Tobacco.org

• Seventy per cent of Bulgarian smokers wanted to quit, survey says  

More than 70 per cent of smokers in Bulgaria wanted to give up smoking, Yulia Medichkova of the Greenwild Foundation was quoted by Bulgarian news agency BTA as saying on November 19 2009.

Medichkova presented the results of a one-year campaign entitled The Culture of Breathing. Over 50 per cent of Bulgarians approved of increased restrictions on smoking that will be introduced by mid-2010. Bulgaria ranks third in the world in terms of number of smokers, after Japan and Greece, Medichkova said.

What was more worrying, according to another survey released by the Health Ministry on November 17 2009, was that every second pregnant woman in Bulgaria smoked during pregnancy.

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• Massachusetts' 'Model' Tobacco Cessation Benefit Spurs Unprecedented Drop in Smoking Rates, Heart Attacks, Asthma, and Birth Complications 

A "model" tobacco cessation benefit offered to Massachusetts' Medicaid participants has produced an astounding 26% drop in smoking rates in only two and a half years, and has already been linked to decreases in heart attacks, hospitalizations for asthma and COPD, and a significant decrease in birth complications.

Researchers from the Massachusetts Tobacco Cessation and Prevention Program (MTCP) found that up to 38% fewer MassHealth cessation benefit users were hospitalized for heart attacks in the first year after using the benefit, and that 18% fewer benefit users visited the emergency room for asthma symptoms in the first year after using the benefit. Researchers also found that there were 12% fewer claims for adverse maternal birth complications since the benefit was implemented.

The Massachusetts Executive Office of Health and Human Services said more than 75,000 people -- a full 40% of MassHealth members who smoke -- have used the benefit to try to quit smoking. Cost savings are being studied, and all indications suggest they will be significant.

"It is clear from these latest findings that the Commonwealth's efforts to help people quit smoking is a sound investment," Executive Office of Health and Human Services Secretary JudyAnn Bigby said. . . .

"As the nation debates the future of its health care system, the national significance of this research cannot be understated," said Robert J. Gould, PhD, President and CEO of Partnership for Prevention, a national organization that advances policies and practices to prevent disease and improve the health of all Americans. "These findings demonstrate that prudent investments in preventive health today will have a dramatic and positive effect on our health care system tomorrow."

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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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• Around One In Five Pregnant Smokers Go Undetected Each Year 

Self-reported smoking during pregnancy underestimates the true number of pregnant smokers in Scotland by 17%, and results in a failure to detect 2400 pregnant smokers each year, finds new research published on bmj.com today.

This results in thousands of smokers not being identified or offered smoking cessation services, say the authors.

It is well known that self reported smoking during pregnancy is an inaccurate way to identify smokers. Yet it is still used widely by antenatal clinics to determine the smoking status of pregnant women and to refer them to smoking cessation services. The Scottish Government also relies on self-reported smoking figures to set targets and measure the success of smoking cessation services. . . .

The authors estimate that the true smoking prevalence for pregnant women in Scotland, after adjusting for area deprivation, maternal age and self-reported smoking is 28%, higher than the 23% based on self report data.

They conclude by calling for more accurate methods of identifying pregnant smokers, so that accurate data is used to inform policy and provide appropriate

Source British Medical Journal

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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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• 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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• Guangzhou To Ban Tobacco Sales To Vulnerable Groups  

Guangzhou has prepared a tobacco control regulation which is pending approval by the city's National People's Congress standing committee.

The new regulation lists ten areas including hospitals, kindergartens, schools, and buses as tobacco-free areas and states that people smoking in these areas will be fined CNY50 and those who sell tobacco products to vulnerable groups such as teenagers and pregnant women will be fined CNY1,000. . . .

In addition, the regulation forbids tobacco manufacturers and sellers to send tobacco products as gifts

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• Eighty per cent of pregnant women in Nunavut smoke 

When Ottawa’s Bob Reid convened a meeting several years ago to discuss Nunavut’s smoking epidemic, the territory’s health officials, Inuit elders and leaders all shared an overriding concern.

Nunavut’s expectant mothers smoked too much, they told him, and required urgent help.

“One of the things that was appalling to community members was the degree to which women continued to smoke throughout pregnancy,” says Reid, associate director of the rehabilitation centre at the University of Ottawa Heart Institute.

Reid, an expert in smoking cessation and behaviour modification, works with heart patients trying to break their addiction to tobacco.

About one-quarter of the 7,000 patients who visit the institute every year are smokers. (Smoking is a leading risk factor for heart disease.)

But the scale of the epidemic among Nunavut’s expectant mothers is of a different magnitude: studies show that up to 80 per cent of pregnant women in the territory smoke.

That level of tobacco use has profound effects on the health of Nunavut’s infants, who suffer the world’s highest rates of hospitalization for pneumonia, bronchiolitis and other respiratory infections.

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• Stillbirths And Infant Deaths Related To Smoking During Pregnancy And Socioeconomic Inequalities 

New research published on bmj.com today reports that addressing the problem of smoking during pregnancy may help to reduce the socioeconomic inequalities in stillbirths and infant deaths by as much as 30 to 40 percent.

Without a doubt smoking during pregnancy has been associated with stillbirth. In addition, infant deaths and smoking rates during pregnancy vary strikingly with socioeconomic position. In order to find out more, a team of researchers began the task of measuring the effects of smoking during pregnancy and on the social inequalities gap in stillbirths and infant deaths.

They assessed the records of 529,317 live singleton births and 2,699 stillbirths delivered at 24 to 44 weeks' gestation in Scotland from 1994 to 2003.

Information on smoking during the pregnancy was gathered. A deprivation score was designated using postcode data from the 2001 population census.

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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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• Pregnant smoking 'psychosis link' 

Mothers who smoke during pregnancy put their children at greater risk of psychotic symptoms such as delusions and hallucinations, a study suggests.

A UK survey of 12-year-olds found those whose mothers had smoked were 20% more likely to suffer such problems.

The link was 84% more pronounced if 20 or more cigarettes a day were smoked.

The researchers suggested tobacco exposure in the womb may affect the child's brain development, but admitted further study of the issue was needed.

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• Smoking pregnant increases baby's asthma risk: study 

Smoking during pregancy increases the risk of a baby developing asthma up to sixfold, said a Swedish study published at the European Respiratory Society's annual congress on Monday.

The study by Professeur Anders Bjerg of the Sunderby central hospital in Norrbotten and his specialists showed that smoking leads to babies being born underweight, a fact that has an impact on the development of asthma.

The Swedish doctors studied asthma in about 3,400 children between 1996 and 2008.

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• Fewer smokers kicking the habit - despite the NHS spending a record £74m on quitting campaign  

The NHS is spending more money helping people stop smoking - but fewer are quitting, say official figures.

The cost per quitter was £219 in 2008/09 compared with £173 in 2007/08 and £160 in 2006/07.

The proportion of people successfully quitting last year went down four per cent. But spending went up 21 per cent last year to £74m - not including the cost of nicotine replacement therapy. Latest figures show that - four weeks on - 337,054 people successfully quit last year, a drop of four per cent on the 350,800 in the previous year.

The figures also found less than half of pregnant women using NHS stop smoking services manage to quit smoking.

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• Mother's smoking increases daughter's pancreatic cancer risk 

A woman who smokes during pregnancy and motherhood appears to boost her daughter's odds of developing pancreatic cancer, the deadly disease that will strike an estimated 21,420 women (and 21,050 men) this year.

Researchers from Harvard University and Imperial College London looked at pancreatic cancer rates in the Nurse's Health Study, one of the nation's oldest and largest studies of women and influences on their health. Although it's long been known that tobacco use is associated with higher rates of pancreatic cancer, researchers wanted to explore the effects of secondhand smoke on a person's risk of developing the disease. In the 24 years over which the women were followed, 384 of 86,673 women were diagnosed with cancer of the pancreas.

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• Passive smoking in pregnancy linked to asthma risk in children 

Children born to women exposed to environmental tobacco smoke (ETS) during pregnancy face an increased risk for asthma symptoms in early life, researchers warn.

“Smoking during pregnancy has been shown to be a considerable risk factor for changes in growth and maturation of the fetal lungs and the later development of wheeze and asthma,” explain Paraskevi Xepapadaki (University of Athens, Greece) and team in the journal Pediatric Allergy and Immunology.

But they add it is not known whether passive smoking in pregnancy is associated with an increased risk for asthma and allergies in offspring.

To investigate, the researchers studied data on 2374 preschool children, aged between 1 and 6 years, from 115 nurseries in five counties of Greece.

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