High levels of prenatal smoking exposure affect sleep patterns in preterm neonates

A study in the issue of the journal Sleep is the first to show that high levels of prenatal smoking exposure strongly modify sleep patterns in preterm neonates, which places infants at a higher risk for developmental difficulties that could persist throughout early and middle childhood.

Results indicate that preterm neonates born to heavy-smoking mothers who smoked more than 10 cigarettes per day displayed disrupted sleep structure and sleep continuity. From 7 p.m. to 8 a.m. they slept almost two hours less than controls who were born to non-smoking mothers, and their sleep was more fragmented. Compared with controls, neonates born to both heavy and low smokers displayed more body movements and, as a result, more disturbed sleep.

Frederic Telliez, principal investigator, and professor of neuroscience at the University of Picardie Jules Verne in Amiens, France said that sleep integrity is critical in the brain development of neonates. Disruption of sleep mechanisms by prenatal smoking exposure may predispose neonates to alterations in some physiological function (such as ventilation) and can result in long-term neurocognitive disorders.

According to the authors, abnormal sleep processes may alter compensatory responses to autonomic cardiovascular/respiratory challenge and increase the likelihood of life-threatening events later in life. Prenatal smoking exposure can lead to deficits in sustained attention and impulsivity in adolescence and a higher risk of attention-deficit/hyperactivity disorder in childhood – effects that could be partially mediated by sleep changes. Prenatal smoking exposure is also highly related to sudden infant death syndrome (SIDS).

"The developing brain is known for its plasticity and ability to reorganise in response to the stimulation provided by the postnatal environment," said Telliez. "Consequently, it is possible that these neonates, if they are not exposed to smoking after birth, could recover and develop normal sleep structures."

Forty healthy preterm neonates (postconceptional age approximately 33.9 weeks) were recruited from the neonatal intensive care unit at Amiens University Medical Center in France. Mothers were subjectively asked how many cigarettes they had smoked during their pregnancy in order to determine the level of in utero exposure to smoking. Neonates born to mothers who did not smoke at all during the pregnancy were placed in the control group; infants born to mothers who smoked less than 10 cigarettes per day were placed in the low smoking group; and those whose mothers had smoked more than 10 cigarettes per day were placed in the heavy smoking group.

The neonates born to heavy-smoking mothers had a significantly lower mean birth weight than controls. Their average weight of 2.92 pounds was 21 percent less than the average weight of controls, which was 3.69 pounds. Neonates born to mothers who smoked less than 10 cigarettes per day had a birth weight that was 11 percent lower than controls, although this result did not achieve statistical significance.

All children were free of neurological, respiratory, and cardiac disorders and had not received caffeine treatment or oxygen therapy. Neonates whose mothers reported substance abuse or passive smoking were excluded from the study. None of the infants had suffered from sleep deprivation in the 48 hours prior to the sleep recording session.

Infants received overnight polysomnographic recordings in isolated rooms. Researchers measured sleep period time, beginning at the first sleep onset and the ending at the last awakening; the percentage and frequency of wakefulness after sleep onset and total sleep time. Special attention was paid to the number and duration of body movements.

Findings indicate that even after 29.7 days without postnatal exposure to smoking or nicotine, and despite the fact that neonates in the heavy-smoking group were nearly 10 days older, infants exposed in utero to high levels of smoking still showed an altered organization of the various behavioural states.

Source: The Science Daily, 09 December 2008
Link: http://tinyurl.com/5cek3y
 

Ban on tobacco displays announced

The open display of tobacco in shops is to be banned in England and Wales, the government has announced. 

But it is understood plans for an outright ban on tobacco vending machines and branding on cigarette packets have been scrapped.

Ministers hope the display ban, which is also under consideration in Scotland, will reduce smoking. Northern Ireland is yet to decide a policy.

Critics say the moves do not go far enough to stop young people smoking.

A government consultation on how to deter young people from smoking launched six months ago found the "overwhelming majority" of 100,000 responses backed the display ban.

Health Secretary for England Alan Johnson said he had been impressed with evidence from other countries, suggesting the move would have an impact on smoking rates.

Ministers say where other countries - such as Iceland - have removed displays, smoking prevalence among young people has fallen by up to 10%.

Alan Johnson said: "They see the point of sale display and as a result of seeing it, it encourages them to take up smoking. This is the key evidence as to why we have 200,00 11 to 15-year-olds smoking."

He said people who start smoking in their youth - aged 11 to 15 - are three times more likely to die a premature death than someone who takes up smoking at the age of 20.

Deborah Arnott, director of the anti-smoking group ASH, backed the ban and said the prohibition of the display of tobacco products at point of sale would be "a proportionate response to the death and disease caused by tobacco".

The Tobacco Manufacturers' Association opposes the cigarette display ban and says it could have serious unintended consequences, such as driving the sale of illicit tobacco.

It could also damage the income of smaller shops that rely heavily on tobacco sales, said the TMA's chief executive Mr Chris Ogden.

Mr Johnson said the big supermarkets would be asked first to remove their displays.

He said other plans had been scrapped as a result of the consultation - such as getting rid of 10-pack cigarettes. Only selling cigarettes in packs of 20 might drive people who are trying to quit to smoke more, he said.

But Mr Johnson said they would clamp down on underage sales from cigarette sales vending machines - people wanting to buy these cigarettes will have to show proof of age to obtain a token to work the machine.

If this doesn't work, Mr Johnson said they had the power to ban vending machines altogether.

The British Heart Foundation says a total ban on vending machines is the only way to prevent children accessing cigarettes.

Vending machines are the source of cigarettes for nearly one in five young smokers aged 11 to 15 - some 46,000 children.

A British Heart Foundation spokeswoman said: "When the government announces further steps on tobacco control we expect nothing less than a robust tobacco control plan which includes a total ban on cigarette vending machines.

"We are concerned about the large number of children being able to access cigarettes without a face to face transaction."

The government had also considered banning all promotional material from tobacco packaging.

But ministers say until there is enough evidence such a move would actually stop young people taking up smoking it will not introduce a ban.

Also covered in:

Source: The Times, 09 December 2008
Link: http://tinyurl.com/6qu7f3

Source: The Telegraph, 09 December 2008
Link: http://tinyurl.com/5duykz

Source: The Guardian, 09 December 2008
Link: http://tinyurl.com/5bbtdz

Source: This is London, 09 December 2008
Link: http://tinyurl.com/6mky9t

Source: The Independent, 09 December 2008
Link: http://tinyurl.com/6z5xpy

 

Source: BBC News, 09 September 2008
Link: http://tinyurl.com/6nrwyu
 

NHS at risk of becoming 'unsustainable'

The government needs to change the way it tackles unhealthy behaviour such as smoking, alcohol misuse and obesity or it runs the risk of the NHS becoming unsustainable. 

The NHS and Primary Care Trust's (PCT's) have been told by the Department of Health (DoH) they must take the lead on supporting changes in behaviour and promoting a healthier life style, but the actions taken are not enough according to a report published today by the King’s Fund.

Norman Lamb, Liberal Democrat health spokesman, said: "Unless the government is more effective in tackling these massive challenges, the cost of obesity and tobacco-related illnesses will be disastrous for individuals and will bankrupt our health service."

Unhealthy behaviour and illnesses contribute a significant proportion of the burden faced by the NHS when dealing with disease and come at a massive financial cost - which could rise continuously and potentially bankrupt the NHS.

The NHS currently spends £6 billion on treating the effects of unhealthy lifestyles and supporting people to change their habits.

Sir Derek Wanless of the King's Fund said: "If action is not taken, the financial cost to the NHS will grow and could make the NHS itself unsustainable. This is why investing in effective behaviour change interventions is more important than ever."

The report found significant changes to the way the NHS and PCTs tackle behaviour need to be made in order to really help people and lower costs.

Behaviour change is a long term process and the NHS and PCT must commit to this long term approach and also recognise that the techniques used are not transferable to all aspects of behaviour change, the report argued.

A greater emphasis needs to be placed at a local level, it continues. Local health services need the freedom to monitor and target the people that live in their communities as social factors play a large part in those who pursue and maintain unhealthy lifestyles.

The use of geodemographics - the science of profiling people by where they live used by commercial marketing - can be used to give an insight for local health workers on the needs and behaviours of the people they are treating.

According to the report, this is because the process of change is determined by more than a person's knowledge. The DoH spent £50 million between 2007 and 2008 on information based projects

Unhealthy behaviour is strongly linked to those from low-income backgrounds and from ethnic minorities. Smoking and obesity remain some of the biggest causes of the substantial and growing inequalities in health between high and low income groups.

One measure that the report believes should be used is the inclusion of financial incentives to help people change their lifestyles.

Monetary encouragement has been successful in local areas like Dundee where pregnant women were given £50 ASDA credit each month if they passed a carbon monoxide breath test. This scheme helped 50 out of 55 women stop smoking and cost a total of £6000, which is very cost effective.

This technique will be ineffective if used on its own, the authors argued. Non financial incentives must also be implemented, such as giving children fruit for break times, giving the individual more support, the use of health coaches, and relaxation strategies.

The NHS should also put into place a process that will enable them to evaluate the impact of the measures, to compensate for a lack of good-quality evidence. This information, if shared, would help to identify what works for whom and make the process of change more effective and efficient.

Source: Politics, 08 December 2008
Link: http://tinyurl.com/5depka

Obama pledges not to smoke in White House?

Barack Obama says you won't catch him lighting up a cigarette in the smoke-free White House.

"There are times where I've fallen off the wagon," the president-elect said when asked in a broadcast interview whether he has kicked the habit.

"I've done a terrific job, under the circumstances, of making myself much healthier," he said. "And I think that you will not see any violations of these rules in the White House," he said on Sunday's "Meet the Press".

Obama told the magazine Men's Health in an interview for its November issue that he wished he had more time for staying fit and that he still occasionally smoked a cigarette.

Obama said in that interview that he had bummed a cigarette a couple of times during the campaign. "But I figure, seeing as I'm running for president, I need to cut myself a little slack," he said. 

Source: The Associated Press, 08 December 2008
Link: http://tinyurl.com/55mtk6