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Smoking prevalence is higher amongst individuals with schizophrenia and depression compared with the general population. Mendelian randomisation (MR) can examine whether this association is causal using genetic variants identified in genome-wide association studies (GWAS).
We conducted two-sample MR to explore the bi-directional effects of smoking on schizophrenia and depression. For smoking behaviour, we used (1) smoking initiation GWAS from the GSCAN consortium and (2) we conducted our own GWAS of lifetime smoking behaviour (which captures smoking duration, heaviness and cessation) in a sample of 462690 individuals from the UK Biobank. We validated this instrument using positive control outcomes (e.g. lung cancer). For schizophrenia and depression we used GWAS from the PGC consortium.
There was strong evidence to suggest smoking is a risk factor for both schizophrenia (odds ratio (OR) 2.27, 95% confidence interval (CI) 1.67–3.08, p < 0.001) and depression (OR 1.99, 95% CI 1.71–2.32, p < 0.001). Results were consistent across both lifetime smoking and smoking initiation. We found some evidence that genetic liability to depression increases smoking (β = 0.091, 95% CI 0.027–0.155, p = 0.005) but evidence was mixed for schizophrenia (β = 0.022, 95% CI 0.005–0.038, p = 0.009) with very weak evidence for an effect on smoking initiation.
These findings suggest that the association between smoking, schizophrenia and depression is due, at least in part, to a causal effect of smoking, providing further evidence for the detrimental consequences of smoking on mental health.
Psychoactive substance use is lower among married compared to divorced or unmarried men; yet, the nature of this effect remains unclear because becoming and staying married is potentially confounded with substance-related background familial and individual factors, like parental divorce and personality. The authors investigated the associations between marital status and substance use; how substance use changed across the transition to marriage; and whether marriage effects were likely to be causal.
The sample included 1790 adults from male–male twin pairs from a population-based registry. Measures of marital status and alcohol, tobacco, and cannabis use came from Life History Calendars. Data were analyzed using regression, co-twin comparison, and within-person models. The latter models are tools for quasi-causal inference that control for familial and individual-level confounders.
Married men used less alcohol, tobacco, and cannabis than men who were divorced/separated or single. In analyses of substance use across the transition to marriage, men reduced their alcohol and cannabis use both before and after marriage, but their tobacco use only after marriage. These effects were largely robust in co-twin and within-person analyses.
Marriage was associated with substantial reductions in substance use compared to being divorced/separated or single, and these reductions began prior to marriage. The co-twin comparison and within-person models ruled out the alternative explanation that marriage effects were due to confounding background familial and individual factors. These results provide strong evidence that the social role expectations associated with marriage reduce psychoactive substance use.
Nicotine replacement therapy sampling (NRTS) refers to providing all smokers, regardless of interest in quitting, with free samples of over-the-counter NRT. NRTS has been shown to increase quit attempts and abstinence.
We conducted a pilot trial with a goal to establish the feasibility and acceptability of NRTS in a dental clinic, where providing free samples is routine and universal.
Participants (N = 30) completed a baseline survey and were randomized to receive or not receive a 2-week supply of NRT samples (14 mg patches and 4 mg lozenges) in a 3:1 ratio.
We enrolled 30 of 50 potentially eligible patients, of whom 26 completed a 4-week follow-up survey. At follow-up, 61% of the NRT group reported use of the samples and 26% said they used more NRT obtained on their own. In the No NRT group, only one patient reported using NRT. No patients reported past week abstinence, but 43% of the NRT group vs. 29% of the No NRT group reported making a quit attempt lasting longer than 24 h.
The pattern of results suggests that conducting a larger trial would be feasible and that the NRTS intervention was acceptable to dental patients.
This chapter covers his business during the first period of his entrepreneurial activity, from 1924 to 1946, when he set up his trading and tramp shipping company. During these first 22 years, he was unknown to the public. The aim is to investigate Onassis’s activities in America as well as in Europe and to reveal the significance of the beginnings of his business. During this period Onassis advanced his career within the Greek maritime tradition established by the Vaglianos, but also led the way to break this tradition, re-invent it, and advance it further. He created the foundations of his Empire, with Buenos Aires as the basis of his entrepreneurial activities. In the 1920s based on his family business know-how and network he collaborated with his father and uncle in Greece, and with his first cousins in Argentina, to found a sound business of tobacco imports. In the 1930s, Onassis devoted himself into learning about Greek and Norwegian shipping methods and techniques and was able to expand and re-invent them. By 1940, he had made the choices that marked his path to global shipping: specialization in tanker shipping, offshore companies and flags of convenience
Current adolescent substance use risk models have inadequately predicted use for African Americans, offering limited knowledge about differential predictability as a function of developmental period. Among a sample of 500 African American youth (ages 11–21), four risk indices (i.e., social risk, attitudinal risk, intrapersonal risk, and racial discrimination risk) were examined in the prediction of alcohol, marijuana, and cigarette initiation during early (ages 11–13), mid (ages 16–18), and late (ages 19–21) adolescence. Results showed that when developmental periods were combined, racial discrimination was the only index that predicted initiation for all three substances. However, when risk models were stratified based on developmental period, variation was found within and across substance types. Results highlight the importance of racial discrimination in understanding substance use initiation among African American youth and the need for tailored interventions based on developmental stage.
The effects of psychoactive substance abuse are not limited to the user, but extend to the entire family system, with children of substance abusers being particularly at risk. This meta-analysis attempted to quantify the longitudinal relationship between parental alcohol, tobacco, and drug use and child well-being, investigating variation across a range of substance and well-being indices and other potential moderators. We performed a literature search of peer-reviewed, English language, longitudinal observational studies that reported outcomes for children aged 0 to 18 years. In total, 56 studies, yielding 220 dependent effect sizes, met inclusion criteria. A multilevel random-effects model revealed a statistically significant, small detriment to child well-being for parental substance abuse over time (r = .15). Moderator analyses demonstrated that the effect was more pronounced for parental drug use (r = .25), compared with alcohol use (r = .13), tobacco use (r = .13), and alcohol use disorder (r = .14). Results highlight a need for future studies that better capture the effect of parental psychoactive substance abuse on the full breadth of childhood well-being outcomes and to integrate substance abuse into models that specify the precise conditions under which parental behavior determines child well-being.
While snus has been the focus of increasing public health interest, twin studies have examined neither sources of individual variation for its use nor the sources of resemblance between snus and cigarette use. Twins from the Norwegian Institute of Public Health Panel were assessed by self-report questionnaire for the initiation of regular use and maximal quantity used for snus and cigarettes. Twin modeling was performed using OpenMx on data from 2767 twins including 856 complete pairs. Fitting univariate twin models produced similar results for cigarette initiation and quantity with estimates of additive genetic, shared environmental and unique environmental effects of approximately 77%, 0% and 23%, respectively. Estimates of snus initiation and quantity were, respectively, approximately 53%, 26% and 21%. Joint analyses suggested that the genetic, shared environmental and unique environmental correlations between cigarette and snus initiation and quantity were +.82, 0 and +.42, respectively. However, these results could not be statistically distinguished from a model which postulated that resemblance between cigarette initiation and quantity resulted from genetic and unique environmental correlations of +.47 and +.43. Compared with cigarette initiation and quantity of use in Norwegian twins, the role of genes was less prominent and shared environment more prominent for initiation and quantity of use of snus. Joint analyses of both tobacco phenotypes suggested, but did not confirm definitively, that genetic risk factors for cigarette and snus use were similar but not identical, while shared environmental factors existed that were specific to snus use.
Weed management in tobacco (Nicotiana tabacum L.) is accomplished primarily with soil-residual herbicides, cultivation, and hand removal. Management practices that reduce weed emergence, like reduced tillage and cover crop mulches, may improve weed management efficacy. Depending on cover-cropping goals, growers face trade-offs in species selection and management priorities—producing weed-suppressive mulches may lead to transplanting difficulties and soil-residual herbicide interception. Managing more complex cover crop mixtures may result in different challenges. We established on-farm trials across 4 site-years to study impacts of cover crop composition [wheat (Triticum aestivum L.) monoculture or mixture], termination treatment (early or late chemical termination or removing aboveground biomass), and soil-residual herbicides on weed density and biomass. The cover crop mixture contained cereal rye (Secale cereale L.), crimson clover (Trifolium incarnatum L.), and hairy vetch (Vicia villosa Roth.), with canola (Brassica napus L.) at 1 site-year. The mixture typically produced more biomass than monoculture wheat, although composition had few impacts on weed density or biomass. With residual herbicides, termination treatment had few impacts on weed density, suggesting that residues did not adversely affect herbicide efficacy. Without residual herbicides, early-season weed density was often higher following the late-terminated cover crop compared with other termination treatments, though midseason weed density was typically lower. When termination treatment affected final weed biomass, it was lower following late termination, with one exception—crop establishment was reduced at 1 site-year, leading to reduced weed–crop competition and greater weed biomass. Our results suggest that growers can use mixtures and, if well-timed to a rainfall event for incorporation, still effectively use soil-residual herbicides to maintain adequate weed control in tobacco regardless of how the cover crop is managed. Later termination, resulting in more residue, may lead to less weed biomass accumulation in the absence of herbicide use.
To study the cluster of differentiation 8 population in the laryngeal mucosa of patients with laryngeal carcinoma. To our knowledge this is the first paper to address this issue.
The study group included 40 patients with known laryngeal cancer who were scheduled for laryngectomy. The control groups included 10 smokers and 10 non-smokers who were scheduled for microlaryngeal surgery. Specimens from the three groups were processed for histopathological and histochemical evaluation.
In patients without cancer of the larynx, the number of cluster of differentiation 8 lymphocytes was greater in smokers than non-smokers. The number of cluster of differentiation 8 lymphocytes was greatest in smokers with laryngeal cancer, and the difference between this group and the two control groups was statistically significant.
The study showed that smoking increased the number of cluster of differentiation 8 T-lymphocytes in the laryngeal mucosa. The increase was greatest in patients who had developed laryngeal cancer.
In this study, we sought to evaluate the influence of cigarette smoke and pH cycling on the chemical composition and surface/cross-sectional enamel microhardness. A total of 40 dental blocks obtained from bovine incisors were divided into four groups (n=10): no treatment (control); exposure to cigarette smoke (CS); exposure to pH cycling (PC); and exposure to cigarette smoke and pH cycling (CS-PC). The samples were analyzed by synchrotron radiation micro X-ray fluorescence, bench mode X-ray fluorescence, as well as surface microhardness (SMH) and cross-sectional microhardness (CSMH) testing. The SMH results were submitted to analysis of variance (ANOVA) and Tukey’s test. The CSMH results were evaluated using split-plot ANOVA and Tukey’s test. A high amount of Cd and Pb and traces of Ni and As were observed in enamel and dentin after exposure to cigarette smoke (CS and CS-PC). The SMH and CSMH of CS were statistically higher when compared with the control. The PC and CS-PC showed lower SMH and CSMH. We conclude that exposure to cigarette smoke promoted heavy metal deposition in enamel/dentin. In addition, it increased the enamel microhardness but did not promote a protective effect on the in vitro development of caries. The clinical significance of this work is that there is significant bioaccumulation of heavy metals from cigarette smoke on the surface and in the enamel and dentin.
To compare nasal mucociliary clearance in adult non-smokers, cigarette smokers and bidi smokers using the methylene blue dye test.
The study sample consisted of 20 non-smokers, 20 cigarette smokers and 20 bidi smokers (age range, 20–40 years). A single drop of the methylene blue dye was placed at the anterior end of the inferior turbinate of the participants’ nasal cavity. The distance travelled by the methylene blue in 15 minutes inside the nasal cavity was measured. Nasal mucociliary clearance of the three groups was compared using the Kruskal Wallis test.
Nasal mucociliary clearance was significantly decreased in bidi smokers as compared to cigarette smokers and non-smokers (p < 0.05). Multivariate analysis revealed a significant association between nasal mucociliary clearance and bidi smoking, number of cigarettes or bidis smoked per day, and pack-years (all p < 0.05).
Nasal mucociliary clearance measurement is a simple and useful index for assessing the effect of smoking on the mucociliary activity of nasal mucosa.
Smoking is purported to increase the risk of peritonsillar abscess formation, but prospective data are needed to confirm this hypothesis. This prospective study aimed to identify this correlation.
Fifty-four patients with peritonsillar abscess were prospectively asked about their smoking behaviour using a questionnaire that was designed and approved by the Robert Koch Institute (Berlin, Germany) to analyse smoking behaviour in epidemiological studies. Afterwards, a consecutive control group (without peritonsillar abscess), matched in terms of age and gender, was surveyed using the same questionnaire. A classification of smoker, former smoker and non-smoker was made, and the numbers of pack-years were calculated and compared.
Statistical analysis of both groups revealed a significant correlation between peritonsillar abscess and smoking experience (p = 0.025). Moreover, there were significantly fewer non-smokers in the non-peritonsillar abscess group (p = 0.04). The number of pack-years was higher in the peritonsillar abscess group (p = 0.037).
There is a statistically significant association between peritonsillar abscess and smoking.
In January 2006, the Spanish government enacted a tobacco control law that banned smoking in bars and restaurants, with exceptions depending on the floor space of the premises. In January 2011, further legislation in this area was adopted, removing these exceptions. We analyse the effect produced on cigarette sales by these two bans. We approach this problem using an interrupted time series analysis while accounting for the potential effects of autocorrelation and seasonality. The data source used was the official data on legal sales of tobacco in Spain, from January 2000 to December 2015 (excluding the Canary Islands and the autonomous cities of Ceuta and Melilla). As confounder variables, we use the log-transformed average prices for manufactured and hand-rolled cigarettes (or the average minimum excise tax as a proxy), and log-transformed real-household disposable income. The implementation of a total smoke-free ban in Spain was associated with an immediate reduction in cigarette sales between 9% to 11%. In contrast, in the period immediately following the partial ban, no such reduction was detected, beyond the trend already present. Our results indicate that, in Spain, partial bans on smoking in public places failed, and that only a total tobacco ban worked.
Smoking is the largest single contributor to poor physical health and increased mortality in people with serious mental illnesses. The aim of the study was to investigate the utility of electronic cigarettes (e-cigarettes) as a harm reduction intervention in this population.
Fifty tobacco smokers with a psychotic disorder were enrolled onto a 24-week pilot study (ClinicalTrials.gov: NCT02212041) investigating the efficacy of a 6-week free e-cigarette intervention to reduce smoking. Cigarette and e-cigarette use was self-reported at weekly visits, and verified using carbon monoxide tests. Psychopathology, e-cigarette acceptability and adverse effects were assessed using standardised scales.
There was a significant (⩾50%) reduction in cigarettes consumed per day between baseline and week 6 [F(2.596,116.800) = 25.878, p < 0.001], and e-cigarette use was stable during this period [F(2.932,46.504) = 2.023, p = 0.115]. These changes were verified by significant carbon monoxide reductions between these time points [F(3.335,126.633) = 5.063, p = 0.002].
The provision of e-cigarettes is a potentially useful harm reduction intervention in smokers with a psychotic disorder.
Cannabis and tobacco have contrasting cognitive effects. Smoking cannabis with tobacco is prevalent in many countries and although this may well influence cognitive and mental health outcomes, the possibility has rarely been investigated in human experimental psychopharmacological research.
The individual and interactive effects of cannabis and tobacco were evaluated in 24 non-dependent cannabis and tobacco smokers in a randomized, placebo-controlled, double-blind, 2 (cannabis, placebo) × 2 (tobacco, placebo) crossover design. Verbal memory (prose recall), working memory (WM) performance including maintenance, manipulation and attention (N-back), psychotomimetic, subjective and cardiovascular measures were recorded on each of four sessions.
Cannabis alone impaired verbal memory. A priori contrasts indicated that tobacco offset the effects of cannabis on delayed recall. However, this was not supported by linear mixed model analysis. Cannabis load-dependently impaired WM. By contrast, tobacco improved WM across all load levels. The acute psychotomimetic effects and ratings of ‘stoned’ and ‘dizzy’ induced by cannabis were not altered by tobacco. Cannabis and tobacco had independent effects on increasing heart rate and interacting effects on increasing diastolic blood pressure.
Relative to placebo, acute cannabis impaired verbal memory and WM. Tobacco enhanced performance on WM, independently of cannabis. Moreover, we found some preliminary evidence that tobacco may offset the effects of cannabis on delayed, but not immediate, verbal recall. In contrast, the psychotomimetic and subjective effects of cannabis were unaffected by tobacco co-administration. By reducing the cognitive impairment from cannabis, tobacco co-administration may perpetuate use despite adverse health consequences.
The relationship between smoking and suicide remains controversial.
A total of 16 282 twin pairs born before 1958 in Finland and alive in 1974 were queried with detailed health and smoking questionnaires in 1975 and 1981, with response rates of 89% and 84%. Smoking status and dose, marital, employment, and socio-economic status, and indicators of psychiatric and somatic illness were assessed at both time points. Emergent psychiatric and medical illness and vital status, including suicide determined by forensic autopsy, were evaluated over 35-year follow-up through government registries. The association between smoking and suicide was determined in competing risks hazard models. In twin pairs discordant for smoking and suicide, the prospective association between smoking and suicide was determined using a matched case–control design.
Smokers had a higher cumulative suicide incidence than former or never smokers. Heavy smokers had significantly higher suicide risk [hazard ratio (HR) 3.47, 95% confidence interval (CI) 2.31–5.22] than light smokers (HR 2.30, 95% CI 1.61–3.23) (p = 0.017). Compared with never smokers, smokers, but not former smokers, had increased suicide risk (HR 2.56, 95% CI 1.43–4.59), adjusting for depressive symptoms, alcohol and sedative–hypnotic use, and excluding those who developed serious somatic or psychiatric illness. In twin pairs discordant for smoking and suicide, suicide was more likely in smokers [odds ratio (OR) 6.0, 95% CI 2.06–23.8].
Adults who smoked tobacco were more likely to die by suicide, with a large, dose-dependent effect. This effect remained after consideration of many known predictors of suicide and shared familial effects, consistent with the hypothesis that exposure to tobacco smoke increases the risk of suicide.
This article updates and expands the literature on the impact of production quotas. Unlike many of the early studies, our focus is largely on the removal of production quota programs. We study cases wherein production quota programs have been eliminated and quota owners were compensated for their losses. Specifically, we examine (1) production quotas in both the absence and presence of trade, (2) production quota buyouts (three case studies), (3) sources of funding, and (4) general equilibrium considerations. A fifth section briefly discusses externalities, the interpretation of consumer surplus measures, and the nature of conducting economic analyses of addictive goods.
To measure the prevalence of self-reported morbidity and its associated factors among adults (aged ⩾15 years) in a select rural Indian population.
Self-reporting of smoking has been validated as population-based surveys using self-reported data provide reasonably consistent estimates of smoking prevalence, and are generally considered to be sufficiently accurate for tracking the general pattern of morbidity associated with tobacco use in populations. However, to gauge the true disease burden using self-reported morbidity data requires cautious interpretation.
During 2010–2011, a cross-sectional survey was conducted under the banner of the Health and Demographic Surveillance System, Birbhum, an initiative of the Department of Health and Family Welfare, Government of West Bengal, India. With over 93.6% response rate from the population living in 12 300 households, this study uses the responses from 16 354 individuals: 8012 smokers, and 8333 smokeless tobacco users. Smokers and smokeless tobacco users were asked whether they have developed any morbidity symptoms due to smoking, or smokeless tobacco use. Bivariate, as well as multivariate logistic regression analyses were deployed to attain the study objective.
Over 20% of smokers and over 9% of smokeless tobacco users reported any morbidity. Odds ratio (OR) with 95% confidence interval (CI) estimated using logistic regression shows that women are less likely to report any morbidity attributable to smoking (OR: 0.69; CI: 0.54–0.87), and more likely to report any morbidity due to smokeless tobacco use (OR: 1.68; CI: 1.36–2.09). Non-Hindus have higher odds, whereas the wealthiest respondents have lower odds of reporting any morbidity. With a culturally appropriate intervention to change behaviour, youth (both men and women) could be targeted with comprehensive tobacco cessation assistance programmes. A focussed intervention could be designed for unprocessed tobacco users to curb hazardous effects of tobacco use.
When we talk about harmonisation, we may mean quite different things. There is a close, yet often unclear, relationship between minimum harmonisation and mutual recognition on the one hand, and between full harmonisation and the country of origin principle on the other hand. This paper will discuss harmonisation in relation to these other regulatory models with, among others, the Tobacco Products and Services Directives as illustrations. Moreover, many years after Tobbaco Advertising I and II it remains entirely unclear how minimum harmonisation instruments must be designed in order to be lawful. This paper proposes a consistent reading of the case law on what is called legislative minimum harmonisation based on Article 114 TFEU. It is also shown that the Court of Justice of the European Union applies a lenient standard to more stringent national measures under what is called constitutional minimum harmonisation based on competences for social policy and the environment.