Study: Cigarette Use May Explain Asthma Epidemic in Children

The rise in cigarette use by adults over the past century may explain the asthma epidemic in children according to a study by researchers at the Mailman School of Public Health. The study is published this month in Annals of Allergy, Asthma & Immunology, the scientific journal of the American College of Allergy, Asthma and Immunology (ACAAI).

The prevalence of asthma has increased at least threefold during the past several decades, but the cause for this remains unknown, according to author Renee D. Goodwin, PhD, MPH, assistant professor in the Department of Epidemiology at the Mailman School of Public Health.

The increase is occurring most prominently in industrialized countries, but now developing countries are beginning to experience similar increases.

“We have identified parallel increases in childhood asthma and cigarette use among adults during the past century in the United States. These parallel trends suggest that the increase in cigarette use may be a contributing factor to the rise in asthma among children during the same period through increased exposure to environmental tobacco smoke,” says Goodwin.

Approximately 4.8 million children under age 18 have asthma in the United States. Although treatment and asthma management strategies can help control symptoms, asthma is a chronic condition with no known cure. Asthma most frequently begins in childhood. The cause is unknown, but allergies are a factor in the majority of children with asthma.

Environmental tobacco smoke (ETS) inhaled unintentionally by nonsmokers has a higher concentration of some toxic substances than the smoke inhaled by smokers, such as carbon monoxide and carbon dioxide. Children breathe more air than adults and have narrower airways, so ETS is a greater causal risk factor of asthma in children. It can also increase the severity of their asthma symptoms.

Both genetic and environmental risk factors for asthma have been identified, notes Goodwin. Globally, six studies have shown environment tobacco smoke to be a risk factor of incident asthma. The risk for the development of childhood asthma was 2.5 times greater in young children with mothers who smoke more than 10 cigarettes per day indoors compared with mothers who smoke fewer cigarettes or not at all. Exposure to environmental tobacco smoke, especially in the home, increases a child’s likelihood of developing asthma by 63 percent according to the Department of Health and Human Services.

Cigarette use, currently considered one of the most pressing public health problems worldwide, has become increasingly concentrated among economically and socially disadvantaged segments of the population, as well as among younger persons.

“Previous data that show more recent higher rates of cigarette smoking among lower socioeconomic status segments of the population within the United States are consistent with our theory, since these are the most vulnerable segments of the population among whom rates of childhood asthma are currently the most concentrated,” she says.

“Although cigarette consumption has declined in some segments of the United States population since its peak around 1981, the consequences and health effects of the drastic increase in the mid-1980s are still affecting adults and children,” Dr. Goodwin says.

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Spiritual Beliefs, Practices May Help Smokers Quit

Unlike many traditional alcohol and drug dependence treatment programs, mainstream smoking cessation programs generally exclude spiritual practice and beliefs from the treatment process. But a study by Oregon Health & Science University Smoking Cessation Center researchers reveals many smokers are receptive to and may benefit from their own spiritual resources, when attempting to quit.

The study, believed to be the first to look at the potential use of spiritual resources for quitting in adult smokers, recently was published in Nicotine & Tobacco Research.

For decades, the OHSU research team encountered some patients in clinical practice who reported that in addition to the treatments provided by the team, they used personal spiritual beliefs and practices in their quit attempts. This led the team to question why spiritual resources were not part of mainstream tobacco dependence treatment programs.

"We theorized the absence of spiritual resources in smoking cessation programs may be due to perceived resistance from smokers or, until recently, the social acceptance of smoking, which may have prevented patients and providers from considering the health effects of tobacco dependence as life-threatening," says David Gonzales, principal investigator of the study, and co-director, OHSU Smoking Cessation Center, OHSU School of Medicine. "We know that smoking cessation medications coupled with behavioral interventions increase quit rates, but quitting is still difficult and some smokers need more support in order to quit successfully. We may be missing opportunities to assist these smokers."

Gonzales and colleagues discovered that women were more likely to report a spiritual practice or belief compared with men, but smokers of both sexes who smoked more than 15 cigarettes per day were more likely to be open to having their health care provider encourage them to use their own (the patient's) spiritual practice to assist in a quit attempt.

"Our findings suggest that although not all clinicians want to talk about spirituality with their patients, those who do feel comfortable doing so will likely find most patients who smoke are receptive. Asking smoking patients if they have a spiritual practice or belief may be important to their care," Gonzales explains.

Patient spirituality is becoming more mainstream in medicine and is accepted as integral to the treatment of many medical conditions, especially cancer, Gonzales says. Surveys show patients would like their providers to discuss spirituality related to their health care. Along with this opportunity there is a challenge for health care providers to respect spiritual beliefs and practices that may be different from their own. Further investigation and program development on how to include spirituality in mainstream tobacco dependence treatment is warranted, he and his team concluded.

To conduct this research, Gonzales and colleagues surveyed 104 current smokers, aged 18 or older and not attempting to quit, in smoking areas outside building on the OHSU Marquam Hill Campus. Study participants were equally male and female, on average 38 years old, and had smoked about 17 cigarettes a day for approximately 21 years. The anonymous surveys included questions about smoking behaviors, and spiritual practices and beliefs.

Of the 104 participants, 92 had some history of using spiritual resources, and of those, 78 percent believed that using those resources when making a quit attempt could be helpful.

Seventy-seven percent believed having treatment staff encourage the use of spiritual resources to help them quit could be beneficial.

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Study Shows Smoking Common During Pregnancy

While pregnancy may be considered an effective motivator for smoking cessation, results of a new study by researchers at the Mailman School of Public Health indicate that pregnant U.S. women commonly smoke, placing themselves and their unborn children at risk for health and developmental complications. The research also finds a significant association between cigarette use, nicotine dependence, and the presence of mental disorders among pregnant women.

The data show that almost 22 percent of these women smoked cigarettes and more than 10 percent were nicotine dependent. The results also indicate that approximately 30 percent of pregnant women who used cigarettes had a mental disorder, with personality disorders, major depressive disorder, and specific phobia among the most common psychological ailments.

Mental disorders were even more common among pregnant women with nicotine dependence, affecting more than 57 percent. In terms of specific disorders, the strongest associations with nicotine dependence were seen for prolonged depression, panic disorder, and major depressive disorder.

"Our research shows that prenatal smoking appears to be more common in pregnant women who are already vulnerable—those who are unmarried, have less than high school education, and have lower personal incomes," says Renee Goodwin, assistant professor of Epidemiology at the Mailman School, and lead scientist. "They also are likely to have limited access to health care services, which may contribute to a lower likelihood of some women quitting smoking upon becoming pregnant."

The study included 1,516 pregnant women at least 18 years old who took part in the 2001–2002 National Epidemiologic Survey of Alcohol and Related Conditions, a nationally representative survey of more than 43,000 U.S. adults administered by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Mental disorders and nicotine dependence were diagnosed through use of the NIAAA Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV.

The findings were published in the April issue of Obstetrics and Gynecology. The study was supported in part by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health.

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Studies Identify DNA Regions Linked to Nicotine Dependence

Americans are bombarded with antismoking messages, yet at least 65 million continue to light up. Genetic factors play an important role in this continuing addiction to cigarettes, suggest scientists at Washington University School of Medicine in St. Louis.

In two studies in the January 2007 issue of Human Molecular Genetics, the scientists show that certain genetic variations can influence smoking behaviors and contribute to a person's risk for nicotine dependence.

The smoking-related genes identified normally facilitate communication between nerve cells in the brain. One gene in particular, the alpha-5 nicotinic cholinergic receptor (CHRNA5) gene, was a very strong indicator of risk for nicotine dependence. Individuals with a specific variation in the gene seemed to have a two-fold increase of developing nicotine dependence once exposed to cigarette smoking. CHRNA5 is from a class of receptors that plays a role in dopamine pathways in the brain, which are linked to a person's experience of pleasure.

The researchers also identified genes related to gamma aminobutyric acid (GABA) receptors, another set of proteins vital to nerve cell function. Both GABA and nicotinic receptors had been suspected of involvement in nicotine addiction, but these findings strengthen those suspicions.

The studies also identified a gene not previously known to be involved with nicotine dependence. Called the Neurexin 1 (NRXN1) gene, it helps regulate the balance between excitatory mechanisms — those that increase communication between nerve cells — and inhibitory mechanisms — those that slow firing between nerve cells.

"An imbalance between excitatory and inhibitory activity in the brain may predispose people to addiction, such as alcoholism, drug dependence or nicotine dependence," says Laura Jean Bierut, M.D., associate professor of psychiatry and principal investigator of both studies. "The Neurexin gene we've identified is really a key factor in the balance between inhibition and excitatory activity in neurons."

Bierut suspects a large number of genes are involved in nicotine dependence, and she says understanding how they work may make it possible to develop new treatments for smoking cessation.

The research team analyzed data from almost 2,000 participants in two ongoing studies. One, called the Collaborative Genetic Study of Nicotine Dependence, is a U.S.-based sample that includes both addicted smokers and "social" smokers from St. Louis, Minneapolis and Detroit. The other is an Australian study of smokers of European ancestry called the Nicotine Addiction Genetics study.

The scientists combined two approaches for analyzing genetic information. One approach scanned the entire human genome for suspicious areas of DNA while the second approach closely examined specific target genes.

"The combination of these two approaches represents the most powerful and extensive study on nicotine dependence to date and is an important step in a large-scale, genetic examination of nicotine dependence," says Elias A. Zerhouni, M.D., the director of the National Institutes of Health, which funded the studies. "As more genomic variations are discovered that are associated with substance abuse, we can better understand addictive disorders."

The researchers identified an area of DNA variation that seems to alter the function of a nicotinic receptor protein. That small variation makes a big difference in risk for nicotine dependence.

Current drug treatments for nicotine dependence continue to be only marginally successful, and Bierut believes using information about genetic traits to tailor medications to individuals could make them significantly more effective. "The type of variant you have at this particular receptor — the alpha-5 nicotinic receptor — may actually predict whether or not you will do well on nicotine replacement therapy," she says.

<---Anyone who's been or is a smoker, knows how hard it is to quit cigarettes. Even after we hear again and agian the risk of lung cancer for some reason we pick up a cigarette, ignoring the cancer statistics. Smokefree seems far away. But eventually, there is a point when quitting smoking makes the most sense.The effect of smoking takes too much of a toll.--->

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