The adverse health effects of tobacco and tobacco-related products

Acute electronic vapour product whole aerosol exposure of 3D human bronchial tissue results in minimal cellular and transcriptomic responses when compared to cigarette smoke

The use of electronic vapour products (EVPs) continues to increase worldwide and with advances in cell culture systems, molecular biology and the computational sciences there is also accumulating evidence of their potential reduced toxicity and reduced potential harm when compared to cigarette smoke. To further understand the potential risks and health effects associated with exposure to EVP aerosols we have assessed the cellular and transcriptomic response from a commercially available lung tissue culture system (MucilAirTM) following a single sub-cytotoxic exposure to cigarette smoke and the equivalent nicotine delivered dose of EVP aerosol. The transcriptomic, cellular (cilia beat frequency (CBF) and percent active area (%AA), trans epithelial electrical resistance (TEER), histology) and cytokine release were assessed at 4- and 48- hours following recovery from air, EVP aerosol (8.4% V/V: mybluTM blueberry flavour, 2.4% nicotine) and 3R4F smoke (3.5% V/V: exposure). No pathological changes were observed at either recovery time point from any exposure. Air and EVP aerosol exposure had no effect on CBF, %AA nor TEER at 48 hours. Exposure to cigarette smoke resulted in a decrease in TEER, an increase in CBF and the release of proinflammatory cytokines at both recovery time points. Although the number of significantly expressed genes was minimal following exposure to EVP aerosol, exposure to 3R4F smoke resulted in a significant upregulation of several disease relevant pathways. These data provide evidence that following an acute exposure to EVP aerosol there is significantly less damage to lung cells in culture than the equivalent, nicotine based, dose of cigarette smoke.

A comparison study on a sulfonated graphene-polyaniline nanocomposite coated fiber for analysis of nicotine in solid samples through the traditional and vacuum-assisted HS-SPME

A simple, rapid, and reliable headspace solid-phase microextraction (HS-SPME) procedure, reinforced by applying vacuum in the extraction vial, was developed. It was applied for the extraction of nicotine in solid samples prior to determination by gas chromatography-flame ionization detection (GC-FID). First, the surface of a narrow stainless steel wire was made porous and adhesive by platinization to obtain a durable, higher surface area, and resistant fiber. Then, a thin film of sulfonated graphene/polyaniline (Sulf-G/PANI) nanocomposite was synthesized and simultaneously coated on the platinized fiber using the electrophoretic deposition (EPD) method. It was demonstrated that the extraction efficiency remarkably increased by applying the reduced-pressure condition in the extraction vial. To evaluate the conventional HS-SPME and vacuum-assisted HS-SPME (VA-HS-SPME) platforms, all experimental parameters affecting the extraction efficiency including desorption time and temperature, extraction time and temperature and moisture content of sample matrix were optimized. The highest extraction efficiency was obtained at 60°C, 10min (extraction temperature and time) and 280°C, 2min (desorption condition), for VA-HS-SPME strategy, while for conventional HS-SPME the extraction and desorption conditions found to be 100°C, 30min and 280°C, 2min, respectively. The Sulf-G/PANI coated fiber showed high thermal stability, good chemical/mechanical resistance, and long lifetime. For analysis of nicotine in solid samples using VA-HS-SPME-GC-FID, linear dynamic range (LDR) was 0.01-30μgg-1 (R2=0.996), the relative standard deviation (RSD%, n=6), for analyses of 1μgg-1 nicotine was calculated 3.4% and limit of detection (LOD) found to be 0.002μgg-1. The VA-HS-SPME-GC-FID strategy was successfully carried out for quantitation of nicotine in hair and tobacco real samples.

Reducing Pulmonary Disease: The Pharmacist’s Role in Smoking Cessation

As an important interface with the healthcare system for many patients, pharmacists are in a unique position to assist patients with quitting smoking, thereby improving patients’ pulmonary health. Because nicotine replacement therapy products and bupropion are available to patients largely via pharmacies, the pharmacist has become a logical candidate for providing smoking cessation assistance. Furthermore, research has shown that when pharmacists counsel patients on medications for quitting smoking, their intervention positively impacts smoking cessation rates. This article provides a review of methods for cessation and provides pharmacists with feasible and effective smoking cessation counseling strategies for implementation into everyday practice. The intervention approach draws heavily upon the U.S. Public Health Service Clinical Practice Guideline for Treating Tobacco Use and Dependence.

Targeted omics analyses, and metabolic enzyme activity assays demonstrate maintenance of key mucociliary characteristics in long term cultures of reconstituted human airway epithelia

3D reconstituted respiratory epithelia have emerged as better in vitro models for toxicological testing compared to cell lines due to the conservation of key morphological features and functions. MucilAir™ is a commercially available human airway epithelia system that can potentially maintain functional attributes for up to a year, however, detailed mucociliary characteristics and xenobiotic metabolism relevant to inhaled pro-toxicant bioactivation is lacking. Here, we assessed in MucilAir™ some key biomarkers that are characteristic of the respiratory epithelia including morphology, function and xenobiotics metabolism. The end points that were measured included targeted proteomics using a panel of 243 airway surface liquid (ASL) proteins, cilia beat frequency (CBF), a qRT-PCR screen of xenobiotic metabolizing enzymes, and CYP2A6/13, CYP1A1/1B1 activity. Comparison of ASL proteomics with human sputum identified key proteins common to both matrices, but present at different levels. Xenobiotic metabolism gene profiling demonstrated strong similarities with the normal human lung and did not reveal any consistent changes when assessed over a 6 month period. Inducibility and activity of CYP1A1/1B1 and activity of CYP2A6/2A13 were present at one month in culture and maintained in one tested MucilAir™ donor for several months. In conclusion, MucilAir™ presented important morphological and metabolic characteristics of a mucociliary epithelium in short and long term culture. MucilAir™ is therefore a potentially useful model to test repeated sub-cytotoxic doses of toxicants.

The changing face of tobacco use among United States youth

Tobacco use, primarily in the form of cigarettes, is the leading cause of preventable morbidity and mortality in the United States (U.S.). The adverse effects of tobacco use began to be recognized in the 1940's and new hazards of active smoking and secondhand smoke (SHS) exposure from cigarettes continue to be identified to this day. This has led to a sustained and wide-ranging array of highly effective regulatory, public health, and clinical efforts that have been informed by extensive scientific data, resulting in marked decreases in the use of cigarettes. Unfortunately, the dramatic recent decline in cigarette use in the U.S., has been accompanied by an upsurge in adolescent and young adult use of new, non-cigarette tobacco and nicotine-delivery products, commonly referred to as alternative tobacco products (ATPs). Commonly used ATPs include hookah, cigars, smokeless tobacco, and electronic cigarettes. While there have been a number of review articles that focus on adult ATP use, the purpose of this review is to provide an overview of what is, and is not known about emerging ATP use among U.S. adolescents on a national scale; as well as to identify research gaps in knowledge, and discuss future health and policy needs for this growing public health concern. This paper is not meant to systemically review all published survey data, but to present clear depiction of selected ATP usage in youth populations using national survey data.

Donor Smoking Negatively Affects Donor and Recipient Renal Function following Living Donor Nephrectomy

Background. While tobacco use by a renal transplant recipient has been shown to negatively affect graft and patient survival, the effect of smoking on the part of the kidney donor remains unknown. Methods. 29 smoking donors (SD) and their recipients (SD-R) as well as 71 non-smoking donors (ND) and their recipients (ND-R) were retrospectively reviewed. Preoperative demographics and perioperative variables including serum creatinine (Cr) and glomerular filtration rate (GFR) were calculated and stratified by amount of tobacco exposure in pack-years. Clinical outcomes were analyzed with a Student's t-test, chi-square, and multiple linear regression analysis (α = 0.05). Results. At most recent followup, SD-R's had a significantly smaller percent decrease in postoperative Cr than ND-R's (-57% versus -81%; P = 0.015) and lower calculated GFR's (37.0 versus 53.0 mL/min per 1.73 m(2); P < 0.001). SD's had a larger percent increase in Cr than ND's at most recent followup (57% versus 40%; P < 0.001), with active smokers having a larger increase than those who quit, although this difference was not statistically significant (68% versus 52%; P = 0.055). Conclusions. Use of tobacco by kidney donors is associated with decreased posttransplant renal function, although smoking cessation can improve outcomes. Kidneys from donors who smoke should be used with caution.

Missed opportunities for tobacco use screening and brief cessation advice in South African primary health care: a cross-sectional study

BACKGROUND

Primary health care (PHC) settings offer opportunities for tobacco use screening and brief cessation advice, but data on such activities in South Africa are limited. The aim of this study was to determine the extent to which participants were screened for and advised against tobacco use during consultations.

METHODS

This cross-sectional study involved 500 participants, 18 years and older, attended by doctors or PHC nurses. Using an exit-interview questionnaire, information was obtained on participants' tobacco use status, reason(s) for seeking medical care, whether participants had been screened for and advised about their tobacco use and patients' level of comfort about being asked about and advised to quit tobacco use. Main outcome measures included patients' self-reports on having been screened and advised about tobacco use during their current clinic visit and/or any other visit within the last year. Data analysis included the use of chi-square statistics, t-tests and multiple logistic regression analysis.

RESULTS

Of the 500 participants, 14.9% were current smokers and 12.1% were smokeless tobacco users. Only 12.9% of the participants were screened for tobacco use during their current visit, indicating the vast majority were not screened. Among the 134 tobacco users, 11.9% reported being advised against tobacco use during the current visit and 35.1% during any other visit within the last year. Of the participants not screened, 88% indicated they would be 'very comfortable' with being screened. A pregnancy-related clinic visit was the single most significant predictor for being screened during the current clinic visit (OR = 4.59; 95%CI = 2.13-9.88).

CONCLUSION

Opportunities for tobacco use screening and brief cessation advice were largely missed by clinicians. Incorporating tobacco use status into the clinical vital signs as is done for pregnant patients during antenatal care visits in South Africa has the potential to improve tobacco use screening rates and subsequent cessation.

The Relationship Between Receptivity to Media Models of Smoking and Nicotine Dependence Among South African Adolescents

The purpose of this study is to determine the association of receptivity to media models of smoking and nicotine dependence among South African adolescents from four ethnic groups. A stratified random sample of 731 adolescents aged 12 to 17 years (mean=14. 55, SD=1.68) was drawn from Johannesburg, South Africa. A structured questionnaire was administered to the participants in their homes by trained interviewers. Receptivity to media models of smoking was assessed with a three-item Likert scale. The dependent variable, nicotine dependence, was assessed with the Fagerström Test for Nicotine Dependence (FTND). Regression analyses showed a positive relationship between media receptivity and nicotine dependence, with control on demographic variables and hours of TV watched by the adolescent. This relationship was found to be strongest among White adolescents and weakest among Black adolescents. Though equally receptive to media models of smoking, Black adolescents have lower FTND scores than their peers from other South African ethnic groups. This may be related to the low prevalence of images in South Africa depicting Black people smoking cigarettes. Cultural norms against smoking among Black adolescents may also serve as a protective factor.

Evidence for systemic oxidative stress in tobacco chewers

OBJECTIVE

To evaluate erythrocyte malondialdehyde (MDA) levels and activities of superoxide dismutase (SOD) and glutathione reductase (GR) in tobacco chewers, in view of possible oxidative stress in oral smokeless tobacco.

MATERIAL AND METHODS

Sixty healthy male tobacco chewers, aged 30.6+/-4.7 years with a 3 to 10-year (7.37+/-2.1) history of tobacco chewing, were included in the study. Thirty-two healthy male volunteers, aged 26.5+/-4.8 years, served as controls. All the participants were from the same community and of similar dietary habits.

RESULTS

The erythrocyte MDA level and activities of erythrocyte SOD and GR were estimated. There was a significant duration- (tobacco chewing) dependent increase in erythrocyte MDA levels along with a significant duration- (tobacco chewing) dependent decrease in erythrocyte SOD and GR activity.

CONCLUSION

Oral smokeless tobacco causes a duration-dependent increase in oxidative stress.

Effects of Smokeless Tobacco "Maras Powder" Use on Respiratory Functions

In Turkey, "Maras Powder," which is a kind of powder yielded from the shields of tobacco, is widely used as smokeless tobacco through buccal mucosa or together with cigarette. Maras powder, composed of ash and a plant named Nicotiana Rustica Linn, is sometimes used to give up smoking. The present study was aimed to investigate the effects of Maras powder use on respiratory functions of healthy subjects who do not have any chronic disease. We found statistically significant differences in percentage of forced expiratory volume in the first second (FEV(1)%) (p = 0.001), the ratio of FEV(1) to forced vital capacity (FEV(1)/FVC) (p = 0.024), percent of maximum expiratory flow rate (FEF(25-75)%) (p = 0.002) and percent of peak expiratory flow (PEF%) (p = 0.037) between cigarette smokers with Maras powder use (n = 23) and control subjects (n = 24). Likewise, when cigarette smokers (n = 24) and control subjects were compared, the differences for all these parameters were significant (p = 0.022, p = 0.048, p = 0.011 and p = 0.047, respectively). Only FEV(1)% and FEF(25-75)% were significantly lower in cigarette smokers with Maras powder use than in Maras powder users (n = 28) (p = 0.011 and p = 0.022, respectively). There was a negative correlation between forced vital capacity and Maras powder use (r = -0.315, p = 0.03). The present study suggests that Maras powder does not cause serious bronchial obstruction. This may be due to usage of the smokeless tobacco through buccal mucosa but not through inhalation as in case of cigarette smoking.

Effects of tobacco smoke on recovery after nerve crush injury in rats

The effects of tobacco smoke on nerve healing after crush injury was studied in a rat model. Thirty-six animals were randomized equally into smoke-exposed or nonsmoke-exposed groups. Two nerve crush injuries were performed on the right posterior tibial nerve of each animal at 4-week intervals to mimic a sustained or chronic nerve injury. Recovery of the two groups was assessed with walking track analysis and nerve histomorphometry. There was no difference in the rate of nerve recovery based on walking track analysis in the smoke-exposed animals compared with nonexposed animals. The study also failed to demonstrate any significant difference between the two groups as assessed by histomorphometric criteria.

Cigarette smoking is associated with an increased incidence of vascular complications after liver transplantation

Hepatic artery thrombosis (HAT) and other vascular complications are significant causes of morbidity after liver transplantation. Although cigarette smoking increases the risk of vascular complications after renal transplantation, its impact after liver transplantation remains unknown. Between May 1995 and April 2001, 288 liver transplantations were performed in 263 patients. Vascular complications developed in 39 patients (13.5%) (arterial complications, 28 patients [9.7%]; venous complications, 11 patients [3.8%]). Patient demographics, comorbid illnesses, and risk factors were analyzed using the Mann-Whitney U test, Chi-squared test, and Fisher's exact test. In patients with a history of cigarette smoking, incidence of vascular complications was higher than in those without history of cigarette smoking (17.8% v 8%, P =.02). Having quit cigarette smoking 2 years before liver transplantation reduced the incidence of vascular complications by 58.6% (24.4% v 11.8%, P =.04). The incidence of arterial complications was also higher in patients with a history of cigarette smoking compared with those without such history (13.5% v 4.8%, P =.015). Cigarette smoking cessation for 2 years also reduced the risk of arterial complications by 77.6% (21.8% v 5.9%, P =.005). However, the incidence of venous complications was not associated with cigarette smoking. Furthermore, there was no significant association between development of vascular complications and all other characteristics studied. Cigarette smoking is associated with a higher risk for developing vascular complications, especially arterial complications after liver transplantation. Cigarette smoking cessation at least 2 years before liver transplantation can significantly reduce the risk for vascular complications. Cigarette smoking cessation should be an essential requirement for liver transplantation candidates to decrease the morbidity arising from vascular complication after liver transplantation.

Immunohistochemical study of vestibular gingival blood vessel density and internal circumference in smokers and non-smokers

BACKGROUND

This study was undertaken to determine: 1) if sections stained with monoclonal antibody to CD34 can be used for measurement of gingival blood vessel density and circumference and 2) if long-term smoking affects either of these 2 parameters.

METHODS

Vestibular gingival biopsy samples were obtained from 17 adults (5 smokers and 12 non-smokers) who were undergoing routine periodontal surgery independently of this study. Hematoxylin and eosin staining was used for histological assessment of inflammation, while immunohistochemical staining with CD34 mouse monoclonal antibody was used to mark the endothelial cells of the blood vessels within each sample. Stringent selection criteria were applied to the 17 biopsy samples, and 7 (from 3 smokers and 4 non-smokers) were chosen to have their vascular density (number of vessels/unit area) and internal vessel circumference (IC) measured under a blinded protocol.

RESULTS

Repeated measurements of vascular density and internal circumference showed small standard deviations, indicating the high reproducibility of the measurement technique. The smoker group showed a higher proportion of small (IC < 50 microns) and a lower proportion of large blood vessels (IC > 100 microns), which was statistically significant (P = 0.0403 and P < 0.001, respectively). The difference between the vascular density of smokers and non-smokers was not significant (P = 0.092).

CONCLUSIONS

The present study indicates that the CD34 immunohistochemical staining technique is a simple and reproducible method for the measurement of density and internal circumference of gingival blood vessels. Based on this technique, cigarette smokers show a higher percentage of smaller blood vessels and a lower percentage of larger vessels, but similar vascular density, to non-smokers.

An outcome study of breast reconstruction: presurgical identification of risk factors for complications

BACKGROUND

Breast reconstruction following mastectomy has been shown to have a salutary effect on the overall psychological well-being of women being treated for breast cancer. Unfortunately, however, not every patient is an ideal candidate for reconstruction. Complications stemming from reconstructive surgery can cause significant morbidity, the most important of which may be the delay of subsequent adjuvant antineoplastic therapies, and therefore may not be in the best interests of the patient.

METHODS

A retrospective study was performed on a consecutive series of 123 breast reconstructions in 98 patients, performed by one of two plastic surgeons, in a university setting over a 5-year period, for all surgical outcomes. Specifically, wound-healing complications, infections, and reoperations leading to the potential delay of subsequent chemotherapy or radiotherapy were recorded, and possible risk factors leading to these were sought.

RESULTS

Three presurgical risk factors were found to have a statistically significant influence on the development of complications following breast reconstruction. These were: (1) increasing obesity, defined by the body mass index, (2) an active or recent (<5 year) history of cigarette smoking, and (3) a history of previous radiation exposure. Odds ratios were used to describe the magnitude of the effect of each factor for the development of complications. An ordinal regression analysis was used to create a nomogram based on this information that can be used to calculate any individual patient's presurgical risk for developing major complications following breast reconstruction, based on the presence of these factors.

CONCLUSIONS

It is possible, based on the presence of specific presurgical risk factors, to predict the probability of developing major complications following breast reconstruction. This information can be useful to the referring physician and plastic surgeon alike in determining which patients are the best candidates for breast reconstruction and which type of reconstruction would be best suited for each individual patient.

Exposure to parental tobacco and alcohol use: effects on children's health and development

This review examines three ways in which parental tobacco and alcohol use compromises the physical and mental health of children: 1) direct exposure to the substances; 2) living with parents who may become ill from using these substances; and 3) children's modeling of parental substance use. Implications for prevention, intervention, and public education are discussed, and a reframing of the national dialogue on youth substance abuse is called for.

Evaluation of benzo(a)pyrene-induced DNA damage in human endothelial cells using alkaline single cell gel electrophoresis

The alkaline version of the 'comet assay' was used to evaluate DNA damage in human umbilical vein endothelial cells (HUVEC) exposed to 0.1, 1.0, or 10 microM benzo(a)pyrene for 90min. The genotoxicity was monitored in HUVEC pretreated with the Ah-receptor agonist beta-naphthoflavone (BNF), previously shown to induce cytochrome P4501A1 (CYP1A1) activity in these cells, and in vehicle-treated HUVEC with only constitutive levels of this enzyme. Increased DNA damage was observed only in cells that had been exposed to 10 microM benzo(a)pyrene, cells exposed to BNF being subjected to the most extensive damage. The CYP1A/B-inhibitor alpha-naphthoflavone (ANF) reduced the benzo(a)pyrene-induced DNA-damage in the BNF-treated HUVEC to the same level as in the uninduced cells. The fact that benzo(a)pyrene induced DNA damage in vehicle-treated HUVEC suggests that there may be at least one alternative route of bioactivation for benzo(a)pyrene in these cells. Consequently, judging from the present results it seems as if tobacco-related polycyclic aromatic hydrocarbons (PAHs) may disrupt the function of the endothelial lining in blood vessels with low monooxygenase activity. It is proposed that exposure to Ah receptor agonists via, for example, tobacco smoke, may enhance the DNA-damaging effects of smoke-related genotoxic PAHs in human endothelial cells. The role of PAHs in endothelial dysfunction of tobacco smokers should therefore be further studied.