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• Nonsmokers Top Smokers in Well-Being Across All Incomes 

Smokers trail nonsmokers in well-being, regardless of income bracket, according to Gallup-Healthways Well-Being Index data collected in 2008 and 2009. In every income group, smokers are less likely than nonsmokers to be "thriving" by at least 12 percentage points. . . .

In the case of emotional health, the connection between smoking and low well-being is especially pronounced for low-income respondents. While the emotional health gap between smokers and nonsmokers is 4 points for the highest income group, the gap for the lowest income group is 10 points.

The differences in the size of the smoking gap across income groups could mean that the emotional consequences of smoking are less pronounced for people in the higher income group. Another possibility is that people in different income groups smoke for different emotional reasons. . . .

Self-reported smoking status is, in fact, strongly linked to depression. . . .

Across all income groups, smokers also fare worse than nonsmokers in physical health as reflected in lower scores on the Physical Health Index. Consistent with medical research connecting smoking to premature mortality, people who are 85 years old or older are unlikely to be smokers.

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• New dementia risk factors study findings reported from University of Minnesota 

Fresh data on dementia are presented in the report 'Risk of dementia hospitalisation associated with cardiovascular risk factors in midlife and older age: the Atherosclerosis Risk in Communities (ARIC) study.' According to recent research published in the Journal of Neurology, Neurosurgery, and Psychiatry, "Cardiovascular risk factors are associated with a higher risk of developing dementia. Studies in older populations, however, have often failed to show this relationship."

"We assessed the association between cardiovascular risk factors measured in midlife and risk of being hospitalised with dementia and determined whether this association was modified by age and ethnicity. We studied 11 151 participants in the population-based Atherosclerosis Risk in Communities cohort, aged 46-70 (23% African-Americans) in 1990-2, when participants underwent a physical exam and cognitive testing. Hospitalisations with dementia were ascertained through December 2004. During follow-up, 203 cases of hospitalisation with dementia were identified. Smoking (hazard ratio (HR), 95% CI 1.7, 1.2 to 2.5), hypertension (HR, 95% CI 1.6, 1.2 to 2.2) and diabetes (HR, 95% CI 2.2, 1.6 to 3.0) were strongly associated with dementia, in Caucasians and African-Americans. . . .

The researchers concluded: "Our results emphasise the importance of early lifestyle modification and risk factor treatment to prevent dementia."

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• Current cigarette smokers at increased risk of seizures 

A recent study determined there is a significant risk of seizure for individuals who currently smoke cigarettes. Boston-based researchers from Brigham and Women's Hospital and Harvard Medical School also found that long-term, moderate intake of caffeine or alcohol does not increase the chance of having a seizure or developing epilepsy. This is the first prospective study to examine the potential risks associated with cigarette smoking, caffeine intake, and alcohol consumption as they independently relate to epilepsy. Full findings of this study are currently available online and will appear in the February 2010 issue of Epilepsia, a journal published by Wiley-Blackwell on behalf of the International League Against Epilepsy. . . .

Barbara A. Dworetzky, M.D., and colleagues used data obtained from the Nurses' Health Study II, a group of 116,608 female registered nurses, aged 25-42 years old who returned mailed questionnaires on their lifestyle and medical history including epilepsy and seizure activity. In the analysis for cigarette smoking, researchers accrued 246 cases and 1,778,307 person-years of follow-up among 116,363 participants. For the analyses of caffeine intake, there were 201 cases and 1,440,850 person-years of follow-up among 105,941 participants, and for the alcohol consumption analyses, 198 cases and 1,427,348 person-years of follow-up among 104,934 participants. The data used in this study were obtained from 1989 through May 31, 2005.

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• Researchers Study PTSD, Smoking Link For Soldiers 

A new University of Wisconsin study set to begin in January is aiming to help troops coping with post-traumatic stress disorder to overcome smoking when they return home.

The study by the UW Center for Tobacco Research and Intervention has a goal of helping soldiers kick their smoking habit.

"A lot of time that you were exhausted and you needed to have some time out," said veteran Deeann Hansen. "We were on a road march and when we were told to stop we were allowed to take a break, and the comment was made to us that, 'Smoke 'em if you got 'em,' and if you don't they told us to pick up cigarette butts and trash."

Studies show Hansen isn't the only one to leave the military addicted to tobacco. It's something she blamed on the high stress load of life in the services.

Around 7 million U.S. vets suffer from PTSD and more than half smoke -- and that statistic is sparking some research.

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• The Geography of Smoking  

One in five Americans continue to smoke cigarettes, according to a new survey by the Centers for Disease Control and Prevention. The smoking rate varies from low of 9.2 percent in Utah to a high of 26.6 percent in West Virginia. The map below, from the Wall Street Journal, shows the smoking rate by state.

The data are interesting and they allow us to look at the extent to which smoking is associated with all sorts of things, from more obvious ones like cancer and heart disease to the economic and demographic characteristics of states with higher or lower levels of smoking and even the relationship between smoking and happiness. With a helpful analytical assist from my colleague Charlotta Mellander, we decided to take a quick look. We ran some simple correlations and scatter-plots between state smoking rates and these factors. As usual, we point out that correlation does not imply causality, but simply points to associations between variables. Still, a number of interesting things stand out.

It will come as little surprise that states with higher levels of smoking have significantly higher rates of death from cancer, heart disease, and cerebrovascular diseases like hypertension. There is a significant correlation between state smoking rates and death rates from cancer (.75), heart disease (.67), and cerebrovascular disease (.59). . . .

Smoking is negatively associated with state happiness (with a correlation of -44.71). Since these correlations only reflect associations between variables and not causality, it's hard to say whether this reflects the fact that happier people smoke less or unhappier ones smoke more, or that both smoking and happiness levels reflect something else. . . .

That said, smoking rate is associated with concentrations of artists, musicians, and entertainers. Contrary to the stereotypical image of cigarette-puffing bohemians or hipsters, smoking is less prevalent in states with more of these artistic types: The correlation is negative (-.450), and about the same as for education.

Lastly, smoking is negatively correlated with larger concentrations of gays and lesbians, as well as immigrants

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• Smoking Tied to Suicide Risk in Bipolar Disorder  

People with bipolar disorder who smoke appear to have a heightened risk of suicidal behavior -- possibly because they are generally prone to impulsive acts, a new study suggests.

Bipolar disorder, also known as manic depression, is marked by dramatic swings in mood -- ranging from episodes of debilitating depression to periods of euphoric recklessness. Previous studies have found that bipolar patients who smoke have a higher suicide risk than their non-smoking counterparts, but the reasons have not been clear.

The new findings suggest that high levels of impulsivity -- one of the symptoms of bipolar disorder -- may draw some patients to both smoking and suicidal behavior.

Dr. Michael J. Ostacher and colleagues at Massachusetts General Hospital in Boston found that among 116 bipolar patients they followed, current smokers generally scored higher on a standard measure of suicidal thoughts and behaviors.

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• State bans smoking in mental hospitals 

The Atlanta Journal-Constitution has learned that the state plans to ban smoking in the seven state mental hospitals on Jan. 5, a steep challenge considering the high percentage of smokers among those with mental illness.

But Tom Wilson, spokesman for the state Department of Behavioral Health and Developmental Disabilities, said the measure will make the patients and facilities healthier. He also said the ban could advance patients' treatment, helping them to give up an often addictive habit.

Wilson acknowledged the challenges, pointing to national statistics that show 75 percent of people with mental illness or addictions smoke, and that nearly half of the cigarettes consumed in the country are smoked by people with mental illness.

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• Smoking while pregnant linked to behavioural problems in children  

Smoking during pregnancy significantly increases the risk of having a child with behavioural problems, according to research published today. Disturbances can manifest themselves in children as young as three years old, the study in the Journal of Epidemiology and Community Health claims.

The findings are based on more than 14,000 mother-and-child pairs drawn from the millennium cohort study, a population-based study of children born between 2000 and 2001 whose families are receiving child benefit.

The research was carried out by Professor Kate Pickett, at the department of health sciences at Hull York medical school, University of York.

Mothers, who were categorised as light or heavy smokers, depending on how many cigarettes they smoked every day during pregnancy, were asked to score their children's behaviour.

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• Mothers' smoking causes newborn discomfort 

French researchers say they have tied maternal smoking to an increased risk of discomfort in newborns.

The study, published in Biological Psychiatry, suggests significantly more discomfort among newborns of smoking mothers may be related to having less monoamine oxidase A an enzyme, which degrades chemicals involved in brain message-sending.

Monoamine oxidase A activity was reduced both in the pregnant smokers and in their newborns when the researchers tested for blood biomarkers of monoamine oxidase A activity in smoking and non-smoking pregnant women and in the cord blood of their newborns.

Smoke exposure-induced low monoamine oxidase A activity in the womb may affect fetus brain neurotransmission and create potential vulnerabilities to behavioral disorders later in life,

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• Addressing smoking beliefs may help schizophrenia patients to quit 

Challenging positive expectations and providing information on the negative consequences of smoking increase the motivation of schizophrenia and schizoaffective patients to quit smoking, conclude US investigators.

It has been shown in a number of different populations that smoking expectations, in terms of both positive expectations of smoking and the negative health consequences, are associated with intention to quit and predict smoking cessation success. However, while smoking has been widely studied in schizophrenia, the links between smoking expectancies and understanding and intention to quit have not been investigated.

Jennifer Tidey, from Brown University in Providence, Rhode Island, and colleagues studied 46 smokers with schizophrenia, 35 smokers with schizoaffective disorder, and 71 smokers without psychiatric illness, all of whom were heavy smokers. . . .

The team concludes in the journal Schizophrenia Research: "The results of this study support the importance of focusing on the expected pros and cons of smoking in motivation interviewing and other cognitive behavioral interventions for tobacco dependence in people with schizophrenia and schizoaffective disorder."

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• Maternal Smoking May Increase Newborns' Discomfort 

A new research study being published in the October 15th issue of Biological Psychiatry suggests that maternal smoking may increase the level of distress of newborns.

Studies have consistently found that prenatal cigarette smoke exposure is associated with increased rates of behavior problems, irritability, attention-deficit/hyperactivity disorder, the risk of violent offenses, conduct disorder, adolescent onset of drug dependence, and the risk for criminal arrest in offspring. This study adds another potential negative outcome to the list of reasons for mothers to stop smoking while pregnant.

Most of the effects of tobacco either during pregnancy or on postnatal outcomes are attributed to nicotine. However, smoking is associated with reduced monoamine oxidase A (MAO-A) activity, enzymes that degrade brain neurotransmitters in smokers. Prenatal smoke exposure-induced low MAO-A activity in fetal life may dysregulate brain neurotransmission, creating a potential vulnerability to develop behavioral disorders later in life. This dysregulation can occur with or without interaction with nicotine's effect on the developing brain.

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• Smoking Keeps Its Grip on Urban Poor  

A full 42 percent of people in Milwaukee's poorest neighborhoods smoke -- more than twice the national U.S. average -- sacrificing $9 on a pack of cigarettes even while most of the households reported earning less than $15,000 a year.

Even more troubling is the fact that a large number of these low-income smokers hold beliefs that make them less likely to quit, according to ongoing research from the University of Wisconsin-Madison.

Over the past 40 years or so, the overall smoking rate in the United States has decreased to about 20 percent, but those gains have taken place largely among people with resources, namely money and education, said Bruce Christiansen, an associate scientist with the University of Wisconsin Center for Tobacco Research and Intervention in Madison, who is one of the researchers on what's known as the "ZIP Code" project.

"With public health, we got 80 percent of the people who were going to quit smoking to quit smoking. That's great, but the next 20 percent is going to be tough," added Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in New Orleans. "Smoking tends to be a disease of poverty and lack of education. Thirty years ago, 50 percent of the population smoked and now we're down to roughly 25 percent. What we have left is a very select group of people."

That select group includes people with mental health issues, which, according to the U.S. Substance Abuse and Mental Health Service Administration (SAMHSA), smoke 44 percent of all cigarettes.

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[W]e got 80 percent of the people who were going to quit smoking to quit smoking. That's great, but the next 20 percent is going to be tough. Smoking tends to be a disease of poverty and lack of education. Thirty years ago, 50 percent of the population smoked and now we're down to roughly 25 percent. What we have left is a very select group of people.
Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in New Orleans.

• Doctors should ask mentally ill to stop smoking, new report says 

Smoking addiction treatment should be included in the care plans for mentally ill patients with tobacco dependence.

Based on the new study, clinical psychologist and lead author Brian Hitsman, of Northwestern University Feinberg School of Medicine, recommended an integrated care model to help mental health patients quit smoking. The method, combining drugs and psychological therapy, addresses the tobacco dependence of mentally ill smokers.

The review review appeared in a recent issue of the Canadian Journal of Psychiatry.

In this Q&A, Hitsman explained his recommended smoking cessation method and why mental health care professionals should consider it.

Q: Why did you decide to focus on the mentally ill for this tobacco addiction review?

A: Smokers with mental illness have been underserved when it comes to tobacco dependence treatments both clinically as well as in the tobacco addiction research field. They just haven’t gotten the attention. The thinking has been that they can’t quit and that if you get them in your clinical trial they won’t show up so what’s tended to happen is that this population has been excluded from treatments.

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• Study Counters Warnings on Quit-Smoking Drug  

The smoking cessation drug varenicline (Chantix) does not increase the risk for self-harm or depression, according to a new British study.

In July, the U.S. Food and Drug Administration mandated that the drug carry a "black-box warning" on its packaging, indicating that people who use it face increased risk for "serious neuropsychiatric symptoms," including changes in behavior, hostility, agitation, depressed mood, suicidal thoughts and behavior and attempted suicide.

In the new study, British researchers analyzed database information on 80,660 men and women, ages 18 to 95, who were prescribed a smoking cessation product between September 2006 and May 2008. Prescriptions were for varenicline, the antidepressant bupropion (Zyban) or nicotine replacement products, such as a patch, inhaler, gum, tablet or lozenge. People were followed through the period of the prescription and for three months after the date of their last prescription.

No clear evidence emerged that varenicline or bupropion increased the risk for self-harm, suicidal thoughts or depression, the study reported.

However, the researchers added that "the limited power of the study means we cannot rule out either a halving or a twofold increased risk."

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• Maternal tobacco, cannabis and alcohol use during pregnancy and risk of adolescent psychotic symptoms in offspring (Full Text) 

Results

Frequency of maternal tobacco use during pregnancy was associated with increased risk of suspected or definite psychotic symptoms (adjusted odds ratio 1.20, 95% CI 1.05–1.37, P = 0.007). Maternal alcohol use showed a non-linear association with psychotic symptoms, with this effect almost exclusively in the offspring of women drinking >21 units weekly. Maternal cannabis use was not associated with psychotic symptoms. Results for paternal smoking during pregnancy and maternal smoking post-pregnancy lend some support for a causal effect of tobacco exposure in utero on development of psychotic experiences.

Conclusions

These findings indicate that risk factors for development of non-clinical psychotic experiences may operate during early development. Future studies of how in utero exposure to tobacco affects cerebral development and function may lead to increased understanding of the pathogenesis of psychotic phenomena. . . .

Possible biological mechanisms

Animal studies indicate that fetal nicotine exposure can result in long-term structural and functional changes,7 including decreased neuronal density and size in the hippocampus and cortex, altered regulation of neuronal apoptosis,7,15 and increased expression of receptors for acetylcholine, which plays a critical role in brain maturation through modulation of axonogenesis and synaptogenesis.15 However, difficulties exist, both conceptually and pragmatically, in the interpretation of results from animal models in relation to effects in humans.

We are not aware of animal studies to date that have examined the effects of nicotine exposure in utero on putative endophenotypes of schizophrenia. Although endophenotypes of schizophrenia that can be modelled in animals are yet to be clearly determined this could potentially become an informative area for future research.

We observed suggestive evidence that maternal smoking during the third trimester was most strongly associated with risk of PLIKS, although results from subgroup comparisons should be interpreted cautiously. This is rather inconsistent with results from studies of famine38,39 and influenza,40,41 where early pregnancy exposure is associated with greatest risk of schizophrenia, but may reflect different sensitive periods of risks in brain development for different types of exposure. Maternal smoking,5,42 particularly during late pregnancy,43 is thought to lead to lower birth weight.7 However, adjusting for birth weight, as well as for gestation and 5-minute Apgar score had no effect on the results, and although these measures are likely to be rather crude markers of pre- and perinatal adversity, it seems unlikely that such adversity mediates or confounds the relationship between maternal smoking and offspring psychotic experiences. . . .

Implications

Observational studies are limited in determining causality due to potential problems of residual confounding. We observed an association between maternal, but not paternal, smoking during pregnancy and risk of psychotic symptoms in the offspring, consistent with accumulating evidence from animal models of adverse effects on brain development from in utero nicotine exposure. These findings suggest that risk factors for development of non-clinical psychotic experiences may operate during early development. Future studies of how in utero exposure to tobacco affects cerebral development and function may lead to increased understanding of the pathogenesis of psychotic phenomena.

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