Medical News Today: Graphic warnings on cigarette packets 'help smokers consider health risks'

With 2016 just around the corner, many individuals will be gearing up to take on one of the most challenging New Year’s resolutions: to quit smoking. But a new study suggests this challenge could be made easier if graphic warning labels were put on cigarette packets, after finding such warnings trigger more negative feelings toward smoking than text warnings alone.
Lead study author Abigail Evans, a postdoctoral researcher at Ohio State University, and colleagues publish their findings in the journal PLOS One.
In 2011, the Food and Drug Administration (FDA) published a final rule that required tobacco companies to include color graphics on cigarette packets that depict the negative health implications of smoking.
In 2012, however, a US federal appeals court overturned the ruling, claiming the images put forward by the FDA were “unconstitutional” and were “unabashed attempts to evoke emotion […] and browbeat consumers into quitting.”
According to Evans and colleagues, their findings suggest the decision to overturn the FDA’s rule based on these grounds was wrong; the team says the graphic images do not “browbeat” consumers, and though they do evoke emotion in smokers, the researchers say these emotions make people think more carefully about the health risks of smoking.
“What the court is missing is that without emotions, we can’t make decisions,” says study coauthor Ellen Peters, professor of psychology at Ohio State. “We require having feelings about information we collect in order to feel motivated to act. These graphic warnings helped people to think more carefully about the risks and to consider them more.”

Feelings produced by graphic images ‘acted as a spotlight’

The team reached their conclusion by assessing 244 adults of an average age of 34 who smoked between 5-40 cigarettes a day.
For 4 weeks, smokers were given their preferred brand of cigarettes in packaging that had been modified; some packets contained warning text only – such as “cigarettes cause fatal lung disease” – some contained warning text plus one of nine graphics depicting the dangers of smoking, while others consisted of warning text, graphics plus additional text detailing the risk of every cigarette smoked.
The warning graphics used were developed by the FDA and contained disturbing images, such as a man smoking through a hole in his throat, depicting a surgical procedure known as a tracheostomy that is a result of some smoking-related cancers.
Each week for the 4-week period, smokers collected their cigarettes from the lab and completed surveys detailing how the new packaging made them feel about smoking.
Compared with participants who received text-only packaging, those who received packaging with graphic warnings were more likely to read or look closely at the information, were more likely to remember the information, and were more likely to report that the packaging made them feel worse about smoking.
“The feelings produced by the graphic images acted as a spotlight,” notes Peters. “Smokers looked more carefully at the packages and, as a result, the health risks fell into the spotlight and led to more consideration of those risks.”
In addition, smokers who received packaging with graphic warnings were also more likely to view the information as more “credible” than those who received text-only packaging, and they were also slightly more likely to say they planned to quit smoking.
“For a health issue like smoking, which causes about a half-million deaths a year in the United States, even small effects can have a large impact in the population,” says Peters. “The effect was small, but it was not unimportant.”
Overall, the researchers say their findings show graphic warnings are more effective than text-only warnings for getting consumers to consider the health risks of smoking. They add: “Policies requiring such labels have the potential to reduce the number of Americans who smoke. The effect induced by graphic warning labels appears to have utility in communicating more and more credible information, useful to promoting risk perceptions and quit intentions among smokers in the US and around the world.”
This research supports another study reported by Medical News Today earlier this year, which found a combination of health warning graphics and text on cigarette packets increased knowledge about the dangers of smoking among young adults, compared with text-only warnings.

National Survey Shows Youth Cigarette Smoking Again Falls to Record Low, but E-Cigarettes and Cigars Threaten Progress

FOR IMMEDIATE RELEASE:            December 16, 2015
National Survey Shows Youth Cigarette Smoking Again Falls to Record Low, but E-Cigarettes and Cigars Threaten Progress
Results Show Why FDA Must Act Now to Regulate E-Cigarettes and Cigars 
Statement of Matthew L. Myers, President, Campaign for Tobacco-Free Kids
WASHINGTON, DC – In terrific news for the nation’s health, the government-sponsored Monitoring the Future survey released today shows that the steep, decades-long decline in youth cigarette smoking continues, with smoking rates falling to record lows in 2015 among all three grades surveyed (grades 8, 10 and 12). Cigarette use among 12th graders fell to just 11.4 percent from 13.6 percent last year and 36.5 percent in 1997, representing extraordinary and historic progress.
However, the survey also contains fresh warning signs that other tobacco products – electronic cigarettes and cigars that are sold in an array of sweet, kid-friendly flavors – may be undermining these gains and luring kids into nicotine addiction. For the second year in a row, the survey finds that significantly more teens reported using e-cigarettes than regular cigarettes in the past 30 days. In addition, teens reported using flavored little cigars at the same rate as cigarettes, and the percentage of teens who smoked tobacco in the past 30 days increased by more than half when cigarillos are included with regular cigarettes.
These findings should spur the White House to quickly issue a long-overdue rule providing for Food and Drug Administration regulation of all tobacco products, including e-cigarettes and cigars. It has been nearly 20 months since the FDA issued its proposed rule and nearly two months since the FDA sent the final rule to the White House for review. We cannot afford further delays that allow the tobacco industry to continue targeting our kids with a new generation of tobacco products. In addition, Congress must let the FDA do its job and reject proposals to weaken the FDA’s authority over e-cigarettes, cigars or any tobacco product.
The continuing decline in youth cigarette smoking is unquestionably good news that will improve the nation’s health and save lives:

  • For all three grades combined, the percentage of students who reporting smoking cigarettes in the prior 30 days fell from 8 percent in 2014 to 7 percent in 2015 – a statistically significant drop. Past-month smoking fell to 3.6 percent among 8th graders, 6.3 percent among 10th graders and 11.4 percent among 12th graders, all record lows.
  • Long-term trends are especially dramatic. Since peaking around 1996-1997, smoking rates have fallen by 83 percent among 8th graders, 79 percent among 10th graders and 69 percent among 12th graders. Daily cigarette use has fallen even more steeply, with just 5.5 percent of 12th graders reporting daily smoking in 2015.

These results demonstrate that we know how to win the fight against tobacco by implementing science-based strategies. These include higher tobacco taxes, strong smoke-free laws, well-funded tobacco prevention and cessation programs that include mass media campaigns, increasing the tobacco sale age to 21 and effective FDA regulation of tobacco products. Progress has accelerated following the largest-ever increase in the federal cigarette tax (a 62-cent increase implemented in 2009) and unprecedented national media campaigns launched by the CDC, the FDA and Truth Initiative. Rather than breeding complacency, our progress should spur elected officials to step up these proven measures and end the tobacco epidemic for good.
The survey’s findings on e-cigarettes and cigars are deeply troubling:

  • In all three grades, e-cigarette use far exceeded regular cigarette use in the past 30 days – 9.5 percent to 3.6 percent among 8th graders, 14 percent to 6.3 percent among 10th graders and 16.2 percent to 11.4 percent among 12th graders. These results also indicate e-cigarettes are more likely to be a pathway to tobacco addiction than away from it. More than half of students said their primary reasons for using e-cigarettes was to experiment and more than 30 percent said it was because they tasted good, while less than 10 percent said they used e-cigarettes to help quit regular cigarettes.
  • Teens reported smoking flavored little cigars at the same rate as cigarettes, with 11.4 percent of 12th graders reporting use of flavored little cigars in the past 30 days. When both cigarettes and flavored cigarillos are included, smoking rates in the past 30 days increased to 6.6 percent among 8th graders, 9.8 percent among 10th graders and 17.8 percent among 12th graders.

These findings are not surprising given the irresponsible marketing of e-cigarettes and cigars in a wide variety of kid-friendly flavors, such as gummy bear, cotton candy and watermelon.  E-cigarette makers have marketed their products with the same tactics long used to market regular cigarettes to kids, including celebrity endorsements, slick TV and magazine ads, and sponsorships of race cars and concerts.
Despite our progress, we cannot let up in the fight against tobacco because the tobacco industry never lets up. The industry spends $9.6 billion a year – more than $1 million every hour – to market its deadly products, and it is constantly seeking innovative ways to entice our kids. It’s no wonder tobacco use is still the number one cause of preventable death in our country, killing more than 480,000 people and costing about $170 billion in health care expenses each year. We cannot win the fight against tobacco unless elected officials put our nation’s kids and health before the special interests of the tobacco industry.
The Monitoring the Future survey has been conducted annually since 1975 by researchers at the University of Michigan and is funded by the National Institute on Drug Abuse.

WebMD News from HealthDay: Tobacco Exposure and Infertility, Early Menopause

By Kathleen Doheny, HealthDay Reporter

Smoking and being exposed to secondhand smoke may trigger early menopause and infertility in women, a new study suggests.
Other research has linked smoking with higher rates of infertility and perhaps earlier menopause. However, “secondhand smoke is less researched,” especially among never-smoking women, said study author Andrew Hyland, chair of health behavior at Roswell Park Cancer Institute, in Buffalo, N.Y.
In the study, Hyland and his colleagues evaluated women enrolled in the Women’s Health Initiative, a large study launched in 1991 to look at a variety of health issues in more than 160,000 generally healthy, postmenopausal women.
Hyland’s team looked at information about age of menopause and fertility, along with tobacco exposure, among some of the women enrolled in the study. The investigators evaluated information available on about 88,000 women to look at the fertility effects. They also looked at information on about 80,000 to examine onset of natural, or nonsurgical, menopause.
Both smoking and exposure to secondhand smoke were linked to fertility issues and early menopause (before the typical age of 50), the researchers found.
Compared with never smokers, current or former smokers were 14 percent more likely to be infertile and 26 percent more likely to have early menopause. Early menopause has been linked with a higher risk of death from all causes, Hyland pointed out.
Among never smokers, those exposed to the highest level of secondhand smoke (such as living with a smoker for 10 years or more) were 18 percent more likely to have fertility problems and early menopause, the study found.
Women who had ever smoked reached menopause about 22 months before those who never smoked or never were exposed to smoke. Those exposed to the highest level of passive smoke reached menopause 13 months earlier than those not exposed, the findings showed.
But the study cannot prove cause and effect, Hyland added. “This is an observational study looking at data already collected,” he said. “It [the link] could be something associated with early development and exposure as a young child.”

Smoke interacts with hormones and can have adverse effects as well, he added.

The study was published online Dec. 15 in the journal Tobacco Control.

The findings are a valuable reminder to avoid all smoke, said Patricia Folan, director of the Center for Tobacco Control at North Shore-LIJ Health System in Great Neck, N.Y.

“This study provides additional motivation and incentive for women of all ages to avoid smoking and exposure to secondhand smoke, as well as to quit smoking,” she said. Both are associated with premature birth, low birth weight, infant death and certain birth defects, she added.

“This evidence, in addition to the data from the current study, offers health care providers, particularly ob-gyn practitioners, the information needed to counsel women about the hazards of smoking and secondhand smoke, and to encourage cessation,” Folan said.

NBC News: Cigarette Smoke Might Cause Infertility, Early Menopause, Study Shows

Tobacco smoke might do more than cause cancer, heart disease and lung damage. It might also injure fertility in women, researchers reported Tuesday.
Women who smoked the most, and who started at the youngest ages, went through menopause almost two years earlier than women who never smoked, Danielle Smith of the Roswell Park Cancer Institute in Buffalo and colleagues reported.
Women who remembered breathing in the most secondhand smoke went through menopause an average of 13 months earlier than women who didn’t think they’d ever breathed any in, the team reported in the journal Tobacco Control.
The team studied more than 93,000 women taking part in the Women’s Health Initiative Observational Study between 1993 and 1998. They filled out very detailed questionnaires on lifestyle habits, health problems and medical diagnoses.
They found that women who smoked 100 cigarettes or more in their lives had a 14 percent greater risk of infertility and a 26 percent greater risk of going through menopause before they turned 50.
The study helps confirm other studies that have linked smoking with early menopause.
Women who grew up with a smoker in the house for 10 years or more, those who lived with a spouse who smoked for 20 years or more, and those who worked with smokers for 10 years or more were 18 percent more likely to have had infertility problems than women who had never been passive smokers.
Overall, about 15 percent of the women said they had struggled to conceive for a year at a stretch or more, and 45 percent said they went through menopause before they turned 50.
There’s a debate over whether fertility rates have fallen, and many people have blamed chemicals known as endocrine disruptors in cans, bottles and in water supplies. But tobacco also contains these.
The toxins in tobacco smoke can interfere with the production of hormones related to fertility cycles, they can damage the production of egg cells, they can hurt the embryo before it gets implanted in the wall of the uterus, and they can restrict the processes that prepare a womb for pregnancy, the researchers said.
“Tobacco toxins also seem to lower the age of natural menopause by reducing circulating estrogen,” they wrote.
Smoking can also affect men in specific ways. For instance, it seems to damage the male Y chromosome especially badly.
Smoking is on the wane in the U.S. Last month, the Centers for Disease Control and Prevention reported the percentage of U.S. adults who smoke cigarettes declined from 20.9 percent in 2005 to 16.8 percent in 2014.
And smoking bans have made secondhand smoke in the workplace and public areas a thing of the past in most states.

New York Times: U.S. Smoking Rate Declines, but Poor Remain at Higher Risk

WASHINGTON — Smoking, the leading cause of preventable death in the United States, continued to decline last year, federal health authorities reported Thursday, with the share of American adults who smoke dropping to 16.8 percent, down from 17.8 percent in 2013.

Smoking has been one of the brightest public health successes of recent history. Nearly half of all Americans smoked in the 1960s, but a broad push against the habit, starting with the surgeon general’s warning in 1964, helped bring rates down. The rate has dropped by about a fifth since 2005, when it was 21 percent.

But the national numbers mask deep trouble spots within the American population. About 43 percent of less educated Americans smoked in 2014, compared with just 5 percent of those with a graduate degree. About a third of Americans insured by Medicaid, the health insurance program for the poor, smoked, compared with 13 percent of Americans with private insurance.

The figures, reported by the Centers for Disease Control and Prevention, underscored the extent to which smoking in America has become a problem of the poor. Nearly six million Americans covered by Medicaid smoke, as well as almost nine million uninsured Americans, or about a third of the uninsured population.

Smoking-related diseases accounted for more than 15 percent of annual Medicaid spending from 2006 to 2010, or about $39 billion a year, according to the American Lung Association.

“Disparities are the single most important issue in smoking,” said Kenneth E. Warner, a professor of public health at the University of Michigan School of Public Health.

Dr. Warner added: “The people who are politically influential believe the smoking problem has been solved. It’s not in their neighborhoods. Their friends don’t smoke. Those who still smoke are the poor, the disenfranchised, the mentally ill. That’s who we need to focus on.”

On Thursday, the federal government appeared to take aim at that problem by proposing a rule that would prohibit smoking in public housing nationwide.

Nationally, success of the antismoking campaign has been striking. Progress among the poor and less educated, however, has been far slower.

About 43 percent of people with only a high school equivalency diploma smoke, virtually unchanged from 2005. In comparison, smoking declined by about 26 percent among people with college degrees, to 8 percent from 11 percent. For people with a high school diploma only, smoking declined by about 12 percent, to 22 percent.

Smoking among people who live at or above the poverty line declined by about 26 percent, to 15 percent from about 21 percent in 2005. Those below the poverty line declined by about 12 percent, to 26 percent from 30 percent, the report found.

American Indians and Alaskan Natives had the highest smoking rate, about 29 percent, followed by Americans of more than one race, about 28 percent of whom smoked.

Whites and blacks smoked at about the same rate in 2014 — about 18 percent — while Hispanics had a much lower rate, 11 percent.

The Washington Post: Who still smokes in the United States — in seven simple charts

Cigarette smoking among U.S. adults has fallen to the lowest rate in generations, according to data released Thursday by the Centers for Disease Control and Prevention. That’s good news, considering that smoking still accounts for about 480,000 deaths annually in the United States, along with an estimated $300 billion in health costs and lost productivity.
But the CDC numbers also offer an interesting glimpse at the 17 percent of adults who continue to light up. People in the Midwest, for instance, smoke more on average than Americans elsewhere in the country. People on Medicaid are more than twice as likely to smoke as those on Medicare. Adults with a GED certificate smoke at eight times the rate of those with graduate degrees. Asians smoke less than other ethnic groups. Men smoke more than women, but not by much.
Here are seven charts, based on CDC data, that detail the current landscape of smoking in the United States:
1) Half a century ago, more than two of every five adults were smokers. But that has fallen steadily over time. From 2005 to 2014, the adult smoking rate declined from 20.9 percent to 16.8 percent. Public health officials are hoping to to drive that rate below 12 percent by 2020.
2) Cigarette smoking has fallen sharply among 18- to 24-year-olds. In fact, the percentage of smokers in that age group dropped by nearly a third over the past decade, CDC data show,  the sharpest decline of any group. But that striking change might be attributable, at least in part, to the growing popularity of e-cigarettes, hookahs and other “non-cigarette tobacco products,” CDC officials said.
3) People with lower levels of education tend to smoke at higher rates. The new data also show that smoking among people with graduate and undergraduate degrees has fallen more sharply over the past decade than among most other groups.
4) Smoking among multiracial people and those classified as American Indian or Alaska Natives (AI/AN) far outpaces that of other ethnic groups. Notably, Asians continue to have the lowest rate of smokers and, along with Hispanics, have cut their smoking rates steeply over the past decade. CDC officials said the disparities across ethnic groups, which are consistent with previous research, might partly be due to cultural differences related to the acceptability of tobacco use.
5) Midwesterners still smoke at higher rates than anyone else in the country. This was true a decade ago. But Thursday’s data show that while other regions have cut smoking rates by 20 percent or more since 2005, the Midwest’s dropped only 14.4 percent.
6) U.S. adults who are uninsured or on Medicaid smoke at rates more than double that of people who have Medicare or private insurance. There could be many factors at play here. But health officials said one contributing factor is likely the “variations in tobacco-cessation treatment coverage and access to evidence-based cessation treatments” across different insurance types.
7) The number of heavy smokers seems to be declining. Between 2005 and 2014, the number of daily smokers dropped from 36.4 million to 30.7 million. Those daily smokers also reported smoking fewer cigarettes over time, from an average of 16.7 a day in 2005 to 13.8 a day in 2014. The number of people smoking more than 30 cigarettes a day fell by almost half.

WebMD: E-Cigarette Use Highest Among Young Adults: Report

Almost 4 percent of all adult Americans use them, new survey shows

WebMD News from HealthDay

By Alan Mozes, HealthDay Reporter

WEDNESDAY, Oct. 28, 2015 (HealthDay News) — In a first-of-its-kind look at electronic cigarettes, a new U.S. government study reports that nearly 13 percent of American adults have tried e-cigarettes at least once and almost 4 percent use them.

According to the 2014 National Health Interview Survey by the U.S. Centers for Disease Control and Prevention, the popularity of e-cigarettes rose slightly among men (about 14 percent) and dipped among women (about 11 percent).

But the most dramatic usage differences break along age lines, the poll of nearly 37,000 adults found. Almost 22 percent of Americans between the ages of 18 and 24 said they had tried the battery-powered aerosol nicotine-delivery device, while usage among those 65 and older was less than 4 percent.

Current users also tend to be younger, the report noted, with more than 5 percent of those 18 to 24 saying they now use e-cigarettes, compared with just over 1 percent of those 65 and older.

And among never-smokers, the usage was also highest among the 18-to-24 age group.

The report found that e-cigarette popularity is greatest among white and Native American adults, with nearly 5 and 11 percent, respectively, now using them. Only about 2 percent of blacks and Hispanics use them.

E-cigs also seem to curry much more favor among those who now smoke traditional cigarettes, or those who only recently kicked the habit: About 48 percent of current smokers have tried an e-cigarette and one in six currently use them. About 55 percent of those who stopped smoking just in the last year have tried them, and 22 percent said they currently use them.

By contrast, only about 3 percent of never-smoking adults said they’ve tried an e-cigarette, and less than half of 1 percent said they use them now. Among young (aged 18 to 24) never-smokers, however, almost 10 percent said they’ve tried one out.

So what’s driving the numbers?

“We really can’t answer that question,” said study co-author Charlotte Schoenborn, a statistician with the U.S. National Center for Health Statistics in the CDC’s division of health interview statistics. “This was the first year that the NCHS has even asked these questions. So we can only speculate as to why, as we watch to see how the trends unfold over time.”

Schoenborn and her colleague Renee Gindi outline their findings in the CDC’s October NCHS report released Oct. 28.
Erika Sward, assistant vice president for national advocacy with the American Lung Association, suggested that the CDC data will end up becoming a “very useful and much needed benchmark” for monitoring e-cigarettes.
“Electronic cigarettes are really the wild, wild West,” Sward said. “There’s absolutely no federal oversight of e-cigarettes, even though the FDA [U.S. Food and Drug Administration] has not found any e-cig to be safe or effective in helping smokers quit. And to our knowledge, no e-cigarette company has even applied to the FDA for approval as a smoking cessation product.”
But many manufacturers market the devices that way anyway, she said.
“So the real take-away message is that the people who are most likely to use e-cigs are our most vulnerable adults: the young, current smokers, and those who have recently quit or are trying to quit,” she said.
Sward added, “So just as we’re seeing traditional cigarette use decline — after years of FDA regulation and state smoke-free policies and taxation — we’re now seeing the tobacco industry continue its narrative of aggressively marketing e-cigarettes to younger people in the hopes of developing a whole new lifelong user.
“And until we act,” she said, “troubling studies like this one suggest that we’re on a path to a real public health crisis that will undo much of the progress that has been made to reduce tobacco use in the U.S.”
The report comes on the heels of a recommendation by the nation’s leading pediatricians group to raise the minimum age for purchasing tobacco products and e-cigarettes to 21 across the United States.
The new policy recommendation by the American Academy of Pediatrics, released Oct. 26, also called for the FDA to regulate e-cigarettes the same way it regulates other tobacco products.

Patient-centered care helps patients overcome mental illness and tobacco use

People diagnosed with chronic mental illness will die an average of 10 years earlier than those without mental illness.
A number of social and biological factors contribute to early mortality, but 40 percent of people with a mental health condition also practice one of the most preventable health risk behaviors — smoking.
A study from the National Institutes of Mental Health found that people with a mental illness smoke nearly half of all cigarettes in America. The Journal of the American Medical Association provided evidence that people with severe mental illness are at a higher risk of cardiovascular death. Depression is three times higher in smokers than in non-smokers, and an estimated 70 to 85 percent of people with schizophrenia are tobacco users.
Evidence supports a bi-directional relationship between tobacco use and depression. For some patients, smoking can alleviate pre-existing symptoms of depression and anxiety by releasing dopamine, a source of pleasure, in the brain. But evidence also suggests that smoking causes depression and other forms of psychosis, and some people with decreased dopamine levels are genetically predisposed to tobacco use and dependence.
Health care providers must address the patient’s tobacco use, a chronic addictive condition, in conjunction with the mental illness to preserve health. To accomplish this, we must:
Treat both conditions at once
Some evidence-based pharmacological methods are dually effective in treating tobacco use and mental illness. For one, bupropion hydrochloride has proven successful in reducing depression and serving as a smoking cessation aid.
Acknowledge the mental health effects of quitting
The decision to quit smoking benefits the patient in the long term, but nicotine withdrawal might exacerbate or lead to depressive symptoms. Patients must communicate with a health care provider about any side effects associated with quitting, such as depression. Patients can also participate in group therapies or meet with a counselor to mitigate the negative effects of quitting smoking.
Ensure that intervention is patient-centered
When patients give up smoking, they’re letting go of a coping mechanism or a companion. The patient should remain the central focus in any intervention, and providers should act with empathy and understanding, because quitting is a process requiring perseverance. A patient-centered plan should incorporate aids to quit smoking as well as mental health support and accessible resources.

Dr. Chizimuzo Okoli is an assistant professor in the UK College of Nursing.

Forbes: Alcohol, Drug Addicts Far More Likely to Smoke Tobacco

Turn on the television at any point of the day to find anti-smoking commercials sprinkled throughout a sports game or nightly sitcom. As many organizations and levels of government focus efforts on eliminating tobacco use from the general population, one sub-population in particular continues to be ignored: individuals addicted to alcohol and drugs in treatment recovery programs.
Published in Addiction – a peer-reviewed journal that covers research related to alcohol, illicit drugs, tobacco and other addictions – a new report concluded that the overall rate of smoking among addicts in treatment for drug and alcohol use was 84%, compared with a rate of 31% for individuals of the general public.
Lead study author Joseph R. Guydish, a professor of Medicine and Health Policy at the University of California, San Francisco (UCSF), said in an interview that tobacco use isn’t just an issue for addiction recovery programs; it’s also a problem for both county and state public health offices supporting rehabilitation facilities.
“At the federal level this means the Substance Abuse and Mental Health Services Administration, the Center for Substance Abuse Treatment, the National Institute on Drug Abuse and the National Cancer Institute,” he said. “Internationally this means the WHO, its Framework Convention on Tobacco Control and its MPOWER principles. These are the agencies that can exert leadership in the area of smoking and addiction treatment, and provide programs with resources needed to better address smoking.”
Researchers reviewed 54 studies, which were published from 1987 to 2013, involving a total of 37,364 participants in 20 countries on six continents. All the reports analyzed were written in English.
“Anyone interested in tobacco control, whether nationally or internationally, should take note,” he said. “We cannot reduce adult smoking much further (at least in the United States) without addressing smoking in sub-populations where smoking rates are high.”
When asked about how often addicts switch over from their drug of choice to nicotine during the recovery process, Guydish admitted that he’s unaware of any relevant data available on the topic. He did note, however, that he believes the “answer would be not very often.”
“Nicotine operates in the same reward pathways of the brain as other addictive drugs, however its effect is relatively weaker than the effect of those other drugs,” he said. “We know that nicotine potentiates the effects of other drugs, but it seems unlikely that a person would stop drug use (for example) and then begin smoking as a replacement. But it is possible.”
He added: “The scenario we hear of more often is one where a person quits smoking, sometimes because they have been in a smoke-free jail or prison, but relapses to smoking in the context of drug treatment where they are surrounded by smokers.”
“Tobacco control researchers have done a great job of implementing tobacco control policies and evaluating their effects in the general population, in healthcare settings and on college campuses,” Guydish said. “Further research should follow this lead and develop, implement, and evaluate a range of policy interventions in addiction treatment programs, such as smoke-free grounds, no evidence of smoking among staff during working hours, and funding to increase availability of smoking cessation interventions.”

Study: Teens using e-cigs much more likely to start smoking cigarettes

More bad news for young people who smoke e-cigarettes.
Doing so makes them much more likely to start smoking traditional cigarettes within a year than peers who don’t smoke e-cigarettes, according to a new analysis published online Tuesday and scheduled for the November issue of JAMA Pediatrics.
The latest news about e-cigarettes comes at a time when their use is soaring among youngsters. The number of middle school and high school students using electronic cigarettes tripled from 2013 to 2014, according to government figures released this spring, a startling increase that public health officials fear could reverse decades of efforts combating the scourge of smoking.
The popularity of e-cigarettes among teenagers now eclipses that of traditional cigarettes, the use of which has fallen to the lowest level in years.
In the latest study, researchers analyzed data from a national sample of nearly 700 nonsmokers who were between ages 16 and 26 in 2012, and again in 2013. All of them said “definitely no” when they were asked if they would try a cigarette offered by a friend or believed they would smoke a cigarette within the next year.
Only 16 of the participants used e-cigarettes when they were initially surveyed, but six of them had progressed to cigarette smoking by the next year, or about 38 percent. By contrast, only 10 percent of the youths who were not e-cigarette users  started smoking traditional cigarettes.
The study was conducted by the University of Pittsburgh Center for Research on Media, Technology and Health and the Dartmouth-Hitchcock Norris Cotton Cancer Center.
In the past, few studies looked at whether e-cigarette users who initially did not smoke were at risk for taking up both the use of e-cigarettes and traditional cigarettes, or the exclusive use of cigarettes. Previous studies could not determine whether e-cigarette use preceded cigarette use, researchers said. Those studies also looked at different youngsters over different time periods.
The latest study analyzed the same individuals over time.
“This is the first longitudinal, national study to show that e-cigarette use among youth directly leads to regular cigarette use, even among people who insist at baseline that they never will smoke regular cigarettes,” said lead author Brian Primack, who is assistant vice chancellor for health and society at Pittsburgh’s Schools of the Health Sciences. “It is also the first to include young adults, as opposed to strictly teenagers.”
Researchers said one limitation was the relatively small number in the sample size. The findings need to be replicated with larger samples. Even so, after controlling for well-known risk factors, such as age, sex, socioeconomic status and risk-taking, “we think the effect is real,” said Samir Soneji, an assistant professor at the Dartmouth Institute for Health Policy and Clinical Practice and one of the authors.
E-cigarettes accelerate the progression to traditional cigarette smoking, he said.
The quandary for public health officials is this, he said. “Are they more dangerous for kids than they are helpful for adults who are trying to quit smoking?”