Nicotine takes much longer than previously thought to reach peak levels in the brains of cigarette smokers, according to new research conducted at Duke University Medical Center.

Traditionally, scientists thought nicotine inhaled in a puff of cigarette smoke took a mere seven seconds to be taken up by the brain, and that each puff produced a spike of nicotine. Using PET imaging, Duke investigators illustrate, for the first time, that cigarette smokers actually experience a steady rise of brain nicotine levels during the course of smoking a whole cigarette.

The findings, scheduled to appear online in the Early Edition of Proceedings of the National Academy of Sciences (PNAS) the week of March 8, could lead to more effective treatments for smoking addiction.

“Previously it was thought that the puff-by-puff spikes of nicotine reaching the brain explained why cigarettes are so much more addictive than other forms of nicotine delivery, like the patch or gum,” says Jed Rose, Ph.D., director of the Duke Center for Nicotine and Smoking Cessation Research. “Our work now calls into question whether addiction has to do with the puff-by-puff delivery of nicotine. It may actually depend in part on the overall rate at which nicotine reaches and accumulates in the brain, as well as the unique habit and sensory cues associated with smoking.”

Yet, when the researchers compared 13 dependent smokers to 10 non-dependent smokers, they were surprised to find the dependent smokers had a slower rate of nicotine accumulation in the brain. “This slower rate resulted from nicotine staying longer in the lungs of dependent smokers, which may be a result of the chronic effects of smoke on the lungs,” surmises Rose.

The difference in rate of nicotine accumulation in the brain doesn’t explain why some people become addicted to cigarettes and others don’t. “Even if you correct for the speed of delivery, our study showed the non-dependent smokers eventually experienced the same high levels of nicotine in their brain as dependent smokers, yet they did so without becoming dependent. The real mystery is why.”

Rose says the absence of addiction in these smokers could be due to genetic differences, differences in the way they smoke, or differences in the psychological effects they derive. “We’re still not able to fully explain why these people are able to smoke without becoming addicted.”

Despite the questions raised, the study provides important insights into the role of the speed and level of brain nicotine levels, and which receptors in the brain are at work. “Different receptors respond to nicotine at different levels of sensitivity,” says Rose. “Knowing the levels of nicotine that are really getting to the brain gives us clues as to which receptors are more likely to be important for the dependence-producing effects of cigarette smoking.”

President Barack Obama’s recent physical examination revealed that he is in generally good health and that he is still trying to quit smoking. His doctor’s advice: keep up his “smoking cessation efforts”; in other words, he should keep trying to kick the habit.

Susan Rausch, health educator at the Pat Walker Health Center and co-chair of the University of Arkansas’ FRESH campaign to promote the Tobacco Free Campus policy, says that stress is one of the reasons people give for not being able to quit smoking.

“Obviously, President Obama has a very stressful job,” she says. “But University of Arkansas students facing mid-term exams know something about stress, too. There are ways to deal with stress and quit smoking, too.”

Her advice for the president, and anyone with the same problem, and same goal, is a five-step plan.

1. Deal with your stress first! Stress by itself is bad for your health. Examine your day and identify the sources of your stress. Research stress reduction strategies and find ones that will work for you. Make physical activity that you enjoy a part of each day.

2. Ask yourself why you want to quit smoking. The key to success is personal choice: It has to be for you. Envision yourself as a non-smoker. Think of quitting as a gift you give yourself, not something that you are taking away.

3. Set a date for quitting.

4. Prepare for that quit date by cutting down and each time you smoke ask yourself how much you “needed” that cigarette. Freshen your surroundings: clean your home, car, clothes even your teeth. The spring season is a prime time for this.

5. On your quit date, plan to be somewhere smoking is not allowed, and reward yourself each day you don’t smoke.

Rausch says it’s also important to remember that relapse is not failure.

“Most smokers try several times before they achieve freedom. Each attempt teaches you something about the type of smoker that you are and the role of tobacco in your life. The better you understand yourself, the more likely you will succeed. The important thing is to keep trying. That’s true for a student, a professor, a staff worker or even the president of the United States.”

Two experts on bmj.com today say that further research is needed before consumers can be reassured that electronic cigarettes (also known as e-cigarettes) are safe.

“Our knowledge on the acute and long term effects of e-cigarette use is, at best, very limited”, say Andreas Flouris and Dimitris Oikonomou, from the Institute of Human Performance and Rehabilitation in Greece.

Interest in alternative smoking products is augmenting since anti-smoking policies are becoming more widespread. Electronic cigarettes or e-cigarettes are one of the most newly introduced products on the market. These are battery operated devices that allow users to inhale a nicotine vapor. They are meant to substitute normal cigarettes and help smokers quit.

There are a number of doubts regarding the safety of e-cigarettes. The US Food and Drug Administration (FDA) had expressed serious concerns. Three reports have been undertaken on the product: one by the FDA, one by a private body called Health New Zealand (HNZ) and another by Demokritos, a publicly-funded Greek research institute.

The authors remark that the interpretations of the three reports diverge significantly. The FDA detected a number of toxins in e-cigarettes and “carefully raises caution on potential harmful effects of e-cigarettes.”On the other hand, HNZ recommends e-cigarettes as they are safer than normal tobacco products. DRI takes a neutral position.

In conclusion, the authors note that while “alternative smoking strategies are always welcome in an effort to reduce the threat to public health caused by the tobacco epidemic”, further research is necessary in order to inform consumers about the safety of these e-cigarettes.

Want to quit smoking for good? You may be more successful if you enlist a loved one to quit smoking with you.

Recent research published in the New England Journal of Medicine found that people are more likely to successfully kick the habit when people in their social network, such as friends, co-workers, siblings, and spouses, do the same.

For example, when a husband or wife quit smoking, their spouses were 67% less likely to smoke. People with a friend who quit smoking were 36% less likely to smoke themselves. In smaller companies, employees are 34% less likely to smoke when a co-worker quits. Those with a brother or sister who quit were 25% less likely to smoke.

“This research shows how people influence one another’s smoking behaviour,” says Cameron Bishop of The Canadian Lung Association. “When one person quits smoking, it can have a powerful ripple effect on their friends, family members and co-workers.”

For Gail Francis, of Fredericton, New Brunswick, the decision to quit smoking with a loved one was pivotal to her success. “Quitting together is very powerful. If it weren’t for my partner Louise, I would have smoked one thousand times. That’s because when you give someone your word, you’d better stick to it,” says Gail, who quit with Louise Steeves on Nov. 11, 2008.

“Having Gail quit with me made a huge difference. If I was tempted to smoke, she talked me down and would remind me of how far I have come,” adds Louise, who turned to exercise, instead of cigarettes.

Now 125 pounds lighter and training for her first half-marathon, Louise has noticed a marked improvement in her asthma since she quit. “At my most recent appointment with the asthma clinic, I had the best breathing test results in my life! My asthma is also so much better controlled.”

Christie Kane and Dan Perley of Sooke, British Columbia, made the decision to stop smoking together. Now they want to inspire other members of their community to quit smoking. “If we can quit, anybody can!”

Tania Hubler quit smoking with her sister-in-law Jill Hubler on August 4, 2008. “Quitting smoking was the beginning of a transformation in my life,” says Tania. “In fact, I inspired four other women in my office to quit. One of them told me that I was one of the heaviest smokers she knew. So when she heard that I quit, she decided she would, too.

“When you’re able to show others that quitting is do-able, it definitely helps you, too. Knowing that my quitting has helped inspire others to stop smoking has strengthened my resolve to stay quit. You really don’t want to let the others (who have quit) down.”

Before patting yourself on the back for resisting that cookie or kicking yourself for giving in to temptation, look around. A new University of Georgia study has revealed that self-control – or the lack thereof – is contagious.

In a just-published series of studies involving hundreds of volunteers, researchers have found that watching or even thinking about someone with good self-control makes others more likely exert self-control. The researchers found that the opposite holds, too, so that people with bad self-control influence others negatively. The effect is so powerful, in fact, that seeing the name of someone with good or bad self-control flashing on a screen for just 10 milliseconds changed the behavior of volunteers.

“The take home message of this study is that picking social influences that are positive can improve your self-control,” said lead author Michelle vanDellen, a visiting assistant professor in the UGA department of psychology. “And by exhibiting self-control, you’re helping others around you do the same.”

People tend to mimic the behavior of those around them, and characteristics such as smoking, drug use and obesity tend to spread through social networks. But vanDellen’s study is thought to be the first to show that self-control is contagious across behaviors. That means that thinking about someone who exercises self-control by regularly exercising, for example, can make your more likely to stick with your financial goals, career goals or anything else that takes self-control on your part.

VanDellen’s findings, which are published in the early online edition of the journal Personality and Social Psychology Bulletin, are the result of five separate studies conducted over two years with study co-author Rick Hoyle at Duke University.

In the first study, the researchers randomly assigned 36 volunteers to think about a friend with either good or bad self-control. Those that thought about a friend with good self-control persisted longer on a handgrip task commonly used to measure self-control, while the opposite held true for those who were asked to think about a friend with bad self-control.

In the second study, 71 volunteers watched others exert self-control by choosing a carrot from a plate in front of them instead of a cookie from a nearby plate, while others watched people eat the cookies instead of the carrots. The volunteers had no interaction with the tasters other than watching them, yet their performance was altered on a later test of self-control depending on who they were randomly assigned to watch.

In the third study, 42 volunteers were randomly assigned to list friends with both good and bad self-control. As they were completing a computerized test designed to measure self-control, the computer screen would flash the names for 10 milliseconds – too fast to be read but enough to subliminally bring the names to mind. Those who were primed with the name of a friend with good self-control did better, while those primed with friends with bad self-control did worse.

In a fourth study, vanDellen randomly assigned 112 volunteers to write about a friend with good self-control, bad self-control or – for a control group – a friend who is moderately extroverted. On a later test of self-control, those who wrote about friends with good self-control did the best, while those who wrote about friends with bad self-control did the worst. The control group, those who wrote about a moderately extroverted friend, scored between the other two groups.

In the fifth study of 117 volunteers, the researchers found that those who were randomly assigned to write about friends with good self-control were faster than the other groups at identifying words related to self-control, such as achieve, discipline and effort. VanDellen said this finding suggests that self-control is contagious because being exposed to people with either good or bad self-control influences how accessible thoughts about self-control are.

VanDellen said the magnitude of the influence might be significant enough to be the difference between eating an extra cookie at a party or not, or deciding to go to the gym despite a long day at work. The effect isn’t so strong that it absolves people of accountability for their actions, she explained, but it is a nudge toward or away from temptation.

“This isn’t an excuse for blaming other people for our failures,” vanDellen said. “Yes, I’m getting nudged, but it’s not like my friend is taking the cookie and feeding it to me; the decision is ultimately mine.”

Drinking green tea could modulate the effect of smoking on lung cancer. Results of this hospital-based, randomized study conducted in Taiwan were presented at the AACR-IASLC Joint Conference on Molecular Origins of Lung Cancer, held here from Jan. 11-14, 2010.

“Lung cancer is the leading cause of all cancer deaths in Taiwan,” said I-Hsin Lin, M.S., a student at Chung Shan Medical University in Taiwan. “Tea, particularly green tea, has received a great deal of attention because tea polyphenols are strong antioxidants, and tea preparations have shown inhibitory activity against tumorigenesis.”

However, previous studies of green tea have been inhibited by the flaws of the epidemiologic model with its inherent biases.

Lin and colleagues enrolled 170 patients with lung cancer and 340 healthy patients as controls. The researchers administered questionnaires to obtain demographic characteristics, cigarette smoking habits, green tea consumption, dietary intake of fruits and vegetables, cooking practices and family history of lung cancer. They also performed genotyping on insulin-like growth factors as polymorphisms on the following insulin-like growth factors: IGF1, IGF2 and IGFBP3, which have all been reported to be associated with cancer risk.

Among smokers and non-smokers, those who did not drink green tea had a 5.16-fold increased risk of lung cancer compared with those who drank at least one cup of green tea per day. Among smokers, those who did not drink green tea at all had a 12.71-fold increased risk of lung cancer compared with those who drank at least one cup of green tea per day.

Lin and colleagues suspect genetics may play a role in this risk differential. Green tea drinkers with non-susceptible IGF1 (CA)19/(CA)19 and (CA)19/X genotypes reported a 66 percent reduction in lung cancer risk as compared with green tea drinkers carrying the IGF1 X/X genotype.

Heavy smokers carrying susceptible IGF1, IGF2 and IGFBP3 genotypes also had a higher risk of lung cancer compared with nonsmokers carrying non-susceptible IGF1, IGF2 and IGFBP3 genotypes.

“Our study may represent a clue that in the case of lung cancer, smoking-induced carcinogenesis could be modulated by green tea consumption and the growth factor environment,” said Lin.

Smokers who received gain-framed messaging from quitline specialists (i.e., stressing the benefits of quitting) had slightly better cessation outcomes than those who received standard-care messaging (i.e., potential losses from smoking and benefits of quitting), according to a new study published online January 7 in the Journal of the National Cancer Institute. Researchers also established that quitline specialists can be trained to provide gain-framed messaging with good fidelity.

Benjamin A. Toll, Ph.D., of the Department of Psychiatry, Yale University School of Medicine in New Haven, Conn., and colleagues randomly assigned 28 specialists working at the New York State Smokers’ Quitline to two groups: one group delivered standard-care messaging and one was trained to deliver gain-framed messages. The researchers assessed whether specialists could be trained to consistently deliver gain-framed messages to smokers and evaluated the cessation outcomes of clients exposed to both kinds of messages. A total of 813 people were exposed to gain-framed messaging and 1,222 were exposed to standard messaging. Phone calls took place between March 2008 and June 2008.

Smokers who received gain-framed messaging reported statistically significantly more quit attempts and a higher rate of abstinence from smoking at the 2-week follow-up interview (99 of the 424 in gain-framed group vs. 76 of the 603 in the standard-care group). However, at 3 months there was no difference between the groups. Researchers also found that quitlines can train staff to deliver gain-framed messages in a consistent fashion.

“The fidelity outcomes from this study should encourage quitlines to test novel counseling strategies for their ability to increase smoking cessation rates and, thus, prevent cancer,” the authors write. “Furthermore, gain-framed statements appear to be somewhat beneficial in enhancing short-term smoking cessation and other secondary outcomes, such as quit attempts and positive health expectancies.”

In an accompanying editorial, Robert T. Croyle, Ph.D., of the Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Md., calls the study timely, given the urgent need for more effective quitline strategies as generations shift.

“Quitline program directors need more specific evidence concerning the types of counseling strategies that are most effective and how to maximize the use of pharmacotherapies,” the editorialist writes. “As new communication technologies are incorporated into quitline services, it will become increasingly important to identify the relative contributions of intervention components through efficacy and effectiveness studies that include cost-effectiveness analyses.”

Study limitations: Characteristics of callers who enrolled and of those who declined were different. Gain-framed interventions were longer than standard-care interventions. Follow-up rates were low. Dichotomous primary smoking outcomes (yes or no) were used. There were different levels of supervision between the counseling groups. No adjustment was made for multiple comparisons.

New research suggests that quitting smoking may raise the risk of developing type 2 diabetes in the short term, and as ex-smokers log more years without touching cigarettes, that risk gradually comes down to that of a never-smoker; the researchers suspect weight gain is the main reason and warn quitters to watch their weight.

These are the findings of a study by researchers from the Johns Hopkins University School of Medicine in Baltimore, Maryland, the University of North Carolina at Chapel Hill, both in the US, and the Federal University of Rio Grande do Sul in Porto Alegre, Brazil.

Cigarette smoking is already a well-established risk factor for type 2 diabetes, but when smokers quit, they typically put on extra pounds.

Lead author, Dr Hsin-Chieh “Jessica” an assistant professor of general internal medicine and epidemiology at Johns Hopkins, told the media that they suspect weight gain by quitters is the main reason why the diabetes risk goes up in the short term.

She and her colleagues stress that these findings should not be used as an excuse to keep smoking, which is also a risk factor for lung disease, heart disease, strokes, and several types of cancer.

“The message is: Don’t even start to smoke,” she said.

“If you smoke, give it up. That’s the right thing to do. But people have to also watch their weight,” she added.

For the study, the researchers enrolled 10,892 adults of middle age who had not been diagnosed with diabetes from 1987 to 1989. They followed them for 17 years and regularly collected data on diabetes status, glucose levels, weight, and other measures.

The measures were taken in different ways: smoking status was assessed by interview at the start of the study, and during follow up. Incident diabetes was assessed from fasting glucose tests up to 1998, self-report of diagnosis by a doctor, or use of diabetes medication up to 2004.

The results showed that:

* Over 9 years of follow up, 1,254 of the subjects developed type 2 diabetes.

* Compared to adults who never smoked, the heaviest smokers (the top third measured by pack-years) had an estimated 42 per cent higher risk of developing diabetes (adjusted hazard ratio 1.42, with 95 per cent confidence interval, CI, ranging from 1.20 to 1.67).

* In the first 3 years of follow up, 380 of the subjects quit smoking.

* On average, over those first three years, quitters gained about 8.4 pounds (3.8 kilos) and their waist circumferences grew by approximately 1.25 inches (3.2 cm).

* After adjusting for several confounders, including age, race, sex, education, adiposity, physical activity, blood fat levels (lipids), blood pressure, and data collection source, compared with never smokers, the estimated relative risk of developing diabetes varied among former smokers (HR 1.22, CI 0.99-1.50), new quitters (1.73, 1.19-2.53) and continuing smokers (1.31, 1.04-1.65).

* These risks changed substantially when the researchers took into account weight change and leukocyte count.

* In an analysis of what the long term risk might be after quitting, the highest risk occured in the first 3 years (HR 1.91, CI 1.19 – 3.05), then gradually went down to zero at 12 years.

The researchers concluded that:

“Cigarette smoking predicts incident type 2 diabetes, but smoking cessation leads to higher short-term risk.”

“For smokers at risk for diabetes, smoking cessation should be coupled with strategies for diabetes prevention and early detection,” they added.

Type 2, or adult onset, diabetes is a common disease that screws up the way our bodies use sugar and control insulin, a pancreas-produced chemical that normally lowers blood sugar after eating.

In people with type 2 diabetes the pancreas makes plenty of insulin but the body can’t use it properly, leaving too much sugar in the blood, which in the long run can result in blindness, heart disease, kidney failure and nerve damage.

People who are overweight, and who have a family history of the disease are at higher risk of developing type 2 diabetes, and smokers are also at higher risk, but exactly how smoking leads to diabetes is not clear.

In this study, the researchers found that the heaviest smokers, and the quitters who put on the most weight, had the highest risk of developing diabetes.

They suggest doctors and healthcare practitioners helping smokers to quit should bear these findings in mind, especially where the heaviest smokers are concerned. They urge them to consider offering more lifestyle counselling, aggressive weight management, and nicotine replacement therapy to support quitters, and to do more blood glucose screening to ensure early detection of any signs of developing diabetes.

As the US population becomes increasingly obese while smoking rates continue to decline, obesity has become an equal, if not greater, contributor to the burden of disease and shortening of healthy life in comparison to smoking. In an article published in the February 2010 issue of the American Journal of Preventive Medicine, researchers from Columbia University and The City College of New York calculate that the Quality-Adjusted Life Years (QALYs) lost due to obesity is now equal to, if not greater than, those lost due to smoking, both modifiable risk factors.

QALYs use preference-based measurements of Health-Related Quality of Life (HRQOL) which allow a person to state a relative preference for a given health outcome. Since one person may value a particular outcome differently than another person, these measures capture how each respondent views his or her own quality of life.

The 1993 – 2008 Behavioral Risk Factor Surveillance System (BRFSS), the largest ongoing state-based health survey of US adults, has conducted interviews of more than 3,500,000 individuals; annual interviews started with 102,263 in 1993 and culminated with 406,749 in 2008. This survey includes a set of questions that measures HRQOL, asking about recent poor health days and tracking overall physical and mental health of the population. The authors analyzed these data and converted the measures to QALYs lost due to smoking and obesity.

From 1993 to 2008, when the proportion of smokers among US adults declined 18.5%, smoking-related QALYs lost were relatively stable at 0.0438 QALYs lost per population. During the same period, the proportion of obese people increased 85% and this resulted in 0.0464 QALYs lost. Smoking had a bigger impact on deaths while obesity had a bigger impact on illness.

Investigators Haomiao Jia, PhD and Erica I. Lubetkin, MD, MPH, state, “Although life expectancy and QALE have increased over time, the increase in the contribution of mortality to QALYs lost from obesity may result in a decline in future life expectancy. Such data are essential in setting targets for reducing modifiable health risks and eliminating health disparities.”

US researchers found that even after the age of 80, smoking increased a person’s risk of developing AMD, age-related macular degeneration, the leading cause of blindness among Americans aged 65 and over, suggesting it is never too late to give up the habit.

The study was the work of lead author Dr Anne Coleman, professor of ophthalmology at the Jules Stein Eye Institute at University of California, Los Angeles (UCLA), and colleagues, and is published in the January issue of the American Journal of Ophthalmology.

AMD causes a darkening and/or blurring of central vision, and prevents you from being able to read, drive and recognize people you know. It is a progressive degeneration of the macula, the centre of the retina, the part of the membrane inside the back of the eye that allows us to see fine details.

Advanced AMD with loss of vision affects about 1.75 million Americans: this figure is expected to rise to just under 3 million by 2020.

Smoking is the second most common risk factor for AMD: age is the first. Coleman and colleagues wanted to find out whether age was linked to the effect of smoking on AMD risk.

Coleman told the press that age was the strongest predictor for AMD, yet most of the research done on the disease only looked at people aged 75 and under.

“Our population was considerably older than those previously studied,” said Coleman.

“This research provides the first accurate snapshot of how smoking affects AMD risk later in life,” she added.

For the study, Coleman and her team compared the retinal photographs of nearly 2,000 women taken at age 78 and 83, looked for signs of AMD and then did logistical regression statistical tests to find out whether smoking affected the women’s risk of developing the disease.

The women were already taking part in a study called the Study of Osteoporotic Fractures, where 45 degree stereoscopic fundus retinal photographs were part of the observations taken at clinic follow ups in year 10 and 15 of the study.

They found that:

* Overall, the smokers had 11 per cent higher rates of AMD than the non-smokers of the same age.

* But among the over 80s, the smokers were 5.5 times more likely to develop AMD than the non-smokers.

The authors concluded that:

“The magnitude of the greater-than-additive effect of smoking on the age-adjusted risk of AMD reinforces recommendations to quit smoking even for older individuals.”

“The take-home message is that it’s never too late to quit smoking,” said Coleman.

“We found that even older people’s eyes will benefit from kicking the habit,” she added.

Speculating on the underlying biological reasons for this link, the authors said there is a theory that smoking increases AMD risk by reducing levels of antioxidants in the blood, changing the blood flow to the eyes and reducing the amount of pigmentation in the retina.

Dr Paul Sieving, director of the National Eye Institute, which funded the research with the National Institute on Aging, said this study gives:

“Yet another compelling reason to stop smoking and suggests that it is never too late to quit.”