

Published: 21/05/2020, Frontiers in Physiology

Abstract: …Quantitative magnetic resonance imaging (MRI) approaches, developed in the authors' laboratory, provide conclusive evidence of acute deleterious effects of e-cig aerosol inhalation in the absence of nicotine in tobacco-naïve subjects. Among the pathophysiologic effects observed are transient impairment of endothelial function, vascular reactivity, and oxygen metabolism. The culprits of this response are currently not fully understood but are likely due to an immune reaction caused by the aerosol containing thermal breakdown products of the e-liquid

Cigarette Smoking and Incident Stroke in Blacks of the Jackson Heart Study

Published: 10/05/2020, Journal of the American Heart Association

Conclusions In a large cohort of blacks, current cigarette smoking was associated with a dose-dependent higher risk of all stroke. In addition, past smokers did not have a significantly increased risk of all stroke compared with never smokers, which suggests that smoking cessation may have potential benefits in reducing the incidence of stroke in blacks.

Examining Pathways Between Genetic Liability for Schizophrenia and Patterns of Tobacco and Cannabis Use in Adolescence

Published: 09/06/2020, Psychological Medicine

Conclusions: Our study provides evidence that genetic risk for schizophrenia is associated with patterns of cannabis use during adolescence. Investigation of pathways other than the cognitive, emotional, and behavioral phenotypes examined here is required to identify modifiable targets to reduce the public health burden of cannabis use in the population.

Translational Research in Nicotine Addiction

Published: 09/06/2020, Cold Spring Harbor Perspective in Medicine

These findings and coordinated efforts between human and rodent studies pave the way for future work determining gene by drug interactions and tailoring treatment options to each individual smoker.

E-cigarettes, Nicotine, the Lung and the Brain: Multi-Level Cascading Pathophysiology

Published: 09/06/2020, Journal of Physiology

[Review]

Research Trawl 30^th May – 5^th June

Impact of UK tobacco control policies on inequalities in youth smoking uptake: A natural experiment study

Published: 29/05/2020, Nicotine and Tobacco Research

Results: UK countries implemented smoke-free public places legislation and increased the legal age for tobacco purchase from 16-18 years between 2006 and 2008. For both policies, smoking initiation reduced following implementation, while inequalities in initiation narrowed over subsequent years.

Impact of cannabis use on nicotine and tobacco use outcomes

Published: 01/06/2020, Nicotine and Tobacco Control

[Editorial Commentary] Cannabis legalization and use are increasing, and perception of risks associated with cannabis use is declining. In conjunction with prior data showing that quit rates are lower among smokers in the US who use cannabis and that cannabis use is increasing among cigarette smokers, further progress in tobacco control may suffer as cannabis use continues to increase.

Which method of assessing depression and anxiety best predicts smoking cessation: Screening instruments or self-reported conditions?

Published: 02/06/2020, Nicotine and Tobacco Control

Abstract: Affective disorders and symptoms (ADS) are predictive of lower odds of quitting smoking. However, it is unknown which approach to assessing ADS best predicts cessation. Conclusions

The single-item question assessing ADS had as much predictive validity, and possibly more, than the battery of screening instruments for identifying participants at risk for failing to quit smoking.

Big tobacco using Trojan horse tactics to exploit Indigenous peoples

Published: 30/05/2020, Tobacco Control

Excerpt: In November 2019, Jeff Gaulin, Director External Affairs with Rothmans, Benson & Hedges Inc (RBH) opened a conference in Calgary, Canada. RBH was not listed on any of the promotional material or the registration platform but Gaulin announced he was one of the driving forces behind the event and he asked the audience of Indigenous health professionals and advocates, “So why is the world’s largest maker of cigarettes assembling a harm reduction conference?”. It’s a good question.

Electronic Nicotine Delivery System Design and Aerosol Toxicants: A Systematic Review

Published: 04/06/2020, PlosOne

Conclusions: Improved ENDS design can reduce toxicant levels. Additional research is needed to develop a framework for optimizing system characteristics to minimize exposure, especially with respect to heating power and e-liquids. Both manufacturers and regulatory agencies have roles in reducing toxicants and potential health risks from ENDS.

Female Vulnerability to the Effects of Smoking on Health Outcomes in Older People

Published: 04/06/2020, PlosOne

Abstract: … From an epidemiological perspective, sex differences in smoking effects are important considerations that could underlie sex differences in health outcomes. These findings also encourage future mechanistic experiments to resolve potential mechanisms of sex-specific cigarette smoke toxicity

Nicotine Promotes Brain Metastasis by Polarizing Microglia and Suppressing Innate Immune Function

Published: Aug/2020, Journal of Experimental Medicine

Abstract: … Our results also highlight a potential risk of using nicotine for tobacco cessation.

Impact of e-cigarette liquid flavoring agents on activity of microsomal recombinant cyp2a6, the primary nicotine-metabolizing-enzyme

Published: 04/06/2020, Chemical Research In Toxicology

Abstract: … These data indicate certain aromatic aldehyde flavoring agents are potent inhibitors of CYP2A6, which may reduce nicotine metabolism in vivo. These findings indicate an urgent need to evaluate the effects of e-cigarette flavoring agents on the pharmacokinetics of nicotine in vivo.

Nicotine and Opioids: A Call for Co-treatment as the Standard of Care

Published: 03/06/2020, Journal or Behavioural Health Services and Research

…The current brief review characterizes the metabolic and neural mechanisms which mediate co-use of nicotine and opioids, and then outlines clinical and policy implications for concurrently addressing these two deadly epidemics.