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E-cigarettes are Poor Substitutes for Conventional Smoking in COPD Patients

According to a recent study published in the Journal of General Internal Medicine, e-cigarettes do not benefit patients with chronic obstructive pulmonary disease (COPD) who are attempting to stop smoking or prevent nicotine-related health complications from occurring. Although e-cigarettes are increasingly popular, there are few studies highlighting the “long-term effects of vaping”.

nov2017 004The study, “Electronic Use in U.S. Adults at Risk for or with COPD: Analysis from Two Observational Cohorts,” was conducted by researchers at the University of North Carolina at Chapel Hill School of Medicine who gathered and analyzed data from two COPD-focused studies, the COPDGene study and SPIROMICS.

“We’ve seen a dramatic increase in the use of e-cigs in the United States, and it’s unclear what the potential consequences are among smokers at-risk or with COPD,” M. Bradley Drummond, MD, MHS, director of the Obstructive Lung Diseases Clinical and Translational Research Center at the UNC School of Medicine, said.

“But there is virtually no information available on older individuals at-risk or with COPD. So we’ve leveraged the data that has already been gathered from two existing COPD-focused [groups] as a way to begin to address this lack of information.” Drummond added.

Overall, the goal of the study “was to determine the use pattern of e-cigarettes,” as well as analyze any beneficial health effects resulting from the use of e-cigarettes among older adults with COPD or those with a high risk of developing it. Surprisingly, researchers discovered that substituting conventional cigarettes with e-cigarettes did not yield any benefits.

In fact, patients who reported to use both e-cigarettes and conventional cigarettes “had the worst outcome in the study.” Drummond believes this stems from the fact that dual users consume more nicotine than those who solely smoke conventional cigarettes.

“We expected to see that folks who quit combustibles would have decreased symptoms because of their decreased tobacco use, but that wasn’t the case.” Drummond said. “Individuals who had tried e-cigarettes as a way to reduce their use of conventional cigarettes were actually less likely to reduce their use or quit combustible cigarettes than those who had never tried e-cigarettes.”

Click Here to Access the Full Article on COPD News Today

Smoking Linked to Increased Risk of Aneurysm Recurrence after Endovascular Treatment

According to a University of Michigan study, individuals who have a history of smoking and undergo endovascular aneurysm treatment are more likely to experience the recurrence of a brain aneurysm.

"There was an almost threefold increase of aneurysm recurrence for smokers," says senior author B. Gregory Thompson, M.D., a neurosurgeon at Michigan Medicine. "We must make a much more profound attempt to convince patients they have to stop smoking."

sept2017image010The study published in the Journal of Neurosurgery, analyzed 247 patients who experienced 296 cerebral aneurysms. Researchers separated individuals into three groups: current smokers, former smokers and those who had never smoked. Those who were former and current smokers had “a recurrence rate of 26.3 percent, and accounted for 232 of the 296 aneurysms documented in this study.” Those who had never smoked “experienced a recurrence rate of 17.2 percent, accounting for the remaining 64 aneurysms.”

"We already know that smoking increases the development, growth and risk of rupture of aneurysms," says Thompson, the John E. McGillicuddy Collegiate Professor of Neurosurgery. "We didn't know that after endovascular treatment the risk of recurrence of an aneurysm is as clearly related to smoking as we've shown in this study.”

Researchers are still unsure of why exactly tobacco utilization results in an initial aneurysm, but there are various suggestions. University of Michigan researchers in particular theorize that smoking might impact how “an aneurysm is obliterated in the first place”, or may prevent or slow the healing process.

All patients participating this study had received endovascular treatment, an increasingly common option despite its lack of durability compared to that of traditional surgery. The study also revealed that former smokers, who had reported smoking cessation at any time, had a 23.8 percent rate of recurrence. Current smokers had rate of 28.4 percent of recurrence, while individuals who had never smoked were only found to have a recurrence rate of 17.2 percent.

Click Here to Access the Full Article on News-Medical.net

Many Hospitals Fail to Support Smoking Cessation for CHD Patients

Over 22 percent of smokers hospitalized due to coronary heart disease (CHD) were highly motivated to stop smoking and received pharmacotherapy aimed at improving smoking cessation during their hospitalization.

According to the study analyzing data from 282 hospitals located in the U.S., the highest performing hospitals initiated smoking cessation treatment in nearly two-thirds of patients while the lowest performing hospitals only initiated therapy “in less than 10 percent” of patients.sept2017image006

"The hospital was a more important predictor of receiving smoking cessation counseling and treatment than the patient," said Quinn Pack, MD, of Baystate Medical Center. "We saw big hospitals, small hospitals, urban, not urban all vary widely across the range, and none of these variables were predictive."

Another study published in JAMA Cardiology revealed a low utilization of smoking cessation medication among older patients who were hospitalized due to a heart attack. In fact, only 7 percent of these patients filled smoking-cessation drug prescriptions within 90 days of being discharged from the hospital.

“...we are really missing the boat when it comes to helping patients at this very critical time. This is really about the administration and the hospital culture. Some hospitals are really pushing this, and at others, smoking cessation treatment doesn't seem to be on the radar," said Pack.

Throughout their studies focusing on 36,675 smokers with CHD, the researchers effectively identified patient and hospital factors that contributed to the use of smoking cessation pharmacotherapy (SCP), as well as the rate of influence each hospital had on a patient’s probability of receiving SCP.  A nicotine patch was the most commonly used medication with patients also choosing to use nicotine gum, lozenge, inhalers, bupropion and varenicline. 

It was also discovered that the “patient-level factors most associated with receipt of SCP” included chronic lung disease, alcohol abuse and depression. A 6 percent increase in mean hospital SCP rate increased between the years of 2004 and 2011, yet there was only a 2 percent increase realized between 2011 and 2014.  

"Hospitalization for a cardiac event provides a teachable moment with high patient motivation to quit smoking; however, our findings suggest that many hospitals are missing this opportunity to improve outcomes for smokers hospitalized for CHD," wrote Pack's group.

To support smoking cessation efforts, it is recommended that hospitals are equipped with smoking cessation protocol and counselors on staff.

Click Here to Access the Full Article on Medpage Today

Truth Initiative, Mayo Clinic Introduce New Smoking Cessation Program

Truth Initiative and Mayo Clinic recently collaborated to create the EX Program. The smoking cessation program is developed “for employers, health systems and health plans to offer to their employees and members.”

The program builds upon EX, a consumer-oriented platform that has been shown to quadruple smoking cessation rates. Since its inception in 2008, EX has helped over 800,000 individuals stop smoking.

"We developed the EX Program to fill a gap in the market," said Robin Koval, CEO and president of Truth Initiative. "Organizations are still burdened with the financial and health impacts of smoking, and many are frustrated with the poor results they're seeing from wellness programs. Tobacco use is a complex addiction that requires specialized treatment from a provider with deep expertise and experience. We aim to be that provider."

june2017_008The EX Program equips users with coaching and medication support provided by tobacco treatment specialists at the Mayo Clinic Nicotine Dependence Center and Truth Initiative. Further, the program also enables access to “proven quitting tools and an online community of thousands of smokers and ex-smokers.”

In addition to these capabilities, the program also sends reports highlighting employee engagement and outcomes to employers and health plans. Guidance is also available “on promoting the program and setting workplace tobacco policy,” to ensure employers meet Affordable Care Act requirements for wellness programs. This is a significant initiative, as smokers cost employers an additional $6,000 each year in contrast to those employees who have never smoked.

"The ability to reach smokers with a digital quit smoking program is unprecedented. Our research has shown that online, interactive interventions are as effective as face-to-face and quit line interventions, but at far lower costs," said Amanda Graham, SVP innovations at Truth Initiative and head of the EX Program. "With the EX Program, smokers can connect with experts and peers at any time, from any device, for as long as they need. Use of the EX community is an independent predictor of success, and 93% of members say they would recommend EX to other smokers who want to quit."

Click Here to Access the Full Article on Drug Store News

Helping Overweight Smokers Quit, Study Identifies Effective Approach

Individuals who are overweight or obese often fear gaining additional weight if they stop smoking, which in turn causes increased health risks.

may2017image008Along with her research team, Marney A. White, Ph.D., M.S., associate professor in the Department of Chronic Disease Epidemiology at the Yale School of Public Health, directed “a randomized control trial of an Internet-administered smoking cessation treatment” that targeted overweight and obese smokers. The study appears in the Journal of Health Psychology.

Participants either volunteered for 12 weeks of nicotine replacement therapy and cognitive behavioral therapy (CBT) or health education. The prevalence of smoking cessation was then measured after 12 weeks following the smokers’ quit date and again 24 weeks later.

Based on the findings, researchers concluded that CBT was more effective than health education for those attempting to regulate weight gain while remaining tobacco free. It was also found that those concerned about weight gain are, “less likely to seek treatment and have reported shorter quit attempts and a higher expectation of relapses if they gain weight.” Individuals were also more likely to cease smoking efforts if they experienced post-quit weight gain.

“There is a need for tailored smoking cessation treatments for smokers who are overweight or obese, because the combined effect of smoking and obesity on health outcomes is quite grave,” said White.

Despite the fact that smokers often weigh less than non-smokers, the severe health implications resulting from smoking far outweigh the benefits of a lower weight. For instance, obese individuals who smoke are 3.5 to 5 times more at risk for developing cardiovascular complications. Due to these risks, researchers concluded the need for smoking cessation treatments, “that address post-cessation weight gain.”

Click Here to Access the Full Article on Yale School of Public Health

What’s Slowing the Decline in Smoking? It Could Be the Rising Rate of Depression

In the past decade, it has been widely reported that the rate of smoking has steadied, but according to new numbers, that is changing. New research shows the slowing in smoking cessation is related to “the prevalence of depression among current, former, and never-smokers in the U.S.”

You might ask, what does depression have to do with smoking rates? Researchers from Columbia University’s Mailman School of Public Health aimed to answer that question.

From data analyzed from the National Household Survey on Drug Use (an annual cross-sectional study of approximately 497,000 Americans ages 12 and over), “depression increased significantly, from 16 percent to 22 percent, among current smokers aged 12 to 17, and the prevalence was consistently more than twice as high as that of never smokers.”

032017image006The team found that “depression appeared to have significantly increased in the U.S. from 2005 to 2013 among smokers, as well as among former and never-smokers. While the prevalence of depression is consistently highest among smokers, the rate of increase in depression was most prominent among former and never-smokers.”

The startling numbers highlight the need for increased public health efforts aimed at decreasing the prevalence of smoking by taking depression and mental health into account.

Researchers also noted that the examination of “factors that may be leading to increases in depression in the U.S. population among both smokers and non-smokers” is a worthy cause, being that scientific evidence continues to show a correlation between the two.

Click Here to Access the Full Story on PsychCentral

Stopping Smoking Helps People Stay Sober and Keep Off Illicit Drugs

Substance abuse recovery is already a weighty task, but new research suggests that smokers have a greater risk of relapse than non-smokers.

04032017Researchers from Columbia University’s Mailman School of Public Health and the City University of New York studied data from 34,653 adults enrolled in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) to determine how the lapse in nicotine dependence treatment during illicit substance use recovery affects those in treatment.

Researchers evaluated study participants at “two time points, three years apart, on substance use, substance use disorders, and related physical and mental disorders. Only those with a history of illicit substance use disorders according to specified criteria were included in the final sample.”

Findings indicated that “daily smokers and non-daily smokers had approximately twice the odds of relapsing to drug use at the end of the three-year period compared with nonsmokers.”

In addition to those findings, those non-smokers found to be smoking three years later “were associated with significantly greater odds of substance use disorders relapse compared to those who remained non-smokers.”

Based on the evidence, researchers surmised that “quitting smoking will improve anyone’s health”, but that those in treatment for illicit drug use stand an even greater benefit by quitting or not picking up the habit at all.

Click Here to Access the Full Article from PsychCentral

Smoking Cessation is Successful When Paired with Lung Screening

New preliminary evidence shows telehealth, or telephone-based smoking cessation counseling provided to smokers shortly after undergoing a lung cancer screening can be “effective at helping people stop smoking.”

032017Lead researcher, Kathryn L. Taylor, PhD, a behavioral scientist and a professor of oncology at Georgetown Lombardi Comprehensive Cancer Center noted that the short period after receiving a screening is a prime example of a “teachable moment,” adding, “When smokers are thinking about their health and may be ready to make a change – offering help makes a difference, and may help save lives.”

For those curious about how telephone-based counseling sessions work, the study provided participants with their first counseling session right after they received their screening results. Over the next three months, six 10-15 minute sessions were conducted. At the conclusion of the study, participants who said they had remained abstinent of smoking were given a nicotine saliva test to confirm their abstinence. “Researchers found that eight (17 percent) people in the telephone counseling group had verifiably quit, compared to two (4 percent) in the other group.”

According to the researchers, the study findings were “so promising that investigators have been funded through [National Institutes of Health (NIH)] to conduct a much larger study of telephone-based cessation counseling.” The addition of more study participants could help significantly increase a life-saving intervention mechanism.

Click Here to Access the Full Article from ScienceDaily

New Treatment for Depressed Smokers Trying to Quit

New research is uncovering factors linking depressed smokers to more difficult resistance to relapses.

Researches are currently, “testing a new smoking cessation treatment, combining medication and behavioral activation therapy,” that is targeted towards depressed smokers, who are often omitted from smoking cessation clinical trials.

"People have thought for some time that depressed smokers have difficulty quitting because they experience a more pronounced withdrawal syndrome, but the evidence is scarce because depressed smokers are hard to recruit and consequently have not been as studied. But now we have gathered together convincing empirical support for this theory, which can be used to justify new treatment approaches," said Professor Lee Hogarth of the University of Exeter’s Psychology department and co-author of the paper.

image008122016The senior author of the study, Professor Brian Hitman of the Northwestern University Feinberg School of Medicine claimed that this is the first targeted approach for depressed smokers that aids with smoking cessation.

According to the study, depressed smokers encounter severe withdrawal states and symptoms that, “contribute to resumption of smoking, including low mood, difficulty engaging in rewarding activities and impaired thinking/memory.” Furthermore, depressed smokers often necessary lack coping techniques. Nicotine often helps to diminish these symptoms, which causes higher relapse rates among depressed individuals.

"Many smokers learn, 'If I smoke in this situation, my mood gets better.' But while smoking improves mood in the short term, it produces a long-term decline in mood," said lead author Amanda Mathew, research assistant professor in preventive medicine at Feinberg and a licensed clinical psychologist. "On the other hand, successfully quitting smoking is associated with improvements in mental health."

Adverse states that occur when depressed smokers attempt to quit include low levels of pleasure in rewarding activities, negative feelings and difficulty with concentrating and decision making.

Researchers are pairing Chantix and behavioral activation to improve concentration, memory and moods. It is believed that through these channels, relapse rates will decrease.

The study is occurring at Northwestern Memorial Hospital and the University of Pennsylvania and is currently accepting participants.

Click Here to Access the Full Article on EurekAlert!

A Talk with a Nurse Can Persuade Hospital Patients to Quit Smoking

A new study, published in the American Journal of Preventative Medicine, shows that smoking cessation outcomes are doubled if hospital patients speak with a nurse or staff member trained in the most effective ways to coach patients on how to stop smoking and where to find additional resources and treatment options.

"They were armed with everything they needed when they left - medication, behavioral tactics, a manual to help them stay on track," said Sonia Duffy, a professor of nursing at The Ohio State University and lead author of the study. "Hospitalization is the perfect time to help people quit. They're more motivated and nurses can explain how smoking harms their health, including slowing healing."

The study focused on the self-reported and lab-confirmed quit rates of 1,528 patients in five Michigan community hospitals after six months of discharge. Three of the hospitals’ nurses had undergone a one-hour training for smoking cessation, met with patients at least once.

After the sixth month of being released, the study found that, “16.5 percent of the smokers from the intervention hospitals said they'd quit, compared to 5.7 percent from the other hospitals.”

image004122016Duffy claims that smoking cessation techniques are not commonly taught in nursing schools and counseling for smoking cessation is “spotty” throughout U.S. hospitals. She also believes that nurses don’t always inform patients about counseling, but instead refer them to the Tobacco Quit Line. Instead, she says that smokers should be provided with a plan and tools while they are in the hospital to effectively enhance the chances of their success.

These “Tobacco Tactics” were developed to adhere to the Joint Commission standards, “which are currently voluntary, but are expected to become mandatory.”

At Tobacco Tactics hospitals, nurses spent an average of nine minutes with patients, while staff at the other two hospitals did not alter their approach to patient care. Nurses provided the most effective tools and quit-smoking aids for to smokers in the Tobacco Tactics hospitals based on their individual addiction and past attempts at quitting. Smoking cessation strategies were also taught to smokers, “including identifying triggers and planning strategies to manage cravings.”

Patients received a brochure and advice from a physician on quitting, as well as a card with the 1-800-QUIT-NOW Tobacco Quit Line number. Patients also had the option to view an informative video on quitting and read the Tobacco Tactics manual and a smoking cessation oriented magazine.

Click Here to Access the Full Article on Medical Xpress

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