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Caponnetto P, DiPiazza J, Kim J, Maglia M, Polosa R. A Single-Arm, Open-Label, Pilot, and Feasibility Study of a High Nicotine Strength E-Cigarette Intervention for Smoking Cessation or Reduction for People With Schizophrenia Spectrum Disorders Who Smoke Cigarettes. Nicotine Tob Res 2021; 23:1113-1122. [PMID: 33723598 PMCID: PMC8186418 DOI: 10.1093/ntr/ntab005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 01/18/2021] [Indexed: 01/14/2023]
Abstract
Introduction An estimated 60%–90% of people with schizophrenia smoke, compared with 15%–24% of the general population, exacerbating the already high morbidity and mortality rates observed in this population. Aims and Methods This study aimed to assess the feasibility of using a new-generation high strength nicotine e-cigarette to modify smoking behavior in individuals with schizophrenia spectrum disorders who smoke cigarettes. A single-arm pilot study was conducted with 40 adults with schizophrenia spectrum disorders who smoked and did not intend to reduce or quit smoking. Participants were given a 12-week supply of a JUUL e-cigarette loaded with a 5% nicotine pod. The primary outcome was smoking cessation at week 12. Additional outcomes included: smoking reduction, continuous abstinence at week 24, adoption rate, adherence to the e-cigarette, feasibility, acceptability, and subjective effects. Results Sixteen (40%) participants quit by the end of 12 weeks. For the whole sample, we observed an overall, sustained 50% reduction in smoking or smoking abstinence in 37/40 (92.5%) of participants and an overall 75% reduction in median cigarettes per day from 25 to six was observed by the end of the 12 weeks (p < .001). Conclusions A high strength nicotine e-cigarette has the potential to help people with schizophrenia spectrum disorders to quit or reduce smoking. Further research with a larger sample and a comparator group is needed. The results provide useful information and direction to augment the existing body of knowledge on smoking cessation for people with schizophrenia spectrum disorders. Implications Considering that most people with schizophrenia spectrum disorders continue smoking, alternative and efficient interventions to reduce or prevent morbidity and mortality are urgently needed. This study showed that adults who smoke and were not motivated to quit, when provided a new-generation e-cigarette with high nicotine content, demonstrated substantially decreased cigarette consumption without causing significant side effects. Although not specifically measured in this study, nicotine absorption in new-generation devices has been shown to be consistently superior compared with the first generation of e-cigarette devices, and this may help explain the lower quit rates in studies using earlier generation devices.
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Affiliation(s)
- Pasquale Caponnetto
- Department of Educational Science, University of Catania, Catania, Italy.,Faculty of Health Science and Sport, University of Stirling, Stirling, UK
| | - Jennifer DiPiazza
- Hunter Bellevue School of Nursing, Hunter College-City University of New York, New York, NY, USA
| | - Jason Kim
- Clinical and Translational Science Center, Weill Cornell Medicine, New York, NY, USA
| | - Marilena Maglia
- Centro per la Prevenzione e Cura del Tabagismo (CPCT), Azienda Ospedaliero-Universitaria "G.Rodolico-S. Marco", Università di Catania, Catania, Italy
| | - Riccardo Polosa
- Center of Excellence for the Acceleration of Harm Reduction (CoEHAR), University of Catania, Catania, Italy.,Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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Orouji MA, Shojaeizadeh D, Sadeghi R, Rafiei M. Effects of a theory-driven educational package and social support on durability of cigarette smoking cessation behavior: A community-based program. Electron Physician 2017; 9:5331-5338. [PMID: 29038718 PMCID: PMC5633234 DOI: 10.19082/5331] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 07/24/2016] [Indexed: 11/20/2022] Open
Abstract
Background According to a World Health Organization (WHO) report, the prevalence of smoking in Iranian individuals aged 15–64 is up to 12%. Objective The aim of the current study was to determine the durability of smoking cessation behavior based on a trans-theoretical model. Methods This educational experimental study was conducted on smokers in Khomein City, Iran, in 2015. Sampling was done through a public announcement and then a random allocation of participants into two study group (50 persons) and control group (60 persons). Tools to gather data were as follows: an individual characteristics form and DiClemente’s stages of change, Velicer’s self-efficacy, Prochaska’s processes of change, Velicer’s decisional balance, and Fagerstrom’s nicotine dependency questionnaires. The study group received five sessions of 45-minute individual counseling each and were followed-up three and six months later. Data were analyzed by SPSS version 16, using paired-samples t-test, independent-samples t-test, and chi-square. Results Within six months of follow-up, 20 persons (40%) of the intervention group reached the maintenance stage of smoking cessation, while no one from controls managed to do that. Except for the perceived barriers and benefits of smoking cessation, all other constructs of the trans-theoretical model (cognitive and behavioral processes and smoking temptation) showed significant changes among the intervention group during six months’ follow-up (p<0.05). There was no significant relationship between variables of having smoker friends, occupation, marital status, education status, and success or failure in cigarette smoking cessation (p>0.05). Conclusion According to our study, selection of cigarette smokers who are willing to quit, delivery of individual counseling according to specific personal characteristics, and also provision of free nicotine replacement therapies should be taken into account in cigarette smoking cessation programs.
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Affiliation(s)
- Mohammad Ali Orouji
- Ph.D. Student of Health Education and Promotion, Department of Health Promotion and Education, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Davoud Shojaeizadeh
- Ph.D. of Health Education and Promotion, Professor, Department of Health Promotion and Education, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Sadeghi
- Ph.D. of Health Education and Promotion, Associate Professor, Department of Health Promotion and Education, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Rafiei
- Ph.D. of Biostatistics, Professor, Department of Biostatistics and epidemiology, School of medicine, Arak University of Medical Sciences, Arak, Iran
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Nicotinic acetylcholine receptor availability in cigarette smokers: effect of heavy caffeine or marijuana use. Psychopharmacology (Berl) 2016; 233:3249-57. [PMID: 27370018 PMCID: PMC4982797 DOI: 10.1007/s00213-016-4367-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 06/16/2016] [Indexed: 12/26/2022]
Abstract
RATIONALE Upregulation of α4β2* nicotinic acetylcholine receptors (nAChRs) is one of the most well-established effects of chronic cigarette smoking on the brain. Prior research by our group gave a preliminary indication that cigarette smokers with concomitant use of caffeine or marijuana have altered nAChR availability. OBJECTIVE We sought to determine if smokers with heavy caffeine or marijuana use have different levels of α4β2* nAChRs than smokers without these drug usages. METHODS One hundred and one positron emission tomography (PET) scans, using the radiotracer 2-FA (a ligand for β2*-containing nAChRs), were obtained from four groups of males: non-smokers without heavy caffeine or marijuana use, smokers without heavy caffeine or marijuana use, smokers with heavy caffeine use (mean four coffee cups per day), and smokers with heavy marijuana use (mean 22 days of use per month). Total distribution volume (Vt/fp) was determined for the brainstem, prefrontal cortex, and thalamus, as a measure of nAChR availability. RESULTS A significant between-group effect was found, resulting from the heavy caffeine and marijuana groups having the highest Vt/fp values (especially for the brainstem and prefrontal cortex), followed by smokers without such use, followed by non-smokers. Direct between-group comparisons revealed significant differences for Vt/fp values between the smoker groups with and without heavy caffeine or marijuana use. CONCLUSIONS Smokers with heavy caffeine or marijuana use have higher α4β2* nAChR availability than smokers without these drug usages. These findings are likely due to increased nicotine exposure but could also be due to an interaction on a cellular/molecular level.
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Jasinska AJ, Zorick T, Brody AL, Stein EA. Dual role of nicotine in addiction and cognition: a review of neuroimaging studies in humans. Neuropharmacology 2014; 84:111-22. [PMID: 23474015 PMCID: PMC3710300 DOI: 10.1016/j.neuropharm.2013.02.015] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 12/28/2012] [Accepted: 02/19/2013] [Indexed: 12/11/2022]
Abstract
Substantial evidence demonstrates both nicotine's addiction liability and its cognition-enhancing effects. However, the neurobiological mechanisms underlying nicotine's impact on brain function and behavior remain incompletely understood. Elucidation of these mechanisms is of high clinical importance and may lead to improved therapeutics for smoking cessation as well as for a number of cognitive disorders such as schizophrenia. Neuroimaging techniques such as positron emission tomography (PET), single photon emission computed tomography (SPECT), and functional magnetic resonance imaging (fMRI), which make it possible to study the actions of nicotine in the human brain in vivo, play an increasingly important role in identifying these dual mechanisms of action. In this review, we summarize the current state of knowledge and discuss outstanding questions and future directions in human neuroimaging research on nicotine and tobacco. This research spans from receptor-level PET and SPECT studies demonstrating nicotine occupancy at nicotinic acetylcholine receptors (nAChRs) and upregulation of nAChRs induced by chronic smoking; through nicotine's interactions with the mesocorticolimbic dopamine system believed to mediate nicotine's reinforcing effects leading to dependence; to functional activity and connectivity fMRI studies documenting nicotine's complex behavioral and cognitive effects manifest by its actions on large-scale brain networks engaged both during task performance and at rest. This article is part of the Special Issue Section entitled 'Neuroimaging in Neuropharmacology'.
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Affiliation(s)
- Agnes J Jasinska
- National Institute on Drug Abuse, Intramural Research Program, 251 Bayview Blvd, Baltimore, MD 21224, United States.
| | - Todd Zorick
- University of California at Los Angeles, Department of Psychiatry, 300 UCLA Medical Plaza, Los Angeles, CA 90095, United States; VA Greater Los Angeles Healthcare System, United States
| | - Arthur L Brody
- University of California at Los Angeles, Department of Psychiatry, 300 UCLA Medical Plaza, Los Angeles, CA 90095, United States; VA Greater Los Angeles Healthcare System, United States.
| | - Elliot A Stein
- National Institute on Drug Abuse, Intramural Research Program, 251 Bayview Blvd, Baltimore, MD 21224, United States.
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Brody AL, Mukhin AG, Mamoun MS, Luu T, Neary M, Liang L, Shieh J, Sugar CA, Rose JE, Mandelkern MA. Brain nicotinic acetylcholine receptor availability and response to smoking cessation treatment: a randomized trial. JAMA Psychiatry 2014; 71:797-805. [PMID: 24850280 PMCID: PMC4634637 DOI: 10.1001/jamapsychiatry.2014.138] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Cigarette smoking leads to upregulation of nicotinic acetylcholine receptors (nAChRs) in the human brain, including the common α4β2* nAChR subtype. While subjective aspects of tobacco dependence have been extensively examined as predictors of quitting smoking with treatment, no studies to our knowledge have yet reported the relationship between the extent of pretreatment upregulation of nAChRs and smoking cessation. OBJECTIVE To determine whether the degree of nAChR upregulation in smokers predicts quitting with a standard course of treatment. DESIGN, SETTING, AND PARTICIPANTS Eighty-one tobacco-dependent cigarette smokers (volunteer sample) underwent positron emission tomographic (PET) scanning of the brain with the radiotracer 2-FA followed by 10 weeks of double-blind, placebo-controlled treatment with nicotine patch (random assignment). Pretreatment specific binding volume of distribution (VS/fP) on PET images (a value that is proportional to α4β2* nAChR availability) was determined for 8 brain regions of interest, and participant-reported ratings of nicotine dependence, craving, and self-efficacy were collected. Relationships between these pretreatment measures, treatment type, and outcome were then determined. The study took place at academic PET and clinical research centers. MAIN OUTCOMES AND MEASURES Posttreatment quit status after treatment, defined as a participant report of 7 or more days of continuous abstinence and an exhaled carbon monoxide level of 3 ppm or less. RESULTS Smokers with lower pretreatment VS/fP values (a potential marker of less severe nAChR upregulation) across all brain regions studied were more likely to quit smoking (multivariate analysis of covariance, F8,69 = 4.5; P < .001), regardless of treatment group assignment. Furthermore, pretreatment average VS/fP values provided additional predictive power for likelihood of quitting beyond the self-report measures (stepwise binary logistic regression, likelihood ratio χ21 = 19.8; P < .001). CONCLUSIONS AND RELEVANCE Smokers with less upregulation of available α4β2* nAChRs have a greater likelihood of quitting with treatment than smokers with more upregulation. In addition, the biological marker studied here provided additional predictive power beyond subjectively rated measures known to be associated with smoking cessation outcome. While the costly, time-consuming PET procedure used here is not likely to be used clinically, simpler methods for examining α4β2* nAChR upregulation could be tested and applied in the future to help determine which smokers need more intensive and/or lengthier treatment. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01526005.
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Affiliation(s)
- Arthur L. Brody
- Department of Research, VA Greater Los Angeles Healthcare System, Los Angeles, California2Department of Psychiatry, University of California, Los Angeles
| | - Alexey G. Mukhin
- Department of Psychiatry, Duke University, Durham, North Carolina
| | - Michael S. Mamoun
- Department of Research, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Trinh Luu
- Department of Research, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Meaghan Neary
- Department of Research, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Lidia Liang
- Department of Research, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Jennifer Shieh
- Department of Research, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Catherine A. Sugar
- Department of Psychiatry, University of California, Los Angeles4Department of Biostatistics, University of California, Los Angeles
| | - Jed E. Rose
- Department of Psychiatry, Duke University, Durham, North Carolina
| | - Mark A. Mandelkern
- Department of Research, VA Greater Los Angeles Healthcare System, Los Angeles, California5Department of Physics, University of California, Irvine
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The Relationship Between Smoking and Health Care, Workers' Compensation, and Productivity Costs for a Large Employer. J Occup Environ Med 2013; 55:879-84. [DOI: 10.1097/jom.0b013e31829f3129] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Bhunu CP, Mushayabasa S, Tchuenche JM. A Theoretical Assessment of the Effects of Smoking on the Transmission Dynamics of Tuberculosis. Bull Math Biol 2010; 73:1333-57. [DOI: 10.1007/s11538-010-9568-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 06/22/2010] [Indexed: 11/24/2022]
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8
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Glaser B, Shelton KH, van den Bree MB. The moderating role of close friends in the relationship between conduct problems and adolescent substance use. J Adolesc Health 2010; 47:35-42. [PMID: 20547290 PMCID: PMC3032885 DOI: 10.1016/j.jadohealth.2009.12.022] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Revised: 12/18/2009] [Accepted: 12/21/2009] [Indexed: 11/20/2022]
Abstract
PURPOSE Conduct problems and peer effects are among the strongest risk factors for adolescent substance use and problem use. However, it is unclear to what extent the effects of conduct problems and peer behavior interact, and whether adolescents' capacity to refuse the offer of substances may moderate such links. This study was conducted to examine relationships between conduct problems, close friends' substance use, and refusal assertiveness with adolescents' alcohol use problems, tobacco, and marijuana use. METHODS We studied a population-based sample of 1,237 individuals from the Cardiff Study of All Wales and North West of England Twins aged 11-18 years. Adolescent and mother-reported information was obtained. Statistical analyses included cross-sectional and prospective logistic regression models and family-based permutations. RESULTS Conduct problems and close friends' substance use were associated with increased adolescents' substance use, whereas refusal assertiveness was associated with lower use of cigarettes, alcohol, and marijuana. Peer substance use moderated the relationship between conduct problems and alcohol use problems, such that conduct problems were only related to increased risk for alcohol use problems in the presence of substance-using friends. This effect was found in both cross-sectional and prospective analyses and confirmed using the permutation approach. CONCLUSIONS Reduced opportunities for interaction with alcohol-using peers may lower the risk of alcohol use problems in adolescents with conduct problems.
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Affiliation(s)
- Beate Glaser
- The MRC Centre for Causal Analyses in Translational Epidemiology, University of Bristol, Bristol, United Kingdom
- Department of Social Medicine, University of Bristol, Bristol, United Kingdom
| | | | - Marianne B.M. van den Bree
- Department of Psychological Medicine, Cardiff University, Cardiff, United Kingdom
- Address correspondence to: Marianne B. M. van den Bree, Ph.D., Department of Psychological Medicine, Cardiff University, Heath Park, Cardiff, CF14 4XN.
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Bolin K, Mörk AC, Wilson K. Smoking-cessation therapy using varenicline: the cost-utility of an additional 12-week course of varenicline for the maintenance of smoking abstinence. J Eval Clin Pract 2009; 15:478-85. [PMID: 19536915 DOI: 10.1111/j.1365-2753.2008.01045.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVES To evaluate the cost-effectiveness of an additional 12-week treatment with varenicline for abstainers who had successfully completed an initial 12-week treatment. DESIGN The Benefits of Smoking Cessation on Outcomes simulation model was used to simulate both direct and indirect effects of smoking cessation. All calculations were performed in 2003 Swedish prices. SETTING Sweden in 2003. PATIENTS OR PARTICIPANTS The modelled cohort consisted of 25% of adult smokers motivated to quit smoking (168,844 males and 208,737 females). The age and sex distributions of the cohort reflect that of the Swedish population in 2003. INTERVENTIONS Smokers who had achieved abstinence for at least 7 days following 12-week open-label treatment with varenicline were randomized to receive an additional 12-week treatment with either varenicline or placebo. MEASUREMENTS AND RESULTS The incremental costs per quality-adjusted life-year (QALY) gained, for abstainers who received an additional 12-week varenicline treatment compared with only 12 weeks, were Euro 7066 for men and Euro 7108 for women, over a 50-year time horizon. (1 Euro approximately equal to SEK 9.12). These estimates excluded indirect effects on production and consumption of increased survival. The corresponding incremental costs per QALY including indirect effects were Euro 24,149 and Euro 24,436, respectively. Sensitivity analysis indicated that the estimated cost-utility ratios are robust, but relatively sensitive to treatment efficiency and intervention costs. CONCLUSIONS An additional 12-week course of varenicline treatment, provided to abstainers after an initial 12-week treatment, produces relatively low incremental cost-utility ratios in the spectrum of life-saving medical treatments.
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Affiliation(s)
- Kristian Bolin
- Lund University Centre for Health Economics, Lund, Sweden.
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Chen GB, Payne TJ, Lou XY, Ma JZ, Zhu J, Li MD. Association of amyloid precursor protein-binding protein, family B, member 1 with nicotine dependence in African and European American smokers. Hum Genet 2008; 124:393-8. [PMID: 18777128 DOI: 10.1007/s00439-008-0558-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2008] [Accepted: 09/01/2008] [Indexed: 01/16/2023]
Abstract
Although epidemiological studies reveal that cigarette smoking is inversely associated with Alzheimer's disease (AD) and Parkinson's disease (PD), the underlying mechanism remains largely unknown. Considering the facts that amyloid precursor protein-binding protein, family B, member 1 (APBB1) is mapped to a suggestive linkage region on chromosome 11 for nicotine dependence (ND), and has been implicated in the pathogenesis of AD and PD, it represents a plausible candidate for genetic study of ND. Five single nucleotide polymorphisms (SNPs) within APBB1 were genotyped in a sample consisting of 2,037 participants of either African-American (AA) or European-American (EA) origin, and examined their associations with ND assessed by three commonly used measures: Smoking Quantity (SQ), the Heaviness of Smoking Index (HSI), and the Fagerström Test for ND (FTND). Individual SNP-based association analysis showed that all five SNPs are associated with at least one ND measure in one of the three samples; however, only the association of SNP rs4758416 with SQ and HSI remained significant after correction for multiple testing in the pooled sample. Haplotype analysis demonstrated three major haplotypes significantly associated with ND after Bonferroni correction. Formed by rs4758416-rs10839562-rs1079199, haplotype C-C-T showed positive association with FTND in the AA and pooled samples, and conversely, haplotype G-C-T showed negative association with SQ and HSI in AA and EA samples. Another haplotype, C-T-G, formed by rs10839562-rs1079199-rs8164, was significantly associated with HSI in the EA sample. Based on these findings, we conclude that APBB1 represents an important candidate gene in the genetic study on ND and neurodegenerative diseases and warrants further investigation in future.
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Affiliation(s)
- Guo-Bo Chen
- Institute of Bioinformatics, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
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Nussbaum J, Xu Q, Payne TJ, Ma JZ, Huang W, Gelernter J, Li MD. Significant association of the neurexin-1 gene (NRXN1) with nicotine dependence in European- and African-American smokers. Hum Mol Genet 2008; 17:1569-77. [PMID: 18270208 DOI: 10.1093/hmg/ddn044] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
The neurexin-1 gene (NRXN1) has been shown to play a fundamental role in synaptogenesis and synaptic maintenance, as well as Ca(2+) channel and NMDA receptor recruitment. A recent study reported that NRXN1 is associated with nicotine dependence (ND); this, together with the intriguing physiological functions of the gene, motivated us to investigate the involvement of NRXN1 with ND in independent samples. In this study, we analyzed 21 single nucleotide polymorphisms (SNPs) within NRXN1 for association with ND, which was assessed by smoking quantity (SQ), the heaviness of smoking index (HSI) and the Fagerström test for ND (FTND). Individual SNP and haplotype association tests were carried out in a sample consisting of 2037 individuals from 602 nuclear families of African-American (AA) or European-American (EA) origin. Individual SNP analysis revealed significant associations of rs2193225 with SQ, HSI and FTND (P = 0.00014-0.0010) in the EA sample and with SQ (P = 0.0019) in the pooled sample under the dominant model and rs6721498 with SQ, HSI and FTND in the AA (P = 0.000090-0.0000086) and pooled (P = 0.0010-0.00099) samples under the additive model, following correction for multiple testing. Haplotype analysis revealed six major haplotypes in the AA sample (minimum P-value = 0.000079), one major haplotype in the EA sample (P = 0.0062) and five major haplotypes in the pooled sample (minimum P-value = 0.00083), which showed significant association with all three ND measures; all of these contained one specific allele from one of the two aforementioned SNPs. Based on our findings that NRXN1 has significant association with ND in two independent samples, recent findings that NRXN1 plays an important role in synaptic development, and the previous report of association, we conclude that this gene represents a strong candidate for involvement in the etiology of ND.
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Affiliation(s)
- Justin Nussbaum
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, USA
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12
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Parent–Child Relations, Conduct Problems and Cigarette Use in Adolescence: Examining the Role of Genetic and Environmental Factors on Patterns of Behavior. J Youth Adolesc 2007. [DOI: 10.1007/s10964-007-9254-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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13
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Arason GJ, Kramer J, Blaskó B, Kolka R, Thorbjornsdottir P, Einarsdóttir K, Sigfúsdóttir A, Sigurdarson ST, Sigurdsson G, Rónai Z, Prohászka Z, Sasvári-Székely M, Bödvarsson S, Thorgeirsson G, Füst G. Smoking and a complement gene polymorphism interact in promoting cardiovascular disease morbidity and mortality. Clin Exp Immunol 2007; 149:132-8. [PMID: 17425651 PMCID: PMC1942025 DOI: 10.1111/j.1365-2249.2007.03391.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
We have demonstrated previously that carriers of a genotype called C4B*Q0 (silent allele of the C4B gene) have a substantially increased risk to suffer from myocardial infarction or stroke, and are selected out from the healthy elderly population. Because smoking carries a major risk for cardiovascular disease (CVD), it seemed worthwhile to study if these two factors interact. Study 1 involved 74 patients with angina pectoris (AP), 85 patients with recent acute myocardial infarction (AMI) and 112 survivors of a previous AMI and 382 controls from Iceland. Study 2 involved 233 patients with severe CVD and 274 controls from Hungary. Smoking habits were registered for each subject. The number of C4A and C4B genes was determined by phenotyping or genotyping. Compared to controls, C4B*Q0 carrier frequency was significantly higher at diagnosis in Icelandic smokers with AP (P = 0.005) and AMI (P = 0.0003) and Hungarian smokers with severe coronary artery disease (P = 0.023), while no such difference was observed in non-smoking subjects. Age-associated decrease in C4B*Q0 observed previously in two remote Caucasian populations was found, in the present study, to be associated strongly with smoking, and to already occur in smokers after age 50 years both in Iceland and Hungary. Our findings indicate that the C4B*Q0 genotype can be considered as a major covariate of smoking in precipitating the risk for AMI and associated deaths.
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Affiliation(s)
- G J Arason
- Department of Immunology, Institute for Medical Laboratory Sciences, Landspítali University Hospital, Reykjavík, Iceland.
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Fowler T, Lifford K, Shelton K, Rice F, Thapar A, Neale MC, McBride A, van den Bree MBM. Exploring the relationship between genetic and environmental influences on initiation and progression of substance use. Addiction 2007; 102:413-22. [PMID: 17298649 PMCID: PMC1974769 DOI: 10.1111/j.1360-0443.2006.01694.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIMS To examine the genetic and environmental contributions to the initiation of use and progression to more serious use of alcohol, cigarettes and marijuana during adolescence, and to examine the relationship between initiation and progression of substance use. DESIGN The study used a twin-based design and a new theoretical model, the causal-common-contingent (CCC) model. This allows modelling of the relationship between initiation of use and progression to heavier use as a two-stage model and the examination of genetic and environmental influences on both stages, while taking into account their relationship. PARTICIPANTS The participants consisted of 1214 twin pairs (69% response rate) aged 11-19 years sampled from the UK population-based Cardiff Study of All Wales and North-west of England Twins (CaStANET). MEASUREMENTS Data on adolescent initiation and progression to more serious use of alcohol, cigarettes and marijuana were obtained using self-report questionnaires. FINDINGS Initiation of alcohol and progression to heavier alcohol use had separate but related underlying aetiologies. For cigarette and marijuana use the relation between initiation and progression to heavier use was stronger, suggesting greater overlap in aetiologies. For all three substances, environmental influences that make twins more similar (common environment) tended to be greater for initiation, while genetic influences were stronger for heavier use. CONCLUSIONS These findings have implications for policy decisions aimed at an adolescent and early adult age group. Specifically, these findings suggest that it may be more efficacious to focus alcohol interventions on risk factors for the development of heavier use rather than initiation of use. In contrast, interventions aimed at reducing the initiation of cigarettes and marijuana use may be more appropriate.
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Affiliation(s)
- Tom Fowler
- Department of Psychological Medicine, Cardiff University, Cardiff, UK.
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Lou XY, Ma JZ, Sun D, Payne TJ, Li MD. Fine mapping of a linkage region on chromosome 17p13 reveals that GABARAP and DLG4 are associated with vulnerability to nicotine dependence in European-Americans. Hum Mol Genet 2006; 16:142-53. [PMID: 17164261 DOI: 10.1093/hmg/ddl450] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
A two-stage association study was conducted targeting a genomic region on chromosome 17p13 that we reported likely to harbor susceptibility gene(s) for nicotine dependence (ND). Participants were 2037 subjects from 602 nuclear families of either African-American (AA) or European-American (EA) origin from our Mid-South Tobacco Family (MSTF) cohort. We first examined 10 single nucleotide polymorphisms (SNPs) in six genes within the targeted region of about 90 kb to determine which SNP/gene was associated with ND, assessed by smoking quantity (SQ), the heaviness of smoking index (HSI) and the Fagerström Test for ND (FTND). Individual SNP analysis revealed that SNPs rs17710 and rs222843 in GABA(A) receptor-associated protein (GABARAP) exhibited a significant association with at least one age- and gender-adjusted ND measure in the EA sample and rs222843 remained significant with the FTND after correction for multiple testing (P = 0.009). Although no SNP in DLG4 was significantly associated with ND, we found a G-G haplotype with a frequency of 14.2% formed by SNPs rs2242449 and rs507506 within the gene that showed significant inverse associations with all three ND measures [P = 0.003, 0.015 and 0.024, for SQ (defined as the number of cigarettes smoked per day), HSI and FTND, respectively]. We also found an A-A haplotype with a frequency of 8.8% formed by SNPs rs17710 and rs222843 in GABARAP, which revealed significant associations with all three ND measures (P = 0.006, 0.019 and 0.024, for SQ, HSI and FTND, respectively). To confirm these findings with a better coverage of GABARAP and DLG4, we conducted a second-stage association analysis by genotyping four more SNPs for GABARAP and nine more for DLG4 on the same set of samples. Our results from the second stage of individual SNP- and/or haplotype-based association analysis supported our finding of significant association of the DLG4 gene with ND. No significant association of GABARAP or DLG4 with ND was detected in the AA sample. Further, by comparing the linkage signal before and after adjustment for the SNPs of GABARAP and DLG4, we found that inclusion of the SNPs of the two genes as covariates largely reduced the linkage signal in the EA sample, but kept nearly unchanged in the AA sample. Taken together, our two-stage association analysis and linkage analysis results indicate that the GABARAP and DLG4 genes are involved in the etiology of ND in EA smokers. Further investigation of neurobiological mechanisms of the two genes in the etiology of ND is thus warranted.
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Affiliation(s)
- Xiang-Yang Lou
- Department of Psychiatry and Neurobehavioral Sciencesm, University of Virginia, Charlottesville, VA, USA
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Bolin K, Lindgren B, Willers S. The cost utility of bupropion in smoking cessation health programs: simulation model results for Sweden. Chest 2006; 129:651-60. [PMID: 16537864 DOI: 10.1378/chest.129.3.651] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES To calculate incremental cost-utility ratios (cost per quality-adjusted life-year [QALY] gained) for bupropion (Zyban; GlaxoSmithKline; Gothenburg, Sweden), as compared to nicotine replacement therapy (NRT) in smoking cessation programs for a follow-up period of 20 years. DESIGN The Global Health Outcomes simulation model was used for a male cohort and for a female cohort as a point of departure but was further extended in order to include the following: (1) the indirect effects of smoking cessation on production and consumption in the economy, and (2) morbidity-specific QALYs gained. SETTING Sweden in 2001. PATIENTS OR PARTICIPANTS Model cohort consisting of 612,851 male and 780,970 female smokers, distributed by age, > or = 35 years old, as in the Swedish population of 2001. INTERVENTIONS Bupropion, as compared to NRT (nicotine patches and nicotine gums), in smoking cessation programs for a follow-up period of 20 years. MEASUREMENTS AND RESULTS When the indirect effects on production and consumption were taken into account, bupropion was cost saving in comparison to both NRTs. When only the direct costs were included, bupropion was still cost saving in comparison to nicotine gum. The incremental costs per QALY gained were relatively low for bupropion in comparison to nicotine patches, 6,600 Swedish kronas (SEK) (approximately 725 euro) per QALY gained for men and 4,900 SEK (approximately 535 euro) for women, all calculations in 2001 Swedish prices. The comprehensive sensitivity analysis showed robust results; results were, however, more sensitive to quit rates and intervention costs than to other variables. CONCLUSIONS Bupropion is a cost-effective therapy in smoking cessation programs. Furthermore, recent studies report even higher effectiveness in terms of quit rates than was assumed here, indicating that our estimated cost-utility ratio should be even more favorable to bupropion.
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Affiliation(s)
- Kristian Bolin
- Lund University Centre for Health Economics, PO Box 705, SE-220 07 Lund, Sweden.
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17
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Abstract
Smoking behaviour is influenced by both genetic and environmental factors. Many years of twin and adoption studies have demonstrated that heritability is at least 50% responsible for both smoking initiation and smoking persistence. Furthermore, the extent, to which genetic and environmental factors contribute to smoking behaviour, is significantly different in men and women. Linkage analyses from several independent studies provide evidences for suggested linkage of smoking behaviour to chromosomes 1, 2, 4, 5, 6, 9, 10, 11, 14, 17, 18 and 21. However, almost none of these loci have been replicated yet. Furthermore, numerous population-based association studies have been performed to examine the effects of a number of candidate genes, such as cytochrome P450, dopamine receptor (DR) and transporter, serotonin transporter and nicotinic acetylcholine receptor, on smoking behaviour. However, many of these reports have not yet received independent confirmation. Of these candidate genes, the D2 dopamine receptor (DRD2) gene has been extensively studied. Meta-analysis of 12 reported studies showed a significantly higher prevalence of the DRD2 TaqI A1 allele in smokers than that in non-smokers (p < 0.0001; pooled OR = 1.50; 95% CI = 1.33-1.70). For other candidate genes, insufficient published studies are available to allow a meta-analysis to be performed, or meta-analysis showed no significant difference between smokers and non-smokers. More studies are necessary to determine whether these genes play a significant role in smoking behaviour.
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Affiliation(s)
- M D Li
- Program in Genomics and Bioinformatics on Drug Addiction, Department of Psychiatry, The University of Texas Health Science Center, Floyd Curl Drive, San Antonio 78229, USA.
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18
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Abstract
Cancer of unknown primary origin (CUP) accounts for 5-10% of all malignant tumors at presentation and remains the death certificate diagnosis in 0.5-5% of patients. We investigated CUP patients whose primary site remained unknown throughout the entire clinical course. We reviewed 9,436 consecutive autopsies performed between 1984 and 1999 at the Mayo Clinic, matched with 177,167 cancer patients treated in the same time period. Sixty-four patients who died of CUP underwent postmortem examination. Antemortem pathologic diagnoses were obtained in 57 patients, agreed with postmortem diagnoses in 98%, and included adenocarcinoma (n=44), undifferentiated carcinoma (n=7), squamous cell carcinoma (n=3), and others (n=3). Autopsy located the primary site in 35 patients (55%). Common primary sites were lung (n=8), the pancreaticobiliary (n=13) and GI tracts (n=9). Of 43 patients evaluated for tumor-specific therapy, only six received no further oncologic treatment and untreated patients survived a median of 57 (range 10-280) days, compared with 225 (range 19-1,129) days for patients treated with chemotherapy and/or radiotherapy (n=37). Our findings show that (1) autopsy studies provide a valuable tool for quality control in the setting of CUP, and (2) treated patients have a small but significant survival benefit.
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Carlson LE, Taenzer P, Koopmans J, Casebeer A. Predictive value of aspects of the Transtheoretical Model on smoking cessation in a community-based, large-group cognitive behavioral program. Addict Behav 2003; 28:725-40. [PMID: 12726786 DOI: 10.1016/s0306-4603(01)00268-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the predictive value of aspects of the Transtheoretical Model (TTM) of behavior change as applied to smoking cessation in a large-group, community-based cognitive-behavioral intervention. RESEARCH APPROACH Cognitive-behavioral intervention followed by 3-month assessment of smoking status. SETTING Regional Outpatient Cancer Centre. STUDY PARTICIPANTS A total of 2069 participants in smoking cessation clinics held between 1992 and 1999. INTERVENTION Eight 90-min sessions over 4 months utilizing education, self-monitoring, a group quit date, and behaviour modification techniques. MAIN OUTCOME MEASURES Cessation rates at 3 months postquit date. Differences between successful and unsuccessful participants on the baseline TTM variables of: stages of change, processes of change, decisional balance and situational temptations, as well as of precessation demographic, smoking history, and smoking behavior variables. RESULTS Nonsmokers at 3 months endorsed using more of only one of the processes of change (Reinforcement Management) more than smokers prior to starting the program. They also endorsed more Cons of Smoking and had a more negative Decisional Balance score. When the variables of tobacco tolerance on the Fagerstrom Test for Nicotine Dependence (FTND), marital status, association with the Cancer Centre, and amount of vigorous exercise were first entered in a logistic regression model, Reinforcement Management and Cons of Smoking continued to be predictive of smoking cessation success, but again none of the other TTM variables added explanatory power. CONCLUSIONS TTM variables measured prior to program attendance added little predictive value for cessation outcome beyond that explained by demographic and smoking history variables. Future studies may benefit from reassessing the TTM variables at the quit date and the 3-month assessment of smoking status to evaluate how the program impacted these variables.
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Affiliation(s)
- Linda E Carlson
- Department of Psychosocial Resources, Tom Baker Cancer Centre, 1331 29 Street Northwest, Calgary, Alberta, Canada T2N 4N2.
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Sellers EM, Tyndale RF, Fernandes LC. Decreasing smoking behaviour and risk through CYP2A6 inhibition. Drug Discov Today 2003; 8:487-93. [PMID: 12818518 DOI: 10.1016/s1359-6446(03)02704-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The consequences of tobacco dependence are both health related and economic. Novel treatment approaches are needed to offer alternatives to patients and to improve treatment outcomes. We review concepts and selected recent discoveries in the area of treatment, with a specific orientation towards drug development. Current treatments are outlined and we highlight new strategies that are based on the manipulation of cytochrome P450 2A6 (CYP2A6) activity, which is responsible for the metabolism of nicotine. The clinical implications of CYP2A6 polymorphisms have been linked to a decreased risk of tobacco dependence, a decrease in number of cigarettes smoked and reduced risk of tobacco-related cancers. Further, we discuss a range of models for proof-of-concept studies for new treatments to alleviate tobacco dependence
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Affiliation(s)
- Edward M Sellers
- Department of Pharmacology, Psychiatry, Medicine University of Toronto, Ontario M5T 3A9, Toronto, Canada.
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21
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Abstract
Today, two generations after the first Surgeon General's report, and with abundant evidence of the catastrophic consequences of smoking, no serious person can be unaware that smokers risk their lives and health. We also know that quitting smoking--at any age--promises significant health benefits. When offered the tools they need, older smokers quit smoking at rates comparable to those of younger smokers despite their skepticism, fatalism, and self-doubt. Older smokers should be encouraged to enter programs that stress the health benefits derived and identify the risks they are avoiding by quitting smoking. These programs establish quit dates, use sound behavioral modification techniques, provide strategies for stress management and relaxation, treat withdrawal symptoms, and provide regular and continuing follow-up. The patient is asked to make an existential change, and the physician should provide encouragement and promote self-confidence by emphasizing that, despite setbacks, with repeated efforts, success can be achieved. Clinicians can influence patients to quit smoking, and they should.
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Affiliation(s)
- David W Appel
- Division of Pulmonary Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY 10461, USA
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22
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Abstract
PURPOSE To summarize our knowledge of the economic impact of smoking on health-related outcomes and to discuss the quality of this evidence. The potential effect of smoking-related health promotion programs on reducing costs is discussed. DATA SOURCES Studies reviewed were cited in recently published reviews, identified through database searches of MEDLINE/HealthSTAR, PsychINFO, and ABI/Inform or obtained from reference lists of other studies. STUDY INCLUSION AND EXCLUSION CRITERIA Included are studies of the health care and other costs of smoking published in English in peer-reviewed journals during the last 20 years. Studies of annual and lifetime costs are included as are studies of employer costs. Forty-nine studies were reviewed. DATA EXTRACTION METHODS Data extracted were total costs, medical care and other direct costs, lost productivity, and mortality costs. Underlying methodologies were described and compared. DATA SYNTHESIS The annual cost of smoking is between 6 and 14% of personal health expenditures. Estimates have increased over time, reflecting better and more comprehensive methodologies. Smoking appears to result in increased lifetime costs, although some studies havefound contrary results. In the workplace, smokers incur greater medical costs and more lost productivity than nonsmokers. They also impose costs on their nonsmoking co-workers. MAJOR CONCLUSIONS The overwhelming body of evidence in the literature asserts that smoking imposes costs on an annual basis, that it leads to increased medical costs over the life span, and that many of these costs are borne by employers. Although the methods for studying this issue have evolved over time and are presently quite comprehensive, future research is needed to further substantiate the findings and develop further refinements.
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Affiliation(s)
- W Max
- Institute for Health & Aging, School of Nursing, University of California, San Francisco 94143-0646, USA
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Richter L, Richter DM. Exposure to parental tobacco and alcohol use: effects on children's health and development. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2001; 71:182-203. [PMID: 11347360 DOI: 10.1037/0002-9432.71.2.182] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This review examines three ways in which parental tobacco and alcohol use compromises the physical and mental health of children: 1) direct exposure to the substances; 2) living with parents who may become ill from using these substances; and 3) children's modeling of parental substance use. Implications for prevention, intervention, and public education are discussed, and a reframing of the national dialogue on youth substance abuse is called for.
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Affiliation(s)
- L Richter
- National Center on Addiction and Substance Abuse, Columbia University, New York, USA.
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