Research digest September 2020

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

 Search period: 29/08 - 02/10

Research Trawl 5^th – 11^th September

Statement on the potential toxicological risks from electronic nicotine (and non-nicotine) delivery systems (E(N)NDS – e-cigarettes)

Published: Sept/2020

A Report by Public Health England – Committee on Toxicology

The misuse of the precautionary principle in justifying Australia’s ban on the sale of nicotine vaping products 

Published: 10/09/2020, Nicotine and Tobacco Research

Implications: The precautionary principle has been misapplied to NVP regulation in Australia. We recommend that the precautionary principle be used in a way that regulates nicotine products in proportion to their risks.

Tobacco control policies to tackle the problem of adolescent tobacco use 

Published: 09/09/2020, Nicotine and Tobacco Research

[editorial]

Systematic review of electronic cigarette use (vaping) and mental health comorbidity among adolescents and young adults 

Published: 09/09/2020, Nicotine and Tobacco Research

Conclusions: Youth EC use is associated with greater mental health problems (compared to non-use) across several domains, particularly among adolescents. Since many existing studies are cross-sectional, directionality remains uncertain. Well-designed longitudinal studies to investigate long-term mental health sequalae of EC use remain needed.

Investigating genetic correlation and causality between nicotine dependence and ADHD in a broader psychiatric context.

Published: 10/09/2020, American Journal of Medical Genetics: Part B, Neuropsychiatric Genetics

Results: We found a high genetic correlation between ND and ADHD, and to a lesser extent also between ND-major depressive disorder and ND-schizophrenia. We did not find evidence for a causal relationship from liability for ADHD to ND (which could be due to a lack of power). The strong genetic correlations might reflect different phenotypic manifestations of (partly) shared underlying genetic vulnerabilities.

Child tobacco smoke exposure and healthcare resource utilization patterns

Published: 06/09/2020, Nature

Impact: i)Tobacco smoke exposure may affect the healthcare resource utilization patterns of children.ii) Evidence is lacking concerning these associations among the highly vulnerable pediatric emergency department patient population.iii) This study examined the association between tobacco smoke exposure and healthcare resource utilization patterns among pediatric emergency department patients.iv) Tobacco smoke exposure increased the risk of pediatric patients having respiratory-related procedures, respiratory-related and non-respiratory-related testing, medications administered during the pediatric emergency department visit, and medications prescribed for home administration.v) Tobacco smoke-exposed patients were more likely to be admitted to the hospital compared to unexposed patients.

Preventing smoking relapse in patients with cancer: A randomized controlled trial.

Published: 09/09/2020, Cancer

Conclusions: A specific ‘smoking relapse prevention’ intervention did not reduce relapse rates overall, compared to usual care, but did appear to have benefited those participants who had the social support of a partner. Future work is needed to extend this effect to the larger population of patients.

Association of heated tobacco product use with smoking cessation in Chinese cigarette smokers in Hong Kong: a prospective study

Published: 09/09/2020, Tobacco Control

Introduction Heated tobacco products (HTPs) are increasingly popular worldwide, but whether they aid or undermine cigarette abstinence remains uncertain. We examined the predictors of HTP initiation and the prospective association of HTP use with cigarette abstinence in community-based smokers in Hong Kong.

Conclusion HTP use was not associated with cigarette abstinence at 6 months in a community-based cohort of smokers with intentions to quit or reduce smoking.

Revisiting the association between worldwide implementation of the MPOWER package and smoking prevalence, 2008–2017

Published: 06/09/2020, Tobacco Control

Background: In 2008, the WHO introduced the ‘MPOWER’ package, comprised of best-practice cost-effective interventions outlined in the WHO Framework Convention on Tobacco Control (WHO FCTC), to assist in the country-level implementation of effective practices to reduce the demand for tobacco. We revisited the association between progress in MPOWER implementation from 2008 to 2016 and smoking prevalence from 2009 to 2017 and offered an in-depth understanding of differential outcomes for various country groups. Conclusion A decade after the introduction of the WHO MPOWER package, we observed that the countries with higher initial tobacco control preparedness and higher smoking burden were able to reduce the adult daily smoking prevalence significantly.

Evaluation of an Interprofessional Tobacco Cessation Train-the-Trainer Program for Respiratory Therapy Faculty

Published: 08/09/2020, Respiratory Care

Conclusions: Training respiratory therapy faculty using a train-the-trainer approach had a positive impact on faculty's perceived confidence and ability to teach tobacco cessation at their institutions

Trends in e-cigarette Use in Adults in the United States, 2016-2018

Published: 08/09/2020, JAMA Internal Medicine

Prenatal tobacco use and the risk of mood disorders in offspring: a systematic review and meta-analysis.

Published: 08/09/2020, Social Psychiatry and Psychiatric Epidemiology

Results: Eight cohort and two case-control studies were included in the final meta-analysis. We found an increased pooled relative risk of mood disorders in offspring exposed to maternal prenatal tobacco use RRs 1.43 (95% CI 1.27-1.60) compared to no prenatal tobacco use. Similarly, the pooled relative risks of bipolar and depressive disorders in offspring were 1.44, (95% CI 1.15-1.80) and 1.44, (95% CI 1.21-1.71), respectively. Moreover, the pooled estimated risk of mood disorders was not significantly attenuated in the studies that reported sibling comparison results [RR = 1.21 (95% CI 1.04-1.41)]. Conclusion: Taken together, there was strong evidence for a small (RR < 2) association between prenatal tobacco use and mood disorders in offspring.

Selective Influence of Smoking on Periodontal Treatment Outcomes after 3 Years of Follow-up.

Published: 04/09/2020, Oral Health Prevention Dentistry

Conclusion: Smoking negatively impacted periodontal treatment outcomes at specific tooth sites (deep pockets, maxillary molars) and periodontitis progression, independent of other risk factors.

Research Trawl 29^th August – 4^th September

Preparing for the Quit Day: Comparing beliefs of nondaily versus daily young adult smokers as they prepare for a quit attempt 

Published: 03/09/2020, Nicotine and Tobacco Control

Outline: This study shows that motivations for quitting smoking between daily and nondaily smokers differs significantly. Most research is based on daily/heavy smokers. As there are increasingly more non-daily smokers it is important to better understand how to support this group in their quit attempts.

Exploitation of the COVID-19 pandemic by e-cigarette marketers

Published: 27/08/2020, Tobacco Control

Introduction: Over the last decade, a wide variety of e-cigarette advertisements have claimed superior healthfulness compared with cigarettes. Recently, we recognised a novel form of health reassurance advertising, promotion of e-cigarettes via COVID-19 pandemic themes. This led us to systematically explore COVID-19 marketing of e-cigarette brands and vape stores on their websites and Instagram accounts.

Exposure to health misinformation about COVID-19 and increased tobacco and alcohol use: a population-based survey in Hong Kong

Published: 27/08/2020, Tobacco Control

Conclusion Our results first showed that exposure to health misinformation that smoking/alcohol drinking can protect against COVID-19 was associated with self-reported increases in tobacco and alcohol consumption in Chinese during the pandemic.

Vaping in the Workplace: Implications for Employer-Sponsored Tobacco Cessation Programs

Published: 01/09/2020, Journal of Occupational and Environmental Medicine

Conclusions: Workplace vaping is a trigger for smoking and vaping among current and former tobacco users. A gap exists between desired support for vaping cessation and current employer-sponsored cessation programs.

E-cigarette sharing behavior among college students: An exploratory study.

Published: 02/09/2020, Journal of American College Health

Results: Of the 121 participants, 24% shared e-cigarettes every day and 76% shared some days. The most common setting (91%) for sharing was at social gatherings, and participants shared most often (52%) with one or two people, which happened most often (99%) with friends. The top reason (80%) for sharing e-cigarettes was to feel the effects of nicotine.

Role of e-cigarettes and pharmacotherapy during attempts to quit cigarette smoking: The PATH Study 2013-16.

Published: 02/09/2020, PLoS One

Conclusion: Among US daily smokers who quit cigarettes in 2014-15, use of e-cigarettes in that attempt compared to approved cessation aids or no products showed similar abstinence rates 1-2 years later.

Emerging Chemicals of Health Concern in Electronic Nicotine Delivery Systems

Published: 03/09/2020, Chemicals Research in Toxicology

These findings will contribute to addressing the information gaps pertinent to the presence of emerging chemicals of health concern (ECC)s in ENDS, and warrant further studies for understanding the potential negative health effects and to what extent those chemicals may cause when using the ENDS, and for developing evidence-based standards to regulatory control the types and levels of ECCs in ENDS products.

Pesticides residues in tobacco smoke: risk assessment study

Published: 02/09/2020, Environmental Monitoring and Assessment

Excerpt: These detected residues represent ten different active ingredients (AI), three of these AIs (thiodicarb, alachlor, and endosulfan) are no longer allowed in Europe. A 54.7% of these residues were quantifiable. Furthermore, it was found that with the use of solid-phase extraction sorbent (SPE) as adsorbent and n-hexane as solvent, higher recoveries of the pesticide residues in the tobacco smoke from the amount spiked can be obtained. It was also found that cigarette filters help to reduce the intake of residues of pesticides that may be present in cigarettes. Finally, the study concluded that both active smoking and passive smoking populations are exposed to pesticide residues in the tobacco smoke.

Alteration of smoking habit at time of first diagnosis influences survival of patients with HNSCC

Published: Nov/2020, Molecular and Clinical Oncology

Abstract excerpt: Alteration of smoking at the first diagnosis of Squamous cell carcinoma of the head and neck, led to a significantly beneficial effect on survival outcomes compared with continued smoking, without significant differences between reduction and cessation of smoking. Detailed analysis revealed that this effect was solely dependent on patients treated by surgery only. Lifelong non-smokers exhibited a significant survival advantage compared with active and former smokers, with no difference in survival between these last two groups. These findings indicated that patients should be encouraged to at least minimize smoking following cancer diagnosis

Protecting Youth From Tobacco Around the Globe: Evidence to Practice

Published: 01/09/2020, Paediatrics

[report]

European practice patterns and barriers to smoking cessation after a cancer diagnosis in the setting of curative versus palliative cancer treatment

Published: 29/09/2020, European Journal of Cancer

Results: Responses from 544 oncologists were included. Oncologists appeared to favour addressing tobacco in the curative setting more than in the palliative setting. Oncologists believe that continued smoking impacts treatment outcomes (C: 94%, P: 74%) and that cessation support should be standard cancer care (C: 95%, P: 63%). Most routinely assess tobacco use (C: 93%, P: 78%) and advise patients to stop using tobacco (C: 88%, P: 54%), but only 24% (P)-39% (C) routinely discuss medication options, and only 18% (P)-31% (C) provide cessation support. Hesitation to remove a pleasurable habit (C: 13%, P: 43%) and disbelieve on smoking affecting outcomes (C: 3%, P: 14%) were disparate barriers between the curative and palliative settings (p < 0.001), but dominant barriers of time, resources, education and patient resistance were similar between settings.

Improved rates of treatment success following alcohol and other drug treatment among clients who quit or reduce their tobacco smoking

Published: 31/08/2020, Drug and Alcohol Review

Discussion and conclusions: Despite low overall rates of smoking cessation, our findings suggest clients who do successfully quit have a greater likelihood of achieving reductions in PDOC use and dependence severity. These results reinforce efforts to promote more comprehensive, routine provision of smoking cessation care (i.e. counselling and nicotine replacement therapy). AOD treatment presents a crucial opportunity to deliver smoking cessation care to all clients who smoke, particularly those who are unconcerned about their use, as this group may stand to benefit most.

Impact of smoking behavior on clozapine blood levels - a systematic review and meta-analysis

Published: 01/09/2020, Acta Psychiatrica Scandinavia

Conclusion: Smoking behavior and any change in smoking behavior is associated with a substantial effect on clozapine blood levels. Reductions of clozapine dose of 30% are recommended when a patient on clozapine stops smoking. Reductions should be informed by clozapine steady-state trough levels and a close clinical risk-benefit evaluation.

Severe Neurological Nicotine intoxication by e-cigarette liquids: Systematic Literature Review

Published: 31/08/2020, Acta Neurologica Scandinavia

Abstract Electronic cigarettes are a popular, easily purchased, alternative source of nicotine that is considered safer than conventional tobacco. However, Intentional or accidental exposure to e‐liquid substances, mainly nicotine, can lead to serious, potentially fatal toxicity. Emergency and critical care physicians should keep in mind acute intoxication of this poison with a biphasic toxic syndrome. We highlight its potentially fatal outcome and suggest monitoring the adverse effects of nicotine according to a multimodal protocol integrating somatosensory evoked potentials, electroencephalography and neuroimaging data with anamnestic report and toxicological and laboratory data.