ASH Daily News for 27 November 2007

Sucked in: Why teenagers smoke

Below is an extract from Thee Guardian.

A new study reveals that teenagers start smoking out of curiosity rather than because they think it's cool. And they are more likely to pick up the habit from their parents than their peers.

According to a new study by the Roy Castle Foundation, 82% of smokers start before the age of 18. The Liverpool Longitudinal Smoking Study, due to be published next year, reveals that while some teenagers take up smoking in the belief that it will win them friends, others start through boredom or stress.

Dr Susan Woods, one of the report's authors, says that although teenagers tend to think people smoke because it's cool or makes them look tough and mature, teen smokers themselves claim to be influenced by curiosity rather than other people. Primary school children, however, are influenced by parental smoking, which is also the biggest predictor of teen smoking.

"Some of the young people we've spoken to said they started because they were having problems at home; they smoke to relieve stress or they have anger management problems. Primary school children associate parental smoking as a need to cope with everyday life," she says.

Dr Lisa McNally, a health psychologist specialising in teen smoking, says that adults need to face up to the fact that focusing on prevention alone isn't enough. "Kids get addicted to nicotine very quickly. We need to address the addictiveness of cigarettes. As a society we are quite uncomfortable with the idea of children being addicts."

What sparse research there is into the role of nicotine replacement therapy (NRT) products, such as patches and inhalers, in helping young people to quit is inconclusive, although some experts argue that they may help tackle the symptoms of nicotine withdrawal. However, when Iain Miller, former head of tobacco control in Durham, introduced a stop-smoking scheme in schools that provided NRT along with support from school nurses, the success rate was very poor. "Only 24% of young people were successful in stopping smoking four weeks after joining the scheme, compared to the general population rate, which is 50-55%," he says.

"NRT can help, but only if someone is determined to give up," says Miller, who believes that children face different pressure to adults, making it difficult to stop smoking.

Two pieces of smoking legislation came into effect this year, the smoking ban was extended throughout the UK and last month the legal age for buying tobacco products rose to 18. But while adults drink in pubs and bars, young people find other places to drink and smoke. And while a ban may signal that smoking is becoming socially unacceptable, young people still see groups of adults smoking and socialising on the street.

Finding one solution to stop all young people smoking seems unlikely. Miller says,  "It's a case of finding the right hooks for the person. If they don't want to stop, they won't."

For image conscious teens, early development of wrinkles and yellowing teeth could be a deterrent. A game launched in October by the Roy Castle Foundation, enables people to upload a photograph of themselves on to a website and view the ageing effects of smoking on their skin, teeth and eyes.

For others, reduced fitness levels affecting their performance in sport might turn them off the habit. Even the corporate nature of the tobacco industry and knowledge about the redeployment of fertile soil for tobacco production rather than food has made some young people think twice about lighting up.

Another technique is counter-marketing, turning the idea that a smoker is someone who is independent and rebellious into one who is in reality a puppet of big business and the government.

Source: The Guardian, 27 November 2007
Link: http://tinyurl.com/2lqgem

Breast cancer gene: smoking link high

According to a study of Australians, smoking more than doubles the risk of developing breast cancer among women with a strong family history of the disease.

The major international review is the first to show a connection between the breast cancer and tobacco in women with the highest risk breast cancer genes, BRCA1 or BRCA2.

About half of women with faulty versions of these genes will develop cancer by the age of 70.

The new research has found the risk is as low as 35 per cent among the non-smokers, rising to almost double, 65 per cent, among smokers with a mutation.

"This study suggests that women with faulty genes can effectively halve their risk of developing breast cancer by not smoking," said Dr Mark Jenkins, a University of Melbourne researcher who was part of the international collaboration.

"If you have a faulty breast cancer gene or a strong family history of breast cancer, not smoking may reduce your risk of developing breast cancer, and you will also get all the other known health benefits of not smoking."

The review, published in the journal Breast Cancer Research and Treatment, analysed data collected from 780 women involved in large breast cancer trials, including more than 300 from the Melbourne-based Australian Breast Cancer Family study.

All the women were aged under 50 and had a faulty BRCA gene, and half had developed cancer.

An analysis found that the women who developed breast cancer were more likely to have smoked than those who were cancer free, Dr Jenkins said.

The risk increased the longer a woman smoked, rising by about seven per cent every year they maintained their habit.

Dr Jenkins says BRCA1 and BRCA2 genes, when functioning normally, repair the type of DNA damage caused by carcinogens such as cigarette smoke.

Women who inherit a faulty copy of the genes are less able to repair DNA damage.

The fact that not all women with faulty genes will develop breast cancer suggests that environmental factors influence their cancer risk.

"This study suggests that smoking plays a major role," he said, "and it adds to the growing body of evidence about the health dangers of smoking."

Source: National nine news, 27 November 2007
Link: http://tinyurl.com/322s6s

The economic effect smoking has on smokers 

While past studies have focused on the cost of cigarette smoking to society, a new report by two Vanderbilt University professors looks at the cost of smoking per pack in terms of the value of the risks to the smoker's life.

Professor W. Kip Viscusi and Professor Joni Hersch found that each pack of cigarettes a man smokes reduces the value of his life by 222 US dollars and by 94 US dollars for women.

This study differs because it takes into account the cost to the smokers themselves based on the value smokers put on their own lives rather than the financial costs to society.

Previous research only considered the increased risk of dying at the end of life, whereas Viscusi and Hersch take note that smoking increases a person's chances of dying at any time in his or her life. And, though it seems counterintuitive, the research finds that the value that a 20-year-old places on reducing the risk of death is actually lower than a 50-year-old's. Although 20 year olds have more of their life at risk, they are less affluent than 50 year olds and consequently value safety less.

Why is the cost lower for women than for men? Viscusi and Hersch said it's because men typically earn more than women over their lifetimes and have a greater mortality risk from smoking.

The question then, said Viscusi, is whether smokers really do like to smoke and also are just more likely to live in the present moment.

Despite the current focus on obesity, Viscusi said the bottom line is still that smoking is one of the worst risks people take with their health.

Viscusi and Hersch's results can be found in their newly released working paper for the National Bureau of Economic Research. You can find a link to their working paper at http://www.nber.org/papers/w13599. The final paper will be published in the Journal of Health Economics

Source: Ascribe, 26 November 2007  
Link: http://tinyurl.com/38l6yu

GPs may be the key for quitting smoking

Scientists at the Centre for Addiction and Mental Health (CAMH) have highlighted the significant role that GPs can play in helping people quit smoking. Many people's attempts to quit are unsuccessful, so effective intervention is critical. 

"Advising patients to quit, just once, helps to double quit rates. Practitioners should initiate as many quit attempts as possible and advise all of their patients who smoke to quit," CAMH researchers, Dr Bernard Le Foll and Dr. Tony George write in their article "Treatment of tobacco dependence: integrating recent progress into practice is a comprehensive summary of tobacco use, causes of nicotine dependence, and advances in treatment and intervention."

Research shows that since an estimated 70% of smokers visit a doctor each year, General Practitioners have a substantial opportunity to influence smoking behaviour. "Even a short intervention of three minutes or less can increase a person's motivation to quit and can significantly increase abstinence rates," the authors write. They provide an algorithm topped by the simple question "Are you smoking?" to help physicians integrate a patient's smoking status and his or her readiness to quit, taking a comprehensive approach that combines assessment, behavioural interventions and pharmacologic treatment of tobacco dependence.

The article also showed that smokers with moderate to severe tobacco dependence have been found to respond best to three types of pharmacotherapy, nicotine replacement therapy, bupropion and varenicline, but there is no clear threshold that can help clinicians decide whether a particular patient will benefit from a particular pharmacotherapy, and there is no consensus on which one should be used first.

Epidemiologic studies have indicated that the majority of successful attempts to quit smoking occur without direct medical assistance or without pharmacotherapy. The authors say, "The use of nonpharmacologic methods such as counselling should be encouraged, especially for people for whom medication use is problematic. The goal is to motivate the patient to try to quit smoking. Moreover, pharmacological interventions are clearly effective and allow doctors to double or triple the odds of success."

Source: Science Daily, 27 November 2007
Link: http://tinyurl.com/2wvsqe