Smoking cessation: why is it a persistent problem in patients with peripheral artery disease?

Nurses play a key role in advising patients to quit smoking, especially those with long-term conditions including cardiovascular disease. Peripheral artery disease (PAD) is an increasingly prevalent condition, and is the third most common presentation of atherosclerotic disease after coronary heart disease and stroke. Smoking cessation is crucial for patients with PAD but can be very challenging. Stopping smoking reduces cardiovascular morbidity and mortality, and improves claudication symptoms in patients with PAD. Those who continue to smoke are at higher risk of disease progression, amputation, myocardial infarction and death, and have poorer therapeutic outcomes. Quitting smoking is difficult, and patients should be offered a combination of behavioural and drug therapy. Nurses can provide several interventions to help patients quit and prevent relapse. A pilot study in a large London hospital found that no smokers had been referred to smoking cessation services by their vascular clinician (although some had been referred by their GP), given brief cessation advice or told how smoking cessation was essential for vascular preservation. Many thought smoking cessation programmes would not work.

Attention-Deficit/Hyperactivity Disorder and Nicotine Dependence in Adults

Introduction

The aim of this study is to assess clinical characteristics and smoking profiles of individuals diagnosed with attention-deficit/hyperactivity disorder (ADHD) and compare their nicotine dependence status with healthy controls for better understanding the mutual and complex relationship between ADHD and smoking.

Methods

We included the following participants in the study: 40 adults with the diagnosis of ADHD, 40 participants who visited the smoking cessation polyclinic without any psychiatric disorders, and 40 healthy controls. A sociodemographic data form, Wender Utah Rating Scale (WURS), Adult ADD/ADHD Diagnosis and Evaluation Inventory, and Fagerstrom Nicotine Dependence Test (FNDT) were administered to the participants.

Results

Mean age of the ADHD, nicotine dependence, and control groups was 28.68±7.22, 34.17±8.60, 33.70±7.45 years, respectively. Percentages of females and males were 27.5% and 72.5% in the ADHD group, 50% and 50% in the nicotine dependence group, 47.5% and 52.5% in the control group. The attention-deficit scores in the ADHD, nicotine dependence, and control groups were 21.18±5.05, 7.23±3.96, 4.75±2.65, respectively (p=0.001), whereas the hyperactivity scores were.73±5.84, 6.43±4.2, and 3.58±2.27, respectively (p=0.001). The related features scores were 56.53±12.96, 24.30±13.93, and 13.13±6.11, respectively (p=0.001), whereas the WURS scores were 61.88±12.69, 23.03±16.07, 11.90±8.15, respectively (p=0.001). FNDT scores in ADHD and nicotine dependence groups were 5.83±2.11 and 6.20±2.74, respectively (p=0.495).

Conclusion

Considering the argument of ADHD being an independent risk factor for nicotine dependence, we think the co-occurrence of the smoking addiction and ADHD symptoms in the context of dopamine dysregulation is important in the clinical setting. Treatment modalities and of preventive strategies should be considered while keeping this in mind.

Ineffectiveness of the Tobacco Hazards Prevention Act in patients with severe and persistent mental illness

OBJECTIVES

The effect of the Tobacco Hazards Prevention Act (THPA) on the reduction of tobacco use in the general population in Taiwan is understood. However, there has been little research on how these policies affect people with severe and persistent mental illness (SPMI). Hence, the influence of the THPA on daily cigarette use by patients with SPMI was investigated in a 3-year follow-up. The risk and protective factors in smoking behavior and cessation were investigated.

STUDY DESIGN

This is an observational study.

METHODS

A total of 144 participants (78 of whom had smoked >100 cigarettes throughout their lifetime) were randomly selected from a healthcare network. Then, 100 of 144 patients with SPMI, included 50 smokers and 50 non-smokers, have agreed with 1st year follow-up. Eighty-two patients with SPMI, consisted of 44 smokers and 38 non-smokers, have agreed with 2nd year follow-up.

RESULTS

Although women were less likely to smoke than men, those who did smoke reduced the number of cigarettes less than men over the 3-year period. Less-educated patients were more likely to smoke than those who were more educated but reduced the number of daily cigarettes more after implementation of the THPA. Maternal overprotection was a risk factor and paternal care a protective factor for smoking. Addiction, a perception of pleasure, interpersonal relationships, and self-destructive behavior increased cigarette smoking. Patients perceived that smoking alleviated their depressive symptoms.

CONCLUSIONS

The THPA was ineffective for patients with SPMI. Some factors had different effects on the development of smoking behavior and the cessation process. Understanding the etiology of smoking can help policymakers establish more effective programs for smoking prevention and cessation.

Genome-wide imaging association study implicates functional activity and glial homeostasis of the caudate in smoking addiction

Background

Nearly 6 million deaths and over a half trillion dollars in healthcare costs worldwide are attributed to tobacco smoking each year. Extensive research efforts have been pursued to elucidate the molecular underpinnings of smoking addiction and facilitate cessation. In this study, we genotyped and obtained both resting state and task-based functional magnetic resonance imaging from 64 non-smokers and 42 smokers. Smokers were imaged after having smoked normally (“sated”) and after having not smoked for at least 12 h (“abstinent”).

Results

While abstinent smokers did not differ from non-smokers with respect to pairwise resting state functional connectivities (RSFCs) between 12 brain regions of interest, RSFCs involving the caudate and putamen of sated smokers significantly differed from those of non-smokers (P < 0.01). Further analyses of caudate and putamen activity during elicited experiences of reward and disappointment show that caudate activity during reward (CR) correlated with smoking status (P = 0.015). Moreover, abstinent smokers with lower CR experienced greater withdrawal symptoms (P = 0.024), which suggests CR may be related to smoking urges. Associations between genetic variants and CR, adjusted for smoking status, were identified by genome-wide association study (GWAS). Genes containing or exhibiting caudate-specific expression regulation by these variants were enriched within Gene Ontology terms that describe cytoskeleton functions, synaptic organization, and injury response (P < 0.001, FDR < 0.05).

Conclusions

By integrating genomic and imaging data, novel insights into potential mechanisms of caudate activation and homeostasis are revealed that may guide new directions of research toward improving our understanding of addiction pathology.

Electronic supplementary material

The online version of this article (10.1186/s12864-017-4124-5) contains supplementary material, which is available to authorized users.

The efficiency of functional brain networks does not differ between smokers and non-smokers

Acute nicotine consumption in smokers impacts on functional brain network topology indicating an increase in the efficiency of information transfer and attentional task performance. The effects of chronic nicotine consumption on functional brain network topology are unknown. We here investigated the effects of chronic smoking-behaviour on functional brain network topology. Minimally-deprived smokers (N=18) and non-smokers (N=17) were measured within an fMRI scanner during a resting state condition. Graph-theoretical metrics of functional network integration (global efficiency and clustering) that have been shown to be affected by acute nicotine administration were compared between both groups. Our results revealed that smoking status did not significantly change functional network integration. Additional tests for non-inferiority confirmed the similarity of regional or nodal network properties. Brain regions such as the left insular and middle frontal gyrus, in which acute nicotine consumption affected network topology, did not reveal any decrease in functional network efficiency following chronic nicotine consumption. Within the limitation of the investigated sample size, our data suggest that the integration of functional brain networks is not altered in minimally-deprived smokers. Our findings are of relevance for clinical studies showing changes in network topology between psychiatric patients with high prevalence of smoking and healthy control subjects.