Smoking, nicotine dependence and mental health among young adults: a 13-year population-based longitudinal study

Abstract

Aims: To investigate prospectively the associations between daily smoking and nicotine dependence and anxiety, depression and suicide attempts.

Methods: Data were from the Young in Norway Longitudinal Study. A population-based sample (n = 1501) was followed for 13 years from ages 13–27 years. Data were gathered on smoking patterns and nicotine dependence; and depression, anxiety and parasuicide. Extensive information on socio-demographic factors, parental and family conditions, parental rearing practices, educational career, conduct problems, alcohol problems and use of illegal substances was also collected.

Results: Young adults who were nicotine-dependent had clearly elevated rates of anxiety, depression and parasuicide. These rates declined after controlling for a previous history of mental health problems and potential confounding factors. After adjustment, nicotine dependence was still associated with anxiety, depression and parasuicide. There was also a significant association with later depression in the group of non-dependent daily smokers. Measures of reduced mental health did not predict later smoking initiation or the development of nicotine dependence.

Conclusions: Mental health was reduced more seriously in nicotine-dependent smokers than in non-dependent smokers. These findings are consistent with the hypothesis that smoking, in particular nicotine dependence, influences mental health.

Source: Pedersen, W. et. al. Addiction, Volume 104 Issue 1, Pages 129 - 137. 12 December 2008
Link: http://tiny.cc/TqPWi

Tobacco giants can be sued over low-tar cigarettes

The American tobacco industry faces another multi-billion-dollar flood of lawsuits after the US Supreme Court ruled that smokers can sue over the way that it promotes light and low-tar brands. The surprise 5-4 ruling was a victory for smokers who claim that the industry has perpetuated a massive fraud by fooling consumers into believing that light cigarettes are healthier than full-tar brands. Smokers may now use state consumer protection and deceptive marketing laws to sue the cigarette makers because of data that shows low-tar cigarettes to be just as harmful as standard ones.

The US tobacco industry is already facing more than 30 class-action lawsuits from smokers and former smokers who are seeking billions of dollars in damages over claims that they were duped by these marketing techniques. More than 45 million Americans are smokers, with nearly 85 per cent using light cigarettes.

The current case involves three residents from Maine, who had sued the Altria Group and its subsidiary, Philip Morris USA – the maker of Marlboro Lights – under the state’s law against unfair marketing practices. The cigarette maker had appealed against a lower court’s ruling that sided with the smokers.

The tobacco companies argued in the Supreme Court that they were protected by a federal law which, in essence, says that the health warning label that is required on cigarette packets prevents individual states from regulating – or passing laws over – any other aspect of cigarette advertising.

The smokers argued that they should be allowed to sue Philip Morris because, they claim, light cigarettes are just as harmful as full-tar brands – and that the tobacco companies have known this for decades. Although research into smoking rightly showed that the cigarettes emitted less tar when burnt, scientists now say that smokers of light brands inhale about the same amount of tar by taking longer puffs and smoking more cigarettes. The smokers claim that the tobacco companies knew about these “compensatory” techniques.

Justice John Paul Stevens, writing for the majority, said that the federal labelling law does not shield the tobacco companies from state laws against deceptive marketing. Yet he made it clear that the people suing the cigarette makers must prove still that the use of the terms light and low-tar actually violate the state antifraud legislation.

When the case was argued in October, Justice Stephen Breyer – who sided with the smokers in yesterday’s ruling – said that allowing the federal health label law to shield the cigarette companies from state law would enable them to make blatantly false claims.

The doctrine under which state product liability lawsuits are thrown out under federal law is known as “preemption”. Mr Breyer, taking issue with the doctrine, said: “Somebody could advertise smoking 42 cigarettes a day will grow back your hair. That’s totally false [and yet] would be preempted.”

The biggest payout forced on tobacco companies came on November 23, 1998, when 46 US states settled their claims against America’s leading cigarette makers to recover tobacco-related healthcare costs. The settlements require the companies to make annual payments to the states in perpetuity, with total payments estimated at $246 billion (£160 billion) over the first 25 years.

Source: The Telegraph, 16 December 2008
Link: http://tiny.cc/d3192

PQ - Measures to reduce youth smoking 

The Secretary of State for Health, Alan Johnson, was asked the following:

Jeff Ennis (PPS (Rt Hon Edward Miliband, Secretary of State), Department for Energy and Climate Change; Barnsley East & Mexborough, Labour): What steps he plans to take to reduce the number of young people taking up smoking.

Alan Johnson (Secretary of State, Department of Health; Kingston upon Hull West & Hessle, Labour): Reducing smoking is a public health priority for the Government. We will bring forward legislation to remove the display of tobacco from retail environments and tighten requirements on vending machines. Both policies primarily aim to protect young people from smoking. Protecting young people will also be a key theme in our new tobacco control strategy.

Jeff Ennis: I thank my right hon. Friend for that very positive response. Does he recall the private Member's Bill that I introduced in October 2005, entitled the Age of Sale of Tobacco Bill, in which I proposed to raise the age for smoking from 16 to 18? That proposal was later incorporated into the Health Bill. Is he also aware that, in Barnsley, one third of all smokers under 18 buy their cigarettes illegally from what are known—for want of a better expression—as the local fag houses? The problem is so acute that Barnsley council has set up a tobacco task group to look at the issue. What more can the Government do to stop the illegal sale of tobacco to young people?

Alan Johnson: I pay tribute to my hon. Friend for his sterling work over a long period of time to get the age of sale increased to 18. From April next year, the "three strikes and you're out" rule will come in. If any retailer is caught selling cigarettes to under-age children three times, they will not be allowed to continue retailing. Other measures to tackle illicit tobacco are important, particularly in the context of the famous Barnsley fag houses that we are now learning about. Micro-chipping illicit cigarettes is an important development from Her Majesty's Revenue and Customs, for example. There is a whole range of steps that should be taken, but that should not detract from the public health initiatives that we are taking in removing tobacco from the point of sale and ensuring that we take action to regulate vending machines.

John Bercow (Buckingham, Conservative): I welcome the Secretary of State's proposed legislation, which offers the prospect of real and lasting progressive change for the better. Will he tell the House what steps he is taking to enlist the services of some of our sporting icons—the Olympic gold medallists spring readily to mind—in trying to persuade young people of the dangers of smoking and the benefits of abstinence?

Alan Johnson:On average, 10 per cent. of 11 to 15-year-olds smoke, but almost one in five 15-year-old girls smoke. They take up smoking—as most of us did in our youth—because they see role models and people whom they admire smoking. The message from Olympians and others, which we will ensure is strongly put forward, will help in that regard. The research evidence clearly shows that the only place where tobacco can now be advertised is on point-of-sale displays and that that gives young people the impression that smoking is normal. That is what we are seeking to address with these proposals.

David Clelland (Tyne Bridge, Labour): Regardless of the merits or otherwise of the proposals, does my right
hon. Friend accept that carrying out the proposed work will involve costs to small shopkeepers? Does he have an assessment of those costs, and does he have any plans to compensate retailers for them?

Alan Johnson: I accept that there are issues for small retailers, and of course there will be a cost. The Save Our Shop campaign is the brainchild of the Tobacco Retailers Association, which is an offshoot of the Tobacco Manufacturers Association, which represents Imperial Tobacco, Gallahers and others in the smoking industry.

David Clelland: Make smoking illegal, then.

Alan Johnson: This might be totally irrelevant to the question that my hon. Friend asked, but the campaign has put the cost at something like £6,000. There is no evidence whatever for that. The evidence from the countries that have introduced these measures is that there is a maximum cost of £1,000. In Canada, it was £500. The cost of putting up the displays is met by the tobacco manufacturers—by the cigarette companies themselves. We will of course offer assistance to small businesses. That is why we are saying that this measure will not be introduced for small shops until 2013. That will give us plenty of time to have a full consultation and to ensure that this will not damage those businesses.

George Young (North West Hampshire, Conservative): I also welcome the steps taken by the Government further to reduce the damage done by smoking-related diseases, but will the Secretary of State reflect on his decision not to make progress with one proposition that achieved 98 per cent. support in the consultation exercise—namely, the proposition that tobacco products should be sold in plain packaging? That seems to have been parked for the time being by the Government. Will the Secretary of State confirm that he is not ruling out considering that matter and that there remains a strong possibility of introducing it at some point?

Alan Johnson: The right hon. Gentleman has welcomed the proposals. I heard the argument from the Conservative Front Bench in last week's Queen's Speech debate that there was no evidence base for the proposals. I have to say, however, that despite the fact that the right hon. Gentleman is quite right about the huge response in favour of plain packaging, there is no evidence base that it actually reduces the number of young children smoking. We want to keep that under review, and when there is an evidence base for it, it could well be another important measure to meet our goal, which is to reduce the number of young people smoking.

David Taylor (North West Leicestershire, Labour): As the chairman of the all-party group on smoking and health, I warmly welcome the proposals. There will not be evidence on plain packaging now, as we are the first country to suggest the measure, so it needs to be piloted in some way. May I say to the Secretary of State that I was disappointed in one aspect of the announcement—the failure to abolish vending machines, which are used as the medium of sale for fewer than 1 per cent. of all cigarettes? The suggestion that we can somehow tighten up to minimise the number of young people buying from vending machines is likely to prove a dead end. The sooner we introduce the abolition, the better.

Alan Johnson: I understand my hon. Friend's argument. We will take a power in the proposed Bill to ban vending machines.
We were persuaded during the consultation, however, that there are other measures to restrict young people's access to vending machines without banning them. I do not think that Governments should move to banning things if there is another alternative. We were persuaded of the alternatives such as carrying out an age check before giving tokens to use in vending machines and other methods that have been used successfully to restrict access by young people. It is sane and rational to try those out first, to have the power to ban in the legislation if necessary and to move towards a ban if the other measures do not work.

Andrew Lansley (Shadow Secretary of State for Health, Health; South Cambridgeshire, Conservative): The Secretary of State knows that we want to proceed on the basis of evidence and he has appealed to evidence. Last Thursday, he told the House: "The number of young smokers in Canada... was reduced by 32 per cent. among 15 and 19-year-olds as a result of the implementation of the measure."[ Hansard, 11 December 2008; Vol. 485, c. 724.] Well, I asked the House of Commons Library to look at the statistics from Canada and it says that the tobacco display ban was not introduced in all provinces; that it was introduced only in Manitoba and Saskatchewan; and that since the tobacco display ban was introduced, there were no statistically significant results for any reduction in the number of young people smoking in either of those provinces. Will the Secretary of State simply apologise for giving the House an inaccurate presentation of the data on Canada and will he put a note in the Library explaining his basis for the proposition that there is a proven reduction in young people smoking?

Alan Johnson: What Cancer Research UK's extensive evidence shows is that young people are more receptive than adults to tobacco advertising; being exposed to tobacco advertising and/or promotion increases the likelihood that a young person will take up smoking; and large displays of tobacco convey the notion that smoking is common. In Canada, 12 out of 13 provinces have introduced this legislation—and they have introduced it because there is absolute evidence, as there is in Iceland and other countries that have introduced it, that it reduces the number of young people smoking.

Norman Lamb (Shadow Secretary of State for Health, Health; North Norfolk, Liberal Democrat): Where else?

Alan Johnson: Thailand and the British Virgin Islands, if the hon. Gentleman wants an exhaustive list, but as my hon. Friend David Taylor said, the point is this: someone has to be in the vanguard, which is why Australia and New Zealand are preparing to introduce such legislation. It is hugely disappointing that there is not a political consensus across the three parties, because the evidence is clear, the evidence is there.

Source: Hansard Health Questions, 16 December 2008
 

Failure to ban cigarette machines puts children’s health at risk

The future health of children is at risk due to Government’s decision not to ban cigarette vending machines, claim leading health groups. The British Medical Association (BMA), British Heart Foundation (BHF) and British Lung Foundation (BLF) all issued press statements condemning the Government’s refusal to issue an outright ban on cigarette vending machines.

All of the groups welcomed the decision to outlaw cigarette displays at point of sale in England and Wales, but felt that the refusal to ban cigarette vending machines was a missed opportunity.

"Today we expected nothing less than a robust tobacco control plan, including a total ban on cigarette vending machines to protect our children’s health. But without a firm commitment, we feel short changed.” director of policy and communications at BHF.
The BHF – which has been promoting an online petition calling for the ban of cigarette vending machines on their website – was clear in its dismay.

Betty McBride, the charity’s director of policy and communications said: "Today we expected nothing less than a robust tobacco control plan, including a total ban on cigarette vending machines to protect our children’s health. But without a firm commitment, we feel short changed. "The only failsafe way to make it impossible for cigarettes to be bought by children is a face-to-face transaction.”

The BMA’s head of science and ethics, Dr Vivienne Nathanson, said: “This is very good news and will help prevent children from starting to smoke. Children who smoke face years of tobacco addiction that can lead to life-threatening diseases and premature death.

“However, the BMA is disappointed that the Government is not planning to ban cigarette vending machines. We hope the proposals to make vending machines 'child-proof' will be rigidly enforced and that if they do not work then this issue will be revisited by ministers.”

Dame Helena Shovelton, chief executive of the British Lung Foundation, released a statement saying: “Nearly three quarters of people with lung disease tell us that they believe there should be a total ban on cigarette vending machines as they are the main source of cigarettes to young smokers. Smoking kills 120,000 people a year and is the cause of many chronic and severe long term illnesses”.

According to the Department of Health, in 2007 England had nearly 200,000 children aged between 11-15 years of age who were regular smokers. It is estimated that these children are three times more likely to die of cancer due to smoking than someone who beings in their mid-20s.

Source: Families First For Health, 10 December 2008
Link: http://tiny.cc/JxCLB

Tobacco use and susceptibility to bacterial infection

Abstract

Active smokers and those exposed to secondhand smoke are at increased risk of bacterial infection. A review of the recent evidence reveals that tobacco smoke increases susceptibility to respiratory tract infections, including tuberculosis, pneumonia and Legionnaires disease; bacterial vaginosis and sexually transmitted diseases, such as chlamydia and gonorrhoea; Helicobacter pylori infection; periodontitis; meningitis; otitis media; and nosocomial infections. Further epidemiological and mechanistic research into this important area is warranted.

Source: Bagaitkar, J et. al. Tobacco Induced Diseases 2008, 4:12, 08 December 2008
Link: http://tiny.cc/EKlyh

China: Health claims for cactus cigarette

A cigarette that blends a small amount of tobacco with other plant material is said to offer tobacco taste with a substantial reduction in tar and nicotine deliveries, according to a Xinhua-PRNewswire report.

Harbin Hainan Kangda Cactus Hygienical Foods, a wholly owned subsidiary of China Kangtai Cactus Bio-Tech, said that it had been granted a patent by the State Intellectual Property Office of China for its "Cactus Health-Preserving Cigarette."

According to the report, Cactus Foods believes that its cigarettes, which, compared with regular cigarettes, offer tar and nicotine deliveries reduced by 70 percent, "will enhance the health of smokers throughout the country."

Source: Tobacco Reporter, November 2008
 

Alcohol consumption and quitting smoking in the International Tobacco Control (ITC) Four Country Survey

Abstract

Although greater alcohol consumption has been associated with decreased odds of quitting smoking in prospective studies, the aspects of drinking most strongly associated with quitting have not been fully explored and examination of potential confounder variables has been limited. Further studies are needed to inform efforts to enhance smoking cessation among the substantial portion of smokers who drink alcohol. The present study examines: (a) drinking frequency, average weekly quantity of alcohol consumption, and frequency of heavy drinking as prospective predictors of quit smoking behaviors, (b) difference across countries in this prediction, and (c) third variables that might account for the association between alcohol consumption and quitting smoking. Data were drawn from the International Tobacco Control Four Country Survey, a prospective cohort study of smokers in Australia, Canada, the UK, and the US. A total of 4831 participants provided alcohol data at one study wave and were re-interviewed 1 year later. Individuals who drank heavily (4 /5 drinks for women and men, respectively) more than once a week had significantly lower rates of quitting smoking than all other participants, in part due to the fact that a significantly lower proportion of those making a quit attempt remained quit for more than 1 month at follow-up. The role of frequent heavy drinking did not differ by country or sex and was not accounted for by demographics, smoking dependence, or attitudes regarding quitting smoking. Neither drinking frequency nor weekly quantity of consumption showed robust associations with quitting behaviors. Results indicate further study of interventions to address heavy drinking among smokers is warranted.

Source: Kahler, C.W. et. al. Drug Alcohol Depend. 2008 Dec 2. [Epub ahead of print]
Link: http://tiny.cc/RNxMf