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- Why Elon Musk And Sam Altman Think Christopher Nolan’s ‘Oppenheimer’ Missed The Mark Benzinga
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Tag Archives: cigarettes
E-cigarettes cause MORE lung inflammation than normal cigarettes
Vape users suffer more inflammation of the lungs than people who smoke regular cigarettes, a study suggests.
University of Pennsylvania researchers said the electronic devices cause ‘unique’ damage to the lungs not yet fully understood.
The study is the latest evidence to highlight how vaping is not the risk-free cessation method it was initially touted as.
Other researchers have found e-cigarettes cause heart and lung damage on par with traditional cigarettes.
Researchers found that vapers suffered more inflammation in their lungs than people who smoke regular cigarettes (file photo)
The radiotracer used by researchers was able to highlight areas of inflammation in the lungs within 45 seconds (red)
The researchers gave 15 people a tracing chemical that sticks to inflammation on the lungs and makes it visible on CT scans.
Participants were either vape users, traditional smokers or people who had never used either device.
Results showed significantly more inflammation in the lungs of vapers than smokers or non-smokers.
But interestingly, tobacco smokers did not suffer more inflammation than those that used neither device.
‘We find evidence that [e-cigarette] use causes a unique inflammatory response in the lungs,’ researchers wrote in the study.
More than 2.5million US minors use e-cigarettes, according to a Centers for Disease Control and Prevention study published last year.
Experts have described the youth’s use as a crisis, and some warn America will face a surge in lung-related health issues in the future.
‘Commercial tobacco product use continues to threaten the health of our nation’s youth,’ Dr Deirdre Lawrence Kittner, the director of the CDC’s Office on Smoking and Health, said in November.
For the Penn study, researchers gathered five non-smokers, five people who smoke typical combustible cigarettes and five vapers.
They were matched by age and gender to one another to control for inflammation tied to outside factors.
Each was injected with a radiotracer called, 207 MBq F-18 NOS. These traces are often used to find radioactive irregularities as they can be spotted on CT scans.
In cancer treatment, for example, a doctor may inject a tracer that binds to tumor tissue and scan a person to find signs they could soon develop the disease.
Within 42 seconds of the injection, the tracer had fully covered a person’s lungs and could spot signs of inflammation.
Researchers, who published their findings last week in the Journal of Nuclear Medicine, found no difference in lung inflammation between non-smokers and cigarette users.
They did find a significant increase in lung inflammation in the group of vapers when compared to the others, though.
Lung inflammation is not always permanent or serious. It is well-known that some suffer lung inflammation after suffering a viral illness such as the common cold.
In some cases, though, the inflammation can lead to tissue scarring – which could later lead to cancer.
This type of damage is also linked to the development of chronic obstructive pulmonary disease (COPD).
The true impact e-cigarettes have on the lungs is still being researched by health officials, but early data shows the devices could have devastating long-term.
One chemical included in many flavored vape products, diacetyl, has been linked to the devastating condition popcorn lung.
Medically known as bronchiolitis obliterans, it occurs when the chemical forms scar tissue in the lungs and blocks the flow of air.
Other studies have linked long-term vaping to obstruction of the lung’s airways, which are linked to conditions such as asthma and COPD.
Another recent study found the devices can cause DNA damage comparable to that of cigarettes – opening users up to developing cancer in the future.
The devices are still believed to be less harmful than cigarettes, though, with the combustible versions linked to many types of cancer and lung conditions.
New Zealand bans sale of cigarettes to those born in 2009 or later
“This bill will create generational change, and it will leave a legacy of better health for our youth,” Associate Health Minister Ayesha Verrall said Tuesday.
Under the new changes, retailers who sell tobacco to anyone born on or after Jan. 1, 2009 — those around 13 years old or younger today — will face fines of up to 150,000 New Zealand dollars, or around $96,000. The ban will go into effect on Jan. 1, 2027, when those born in 2009 will start turning 18.
The legislation also overhauls several existing tobacco laws by reducing the number of retailers authorized to sell tobacco in New Zealand to 600 and imposing stricter nicotine limits in smoked tobacco products.
“Thousands of people will live longer, healthier lives and the health system will be $5 billion better off from not needing to treat the illnesses caused by smoking, such as numerous types of cancer, heart attacks, strokes, amputations,” Verrall said in a press release.
The ban comes as other countries weigh similar proposals to curb tobacco use. Ireland and Wales have set similar goals to render their countries smoke-free within the decade.
In March, Denmark unveiled a proposal to ban tobacco sales to those born after 2010, but European Union laws prevented it from enacting the ban. Bhutan passed a sweeping ban on tobacco products in 2010, but an underground market began flourishing there and the government temporarily lifted its ban during the first year of the pandemic.
New Zealand’s bill passed through its parliament 76-43 with support from left-leaning parties, including the leading Labour Party. Members of the right-leaning New Zealand National and ACT New Zealand voted against the ban.
One ACT leader called the new measures “nanny-state prohibition” during Tuesday’s parliamentary session.
The new laws come as New Zealand’s government nears a self-imposed deadline for a decade-long commitment to eliminating smoking, which began after a 2010 inquiry by the Māori Affairs Committee. The committee, which examines issues affecting the country’s Indigenous population, reported on tobacco’s health effects and its disproportionately severe toll on the Māori population. In 2011, the government pledged to reduce smoking to under 5 percent of the population by 2025.
Smoking rates have steadily declined in New Zealand since then, according to a report issued by the Health Ministry. Eight percent of adults in the country smoke daily, according to New Zealand’s latest health survey, though smoking rates among the Māori population remain higher, at 19.9 percent.
Tuesday’s legislation follows years of annual tax hikes on tobacco products and mandates to display health warnings on tobacco packaging, while alternatives like vaping have risen in popularity. Still, data showed New Zealand would fall short of its goal without more drastic measures, said Nick Wilson, who studies tobacco control at New Zealand’s University of Otago.
“Progress was occurring, but it wasn’t fast enough,” Wilson said.
Wilson said several factors might aid New Zealand in enforcing its ban: The country lacks a large domestic tobacco-growing base and, as an island nation, can more easily guard its borders against illicit imports.
The generational ban on tobacco sales also may not be the most important part of the new laws, Wilson added. Clinical trials suggest that restricting nicotine levels in tobacco products will be more effective at reducing smoking rates, Wilson said. Less nicotine can make smoking less satisfying to some, and that “dramatically improves the quit rate,” he said.
If New Zealand’s bid to go smoke-free is successful, it may have to tackle the most popular alternative next: vaping. Underage vaping has increased in recent years and is also prevalent among Māori teenagers, advocacy group Action for Smokefree 2025 found in November.
“If New Zealand’s done well on tobacco control generally, it’s taken a pretty laissez-faire approach up to recently regarding vaping,” Wilson said. “Maybe there needs to a vaping endgame for New Zealand as well.”
Rachel Pannett contributed to this report.
Supreme Court declines to block California’s ban on flavored cigarettes
CNN
—
The Supreme Court on Monday denied a request from tobacco company R.J. Reynolds to challenge a California law that bans the sale of flavored cigarettes.
There were no noted dissents.
The company, which makes menthol cigarettes, argued the state law conflicts with a federal law called the Tobacco Control Act that gives the federal Food and Drug Administration the authority to regulate the sale of cigarettes.
The ban is set to go into effect December 21, and the tobacco company said that without the Supreme Court’s intervention it would be barred from selling its menthol cigarettes – which make up approximately one-third of the cigarette market – in one of the nation’s largest markets.
In November, Californians went to the polls and approved the ballot initiative by a 63.5% to 36.5% margin. The law, SB 793, makes it illegal to “sell, offer for sale, or possess with the intent to sell or offer for sale, a flavored tobacco product or a tobacco product flavor enhancer.”
Lawyers for R.J. Reynolds argued that the lower court was wrong to “ignore” federal law and permit states to “completely prohibit” the sale of flavored tobacco products for failing to meet “tobacco product standards.”
They noted that in 2009, Congress “enacted a comprehensive regime” to distribute authority over tobacco product regulation between the FDA and state and local governments and that the law granted the FDA “primary authority” to regulate tobacco products.
In legal briefs, California urged the justices to stay out of the dispute, arguing that for more than a century, states have “carried out their authority” to “guard the health” of their citizens. California Attorney General Rob Bonta said the law at issue was necessary because “flavored tobacco products are the central cause of unfavorable trends in youth addiction to tobacco.”
He noted that the tobacco industry spent “tens of millions of dollars” trying to persuade voters to defeat California’s ban and failed to do so. He also said that when Congress passed the Tobacco Control Act in 2009, it “protected the pre-existing authority” of states with respect to the sale of tobacco products.
In a statement following the order, Bonta applauded the high court “for denying Big Tobacco’s latest attempt to block California’s commonsense ban on flavored tobacco products.” He added, “The voters of California approved this ban by an overwhelming margin in the November election and now it will finally take effect. I look forward to continuing to defend this important law against any further legal challenges.”
Smoking marijuana more deadly in cigarette smokers: study
Smoking marijuana in combination with cigarettes may do more damage to lungs than cigarettes alone, a new study suggests.
A study published Tuesday in the peer-reviewed journal Radiology showed that marijuana use may be linked to an increased risk of emphysema versus smoking only tobacco. The trend is made more worrisome by the fact that cannabis users were younger on average — most were under 50 — than cigarette smokers.
Emphysema develops over time as lung tissue is damaged and causes air sacs to rupture and trap air in the damaged tissue and prevent oxygen from moving through the bloodstream. It can cause shortness of breath, coughing with mucus, wheezing and chest tightness, and is irreversible once it develops.
Over 3 million people in the United States have been diagnosed with the potentially deadly disease despite it being one of the most preventable respiratory illnesses, according to the American Lung Association.
Researchers from the Department of Radiology at Ottawa Hospital found that 75% of the people in the study who smoked marijuana, potentially alongside tobacco, had developed emphysema, while just 67% of the tobacco-only smokers showed signs of the disease. Only 5% of complete nonsmokers were diagnosed.
Furthermore, they saw that paraseptal emphysema, a specific subtype of the disease that affects the outermost parts of the lung, was more common among marijuana smokers compared to those who only smoke tobacco.
The study reviewed chest scans of 56 marijuana smokers — 50 of whom were also current or former tobacco users — 33 tobacco-only smokers and 57 nonsmokers, taken between 2005 to 2020.
But the small-scale study of 150 participants based in Canada had limitations. Researchers did not gather sufficient data on how subjects consumed cannabis, how often they smoked it or for how long they’ve kept up the habit. The method by which cannabis users inhale the substance makes a difference: Blunts, for example, contain tobacco in the wrap.
Tobacco-only smokers in the study were noted to have consumed at least one pack — 20 cigarettes — per day for the past 25 years.
Researchers also did not account for other previous health conditions.
“There’s a public perception that marijuana is safe, or that it’s safer than cigarettes. But this study raises concerns that this may not be true,” said lead study author Dr. Giselle Revah, assistant professor of radiology at the University of Ottawa, in a statement to Agence France-Presse.
“The American Lung Association says the only thing that should go into your lungs is clean air, so if you’re inhaling anything, it could potentially be toxic to your lungs,” Revah said in a CNN report.
“There’s definitely a concern that we’re going to see another generation of lung disease related to these behaviors,” Dr. Albert Rizzo, chief medical officer of the American Lung Association, told USA Today.
Researchers point out that marijuana and tobacco are smoked differently, with marijuana smokers usually inhaling deeper and longer, while tobacco is commonly smoked with quick exhalations. Conventionally manufactured cigarettes also have a filter, which may catch certain harmful toxins.
Due to the limitations, experts admit that the study cannot fully the compare the safety of marijuana and tobacco, but agreed that the findings suggest more research should be done as use of the drug is on the rise. E-cigarettes, too, are increasingly popular and should be factored into future research.
Smoking Marijuana May Be Worse for Lungs Than Smoking Cigarettes
Airway inflammation and emphysema are more common in marijuana smokers than cigarette smokers, according to new research.
Emphysema More Common in Marijuana Smokers Than Cigarette Smokers
According to new research, airway inflammation and emphysema are more common in marijuana smokers than cigarette smokers. Investigators said the difference may be due to the way that marijuana is smoked and the fact that marijuana smoke enters the lungs unfiltered. The research study was published on November 15 in Radiology, a journal of the Radiological Society of North America (RSNA).
Marijuana is the most-commonly smoked substance after tobacco and one of the most widely used psychoactive substances in the world. Amid the legalization of recreational marijuana in Canada and many states in the U.S., its use has increased substantially in recent years. With the growing use, there is an urgent need for information on marijuana’s effects on the lungs, something that is currently lacking.
“It has been suggested that smoking a marijuana joint deposits four times more particulates in the lung than an average tobacco cigarette.” — Giselle Revah, M.D.
“We know what cigarettes do to the lungs,” said study author Giselle Revah, M.D., a cardiothoracic radiologist and assistant professor at the University of Ottawa in Ottawa, Canada. “There are well-researched and established findings of cigarette smoking on the lungs. Marijuana we know very little about.”
To find out more, Dr. Revah and colleagues compared chest CT results from 56 marijuana smokers with those of 57 non-smoking controls and 33 tobacco-only smokers.
Three-quarters of the marijuana smokers had emphysema, a lung disease that causes difficulty with breathing, compared with 67% of the tobacco-only smokers. Only 5% of the non-smokers had emphysema. Paraseptal emphysema, which damages the tiny ducts that connect to the air sacs in the lungs, was the predominant emphysema subtype in marijuana smokers compared to the tobacco-only group.
Airway changes in a 66-year-old male marijuana and tobacco smoker. Contrast-enhanced (A) axial and (B) coronal CT images show cylindrical bronchiectasis and bronchial wall thickening (arrowheads) in multiple lung lobes bilaterally in a background of paraseptal (arrows) and centrilobular emphysema. Credit: Radiological Society of North America
Airway inflammation was also more common in marijuana smokers than non-smokers and tobacco-only smokers. The same was true for gynecomastia, a condition of enlarged male breast tissue due to a hormone imbalance. Gynecomastia was found in 38% of the marijuana smokers, compared with just 11% of the tobacco-only smokers and 16% of the controls.
The researchers found similar results among age-matched subgroups, where the rates of emphysema and airway inflammation were again higher in the marijuana smokers than the tobacco-only smokers.
There was no difference in coronary artery calcification between age-matched marijuana and tobacco-only groups.
According to Dr. Revah, the results were surprising, especially considering that the patients in the tobacco-only group had an extensive smoking history.
Pulmonary emphysema in (A, B) marijuana and (C, D) tobacco smokers. (A) Axial and (B) coronal CT images in a 44-year-old male marijuana smoker show paraseptal emphysema (arrowheads) in bilateral upper lobes. (C) Axial and (D) coronal CT images in a 66-year-old female tobacco smoker with centrilobular emphysema represented by areas of centrilobular lucency (arrowheads). Credit: Radiological Society of North America
“The fact that our marijuana smokers—some of whom also smoked tobacco—had additional findings of airway inflammation/chronic bronchitis suggests that marijuana has additional synergistic effects on the lungs above tobacco,” she said. “In addition, our results were still significant when we compared the non-age-matched groups, including younger patients who smoked marijuana and who presumably had less lifetime exposure to cigarette smoke.”
According to the CDC, 48.2 million people, or about 18% of Americans, used marijuana at least once in 2019.
There are likely several factors that contribute to the differences between the two groups. Marijuana is smoked unfiltered, Dr. Revah noted, while tobacco cigarettes are usually filtered. This results in more particulates reaching the airways from smoking marijuana.
In addition, marijuana is inhaled with a longer breath hold and puff volume than tobacco smoke.
“It has been suggested that smoking a marijuana joint deposits four times more particulates in the lung than an average tobacco cigarette,” Dr. Revah said. “These particulates are likely airway irritants.”
The higher incidence of emphysema may also be due to the way that marijuana is smoked. Full inhalation with a sustained Valsalva maneuver, an attempt at exhalation against a closed airway, may lead to trauma and peripheral airspace changes.
More research is needed, Dr. Revah said, with larger groups of people and more data on how much and how often people are smoking. Future research could also look at the impact of different inhalation techniques, such as through a bong, a joint, or a pipe.
“It would be interesting to see if the inhalation method makes a difference,” Dr. Revah said.
For more on this research, see Emphysema More Common in Marijuana Smokers Than Cigarette Smokers.
Reference: “Chest CT Findings in Marijuana Smokers” by Luke Murtha, Paul Sathiadoss, Jean-Paul Salameh, Matthew D. F. Mcinnes and Giselle Revah, 15 November 2022, Radiology.
DOI: 10.1148/radiol.212611
Smoking marijuana may be more harmful to lungs than smoking cigarettes, study finds
As recreational pot has gained traction in states all across the country, more research has been focusing on its health effects. One argument marijuana supporters have stood by for years – that weed is healthier than cigarettes – is now coming under fire.
A new study has found that smoking marijuana may be more likely to cause certain health problems than tobacco.
“Perhaps it’s time to just pause and think about what you’re doing to yourself until we get more information,” said Dr. Scott Brandman, a thoracic radiologist, in reference to the new study published in the Radiological Society of North America.
That study reviewed lung scans of smokers and found that rates of emphysema, airway inflammation and enlarged breast tissue were higher in marijuana smokers than tobacco smokers. Emphysema is already the third leading cause of death in America.
“Marijuana smoke not only damages the airways in the lung… but it’s actually making holes in it,” Brandman explained. “We’re seeing for the first time these holes being created in the lung. That is going to be irreversible damage for these people.”
The Centers for Disease Control and Prevention say about 20% of all Americans have tried pot. It’s also the most commonly used drug in America that is still illegal at the federal level.
Brandman says one factor that may affect weed smokers is how they inhale: deeper, holding the smoke in their lungs longer.
“It’s going deeper into the lung and its having an opportunity to stay there for a longer time during that deeper, longer breath hold,” he said.
And researchers are also looking at something within pot.
“There’s a carcinogen or chemical that we haven’t yet identified in marijuana smoke, that we’re theorizing is damaging the lung and creating these holes,” Brandman added.
If you’re using marijuana for medical reasons, Brandman suggests talking to your doctor about edibles or ways other than smoking to use marijuana.
Some health effects of marijuana, such as brain development issues, high blood pressure, and increased risk of heart attacks and strokes, have been studied. However, according to Dr. Albert Rizzo, lung doctor and chief medical officer of the American Lung Association, “We don’t know the long-term effects of marijuana as we do for the long-term effects of tobacco.”
Tobacco smoke is also filtered, but marijuana smoke is not. All of these factors contribute to inflammation and irreversible damage, doctors say.
“Anything you inhale that could irritate the lungs would not be advisable, so I would recommend they stop,” Rizzo said. However, he recognizes that some users have medical necessity.
“There is a public perception that marijuana is safe. This study signals that marijuana could be more harmful than people realize,” said Dr. Giselle Revah, study co-author and cardiothoracic radiologist.
ABC News contributed to this report.
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Marijuana May Hurt Smokers More than Cigarettes Alone
Marijuana might do more damage to smokers than cigarettes alone.
A study published Tuesday in the journal Radiology demonstrated higher rates of conditions including emphysema and airway inflammation among people who smoke marijuana than among nonsmokers and people who smoked only tobacco. Nearly half of the 56 marijuana smokers whose chest scans were reviewed for the study had mucus plugging their airways, a condition that was less common among the other 90 participants who didn’t smoke marijuana.
“There is a public perception that marijuana is safe and people think that it’s safer than cigarettes,” said Giselle Revah, a radiologist who helped conduct the study at the Ottawa Hospital in Ontario. “This study raises concerns that might not be true.”
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Should the results of this study change public policy around marijuana? Join the conversation below.
One-fifth of Canadians over 15 years old reported using marijuana in the past three months, according to a 2020 survey of some 16,000 people conducted by Canada’s national statistical office. About 18% of Americans reported using marijuana at least once in 2020 in the U.S. Substance Abuse and Mental Health Services Administration’s National Survey of Drug Use and Health, including about one in three young adults age 18 to 25. The surveys didn’t ask how marijuana was consumed. About one-fourth of people over 12 years old believed there was great harm from smoking marijuana once or twice a week, according to the survey.
Previous studies have found that marijuana is more likely than tobacco to be smoked unfiltered and that smokers tend to inhale more smoke and hold it in their lungs longer. Bong smoke contains tiny pollutants that can linger indoors for up to 12 hours, a study published in March in JAMA Network Open showed.
Among the 56 marijuana smokers in the Ottawa study, 50 also smoked tobacco. The tobacco-only smokers were patients whose chest scans were performed as part of a high-risk lung-cancer screening program that included people age 50 and above who had smoked for several years.
Marijuana’s illicit status long discouraged substantial research into the long-term effects of its use, said Albert Rizzo, chief medical officer for the American Lung Association, who wasn’t involved in the study. Inhaling any heated substance can irritate airways, among other health dangers, he said.
“There could be an additive effect if you smoke cigarettes as well as marijuana,” Dr. Rizzo said.
The study authors found bronchial thickening in 64% of marijuana smokers versus 42% of tobacco-only smokers and a condition that leads to excess mucus buildup in 23% of marijuana smokers versus 6% of tobacco-only smokers.
Age-matched marijuana smokers had higher rates of emphysema (93%) than tobacco-only smokers (67%), and the emphysema, which appears in imaging as small holes in lung tissue, was more prevalent in the marijuana smokers, the study found.
Write to Julie Wernau at julie.wernau@wsj.com
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‘The new tobacco’: Cannabis is as bad for the heart as cigarettes, new research reveals
‘The new tobacco’: Cannabis is as bad for the heart as cigarettes, new research reveals
- Cannabis was found to increase blood pressure and heart rate, like cigarettes
- Scientists in Canada warned it could increase the risk of heart attacks
- Recreational cannabis is legal in 19 US states but remains illegal in the UK
Cannabis has been dubbed ‘the new tobacco’ by doctors after a raft of new research revealed it is as damaging to the heart as smoking cigarettes.
In regular users, the drug was found to increase blood pressure and heart rate significantly in a similar way that heavy smoking does, according to the results of one study.
In the trial, scientists in Canada – where recreational use is legal – gave 21 otherwise healthy volunteers who smoked cannabis frequently a ‘vape’ containing the drug.
A single session of inhaling it was enough to alter the part of nervous system responsible for blood pressure and pulse, according to scans.
Cannabis has been dubbed ‘the new tobacco’ by doctors after a raft of new research revealed it is as damaging to the heart as smoking cigarettes (file image)
The changes could be enough to increase the risk of a heart attack in less healthy patients, they warned.
New Jersey-based cardiologist Dr Abbas Alshami, who has been involved in the research, said: ‘When the tobacco industry first began, we didn’t know the damage smoking caused.
‘It was only once it was in widespread use that we started seeing the health consequences, and acted to try to limit it. Unfortunately, millions of people died avoidable deaths before that happened.
‘I feel like we are going through the same thing with cannabis now. We’re alarmed by what we’re seeing, and would like to see much tougher restrictions reimposed. Many people here [in the US] have no idea the cannabis is harmful but, clearly, it is.’
In regular users, the drug was found to increase blood pressure and heart rate significantly in a similar way that heavy smoking does, according to the results of one study (file image)
In another study, American researchers examined almost 35 million hospital admission records.
It found that the odds of cannabis users developing acute coronary syndrome – an umbrella term for conditions in which the blood supply to the heart becomes compromised, including heart attacks and angina – was the same as for heavy cigarette smokers.
Other research found older cannabis users who had common conditions such as chronic kidney disease, which affects 3.5 million Britons, were more likely to suffer heart attacks than those who didn’t touch the drug, and over-60s who used it were also more likely to have a stroke.
A study found the odds of cannabis users developing acute coronary syndrome – an umbrella term for conditions in which the blood supply to the heart becomes compromised, including heart attacks and angina – was the same as for heavy cigarette smokers (file image)
American Heart Association medicines expert Professor Robert Page said he believed cannabis was ‘absolutely the new tobacco’ in terms of heart risk.
He said: ‘Cannabis is a psychotropic drug that not only has an impact on the brain but also the nervous system, so what we’re seeing in these studies makes a lot of sense.
‘The worry is that we’re observing an increased risk of heart attacks and strokes even in younger adults, who are the biggest recreational users of cannabis. This is a huge signal that warrants more research.’
Recreational cannabis use is legal in 19 US states. However, it remains illegal for recreational purposes in the UK.
Reduced-Nicotine Cigarettes Result in Less Smoking in Anxious and Depressed Smokers
Summary: Lowering nicotine levels to non-addictive levels reduces smoking without worsening symptoms of depression and anxiety for those suffering from mental health disorders.
Source: Penn State
Lowering the amount of nicotine in cigarettes to non-addictive levels may reduce smoking without worsening mental health in smokers with mood or anxiety disorders, according to Penn State College of Medicine and Harvard Medical School researchers.
They said reducing nicotine content in cigarettes could also lessen addiction, lower exposure to toxicants and increase a smoker’s chances of quitting.
Tobacco remains the leading preventable cause of premature death and disease in the United States. Recent proposals by the U.S. Food and Drug Administration and the New Zealand government seek to limit the amount of nicotine in cigarettes to minimally addictive levels.
Prior research indicates that reducing nicotine content could help smokers quit, but there is little evidence to demonstrate if these policies could adversely affect smokers with current or prior affective disorders like depression and anxiety disorders — which affect an estimated 38% of U.S. cigarette smokers.
According to Jonathan Foulds, professor of public health sciences and of psychiatry and behavioral health, smokers with mental health conditions are more likely to have severe nicotine withdrawal symptoms and less success at quitting.
He also said there is speculation that lessening nicotine content to very low levels could worsen psychiatric symptoms in smokers with mental health conditions and lead to heavier smoking and increased exposure to toxicants, or harmful chemicals.
The researchers studied 188 smokers with a history of or who had a current mood or anxiety disorder and had no plans to quit.
Volunteer participants were randomly assigned to a group that received either research cigarettes containing the usual amount of nicotine (11.6 mg nicotine/cigarette) or a progressively reduced amount of nicotine for an additional 18-week period (the final amount was 0.2 mg nicotine/cigarette).
At the beginning and conclusion of the study, the researchers measured levels of cotinine, a metabolite of nicotine, levels of harmful chemicals, cigarette dependence indexes and various mental health measures.
The researchers observed no statistically significant differences in mental health measures between the two groups at the conclusion of the study.
The team used the Kessler Psychological Distress Scale, a six-item self-report assessment where participants reported on a 5-point scale the degree to which they experienced feelings or emotions like “nervous,” “hopeless” or “so depressed that nothing could cheer them up.” Scores are developed by summing points for the six experiences.
Participants in the reduced nicotine content group scored an average of 5.3 at the beginning of the study and finished at an average score of 4.6, while participants in the usual nicotine content group scored 6.1 at the beginning of the study and finished around 4.9.
“These findings are important because we want to understand the effect these policies would have on smokers with anxiety or depressive disorders,” said Foulds, a Penn State Cancer Institute researcher.
“Our data showed that there wasn’t a significant difference in mental health measures between the groups, suggesting reduced nicotine cigarettes might not have adverse psychological effects on this population.”
Similar to what prior studies reported, Foulds and team found that groups in the reduced nicotine content group were absorbing lower amounts of nicotine and ingesting lower levels of harmful carcinogens such as the biomarker 4-(methylnitrosamino)-1-(3-pryidyl)-1-butanol), more commonly known as NNAL. That group also smoked fewer cigarettes and reported lower levels of nicotine addiction by the end of the randomized phase of the trial.
The results were published in PLOS ONE today, Nov. 2.
Unique to this study, participants in both groups were also given the choice to “choose their treatment,” after the 18-week period. They could go back to using their own cigarettes, continue smoking the research cigarettes or attempt to quit.
Of the 188 participants in the study, those randomized to reduced nicotine content cigarettes were more likely to have quit smoking 12 weeks later (18.1%), compared to those in the control (usual nicotine content) group (4.3%).
“We believe this is the first randomized trial to find that smokers who used very low nicotine cigarettes were significantly more likely to have quit smoking (with biochemical verification), three months after the end of the trial,” Foulds said.
“Our results suggest that these policies will likely result in reduced nicotine absorption from cigarettes without worsening the mental health of smokers with mood or anxiety disorders,” said Dr. Eden Evins, Cox Family Professor of Psychiatry at Harvard Medical School. “They also suggest that with proper support and resources, smokers with mood and anxiety disorders could quit successfully as a result of these policies.”
For more information on nicotine, smoking and health studies at the Penn State Center for Research on Tobacco and Health, visit https://research.med.psu.edu/smoking/#participants.
See also
Susan Veldheer, Ahmad Hameed, Sophia Allen, Jessica Yingst, Erin Hammett, Jennifer Modesto, Nicolle Krebs, Courtney Lester, Neil Trushin, Lisa Reinhart, Emily Wasserman, Junija Zhu, Jason Liao, Joshua Muscat and John Richie of Penn State College of Medicine; Shari Hrabovsky of Penn State Ross and Carol Nese College of Nursing; and Gladys Pachas, Corinne Cather, Nour Azzouz and A. Edin Evins of Harvard Medical School also contributed to this research. Foulds and Evins have done paid consulting for pharmaceutical companies involved in producing smoking cessation medications. Other author conflicts of interest are noted in the manuscript.
Funding: This research was supported by the National Institutes of Health through the National Institute on Drug Abuse of the National Institutes of Health (award P50DA036107) and the National Center for Advancing Translational Sciences through Penn State Clinical and Translational Science Institute (award UL1 TR000127). The research was also supported by the Center for Tobacco Products of the U.S. Food and Drug Administration. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Food and Drug Administration.
About this nicotine addiction and mental health research news
Author: Sara LaJeunesse
Source: Penn State
Contact: Sara LaJeunesse – Penn State
Image: The image is in the public domain
Original Research: Open access.
“The effects of reduced nicotine content cigarettes on biomarkers of nicotine and toxicant exposure, smoking behavior and psychiatric symptoms in smokers with mood or anxiety disorders: A double-blind randomized trial” by Jonathan Foulds et al. PLOS ONE
Abstract
The effects of reduced nicotine content cigarettes on biomarkers of nicotine and toxicant exposure, smoking behavior and psychiatric symptoms in smokers with mood or anxiety disorders: A double-blind randomized trial
Background
The U.S. Food and Drug Administration and the government of New Zealand have proposed a reduction of the nicotine content in cigarettes to very low levels. This study examined the potential effects of this regulation in smokers with affective disorders.
Methods
In a randomized controlled parallel group trial conducted at two sites in the USA (Penn State University, Hershey, PA and Massachusetts General Hospital, Boston, MA) 188 adult smokers with a current (n = 118) or lifetime (n = 70) anxiety or unipolar mood disorder, not planning to quit in the next 6 months, were randomly assigned (1:1) to smoke either Usual Nicotine Content (UNC) (11.6 mg nicotine/cigarette) research cigarettes, or Reduced Nicotine Content (RNC) research cigarettes where the nicotine content per cigarette was progressively reduced to 0.2 mg in five steps over 18 weeks. Participants were then offered the choice to either receive assistance to quit smoking, receive free research cigarettes, or resume using their own cigarette brand during a 12-week follow-up period. Main outcomes were biomarkers of nicotine and toxicant exposure, smoking behavior and dependence and severity of psychiatric symptoms. The pre-registered primary outcome was plasma cotinine.
Results
A total of 143 (76.1%) randomized participants completed the randomized phase of the trial, 69 (73.4%) in the RNC group and 74 (78.8%) in the UNC group. After switching to the lowest nicotine content cigarettes, compared to smokers in the UNC group, at the last randomized visit the RNC group had significantly lower plasma cotinine (metabolite of nicotine): difference between groups, -175.7, 95% CI [-218.3, -133.1] ng/ml. Urine NNAL (metabolite of NNK, a lung carcinogen), exhaled carbon-monoxide, cigarette consumption, and cigarette dependence were also significantly lower in the RNC group than the UNC group. No between-group differences were found on a range of other biomarkers (e.g. 8-isoprostanes) or health indicators (e.g. blood pressure), or on 5 different psychiatric questionnaires, including the Kessler K6 measure of psychological distress. At the end of the subsequent 12-week treatment choice phase, those randomized to the RNC group were more likely to have quit smoking, based on initial intent-to-treat sample, n = 188 (18.1% RNC v 4.3% UNC, p = 0.004).
Conclusion
Reducing nicotine content in cigarettes to very low levels reduces some toxicant exposures and cigarette addiction and increases smoking cessation in smokers with mood and/or anxiety disorders, without worsening mental health.
Trial registration
TRN: NCT01928758, registered August 21, 2013.