Wednesday, December 23, 2015

Real-world study shows disturbing images get smokers to think about risks

Newswise, December 23, 2015– A new study is the first to provide real-world evidence of the effectiveness of smoking warning labels that include graphic photos of the damage caused by regular tobacco use.

Researchers found that smokers who saw graphic warning labels on every pack of cigarettes they smoked for four weeks had more negative feelings about smoking compared to those who saw just text warnings, which led them to look more closely at the warnings and put more credence into them.

This was associated with them thinking their habit was more dangerous and being more likely to consider quitting.

They also remembered more of the health risks of their habit.
“The graphic images motivated smokers to think more deeply about their habit and the risks associated with smoking,” said Ellen Peters, co-author of the study and professor of psychology at The Ohio State University.

The study, which was a joint project between Ohio State and the Annenberg Public Policy Center of the University of Pennsylvania, appears in the journal PLOS ONE.

The research is the first to look at the impact of graphic warning labels on smokers outside of a laboratory and over a relatively long period of time.

“Our study provides real-world evidence of how viewing these graphic images over time has an impact on smokers beyond what occurs with simple text warnings,” said Abigail Evans, lead author of the study and a postdoctoral researcher in psychology at Ohio State.

Other co-authors were Daniel Romer of the University of Pennsylvania’s Annenberg Public Policy Center; Andrew Strasser of the University of Pennsylvania; Lydia Emery of Northwestern University; and Kaitlin Sheerin of the University of Missouri.

For the study, the researchers used graphic warning labels created by the U.S. Food and Drug Administration. One of the labels included an image of a man smoking through a hole in his throat, called a tracheostomy. A tracheostomy may be necessary as a result of some smoking-related cancers.

The use of graphic warning labels was mandated by law to appear on cigarette packs in the United States in 2009. The warnings proposed by FDA were later invalidated by a federal appeals court.

The court concluded the labels were unconstitutional in part because the images were “unabashed attempts to evoke emotion … and browbeat consumers into quitting.”

This study suggests that the court was not correct in its assessment of how these images work to discourage smoking, Peters said.

“Smokers weren’t browbeaten by the images. The images definitely did stir their emotions, but those emotions led them to think more carefully about the risks of smoking and how those risks affected them,” Peters said.

“What the court is missing is that without emotions, we can’t make decisions. We require having feelings about information we collect in order to feel motivated to act. These graphic warnings helped people to think more carefully about the risks and to consider them more.”

The study involved 244 adults who smoked between 5 and 40 cigarettes each day.

Participants were provided with their preferred brand of cigarettes for four weeks, in modified packages. All packages had the same text messages, such as “Cigarettes cause fatal lung disease.”

 Some participants received packs with only these messages. Some received packs with the text warnings plus one of nine graphic, somewhat disturbing images showing the dangers of smoking. A third group received the simple text and the image, plus additional text detailing how every cigarette entails risk.

Participants returned to the lab each week to receive additional cigarettes and respond to surveys about their experiences with the new packaging.
Results showed that smokers who had the warning labels with the graphic labels were more likely than those who received only text warnings to report that the packaging made them feel worse about smoking.

They were also more likely to read or look closely at the information on the warning labels and they better remembered what was on the labels.

Smokers who had the graphic labels also saw the warnings as more credible.

“The feelings produced by the graphic images acted as a spotlight. Smokers looked more carefully at the packages and, as a result, the health risks fell into the spotlight and led to more consideration of those risks,” Peters said.

Smokers who viewed the graphic labels were also slightly more likely to say they intended to quit smoking.

“For a health issue like smoking, which causes about a half-million deaths a year in the United States, even small effects can have a large impact in the population,” Peters said.

“The effect was small, but it was not unimportant.”

The results show warning labels with graphic images really do work, Evans said.

“Policies requiring such labels have the potential to reduce the number of Americans who smoke,” she said.

The study was supported by grants from the National Cancer Institute and the FDA Center for Tobacco Products.

Friday, December 18, 2015

Binge Drinking with Chronic Alcohol Use More Destructive than Previously Thought

Newswise, December 18, 2015― Excessive alcohol consumption is a global public health issue. In the United States, binge drinking is the most common form ― so common, in fact, that the Centers for Disease Control and Prevention reports approximately one in six adults binge drinks about four times each month.

Now, a study by University of Missouri School of Medicine researchers shows that chronic alcohol use, when combined with repeated binge drinking, causes more damage to the liver than previously thought.

“Heavy binge drinking by those who habitually consume alcohol is the most common cause of liver damage in chronic alcoholic liver disease,” said Shivendra Shukla, Ph.D., the Margaret Proctor Mulligan Professor of medical pharmacology and physiology at the MU School of Medicine and lead author of the study. 

“We know that this behavior causes large fatty deposits in the liver that ultimately impair the organ’s ability to function properly. However, we wanted to understand the mechanism that causes this damage and the extent of the harm. Our research focused on different forms of alcohol abuse and the results of those behaviors.”

Shukla’s team studied mice to examine the extent of liver injury caused by chronic alcohol use, repeat binge episodes and a combination of both. During a four-week period, the team found that mice exposed to chronic alcohol use and repeated binge consumption exhibited the highest levels of liver damage.

“Either chronic alcohol use or acute repeat binge episodes caused moderate liver damage when compared to the control group not exposed to alcohol,” Shukla said.

“This outcome came as no surprise. However, in the mice exposed to both chronic use and repeat binge episodes, liver damage increased tremendously. Even more shocking was the extent of fatty deposits in the livers of those exposed to chronic plus binge alcohol. It was approximately 13 times higher than the control group.”

The highly amplified fat accumulation was in part caused by metabolic changes within the liver. These changes not only significantly increased fatty liver deposits, but increased stress on the organ while decreasing the liver’s ability to fight the stress.

Shukla also pointed out that chronic and excessive alcohol use should not be associated only with liver damage.

“Drinking alcohol excessively can create an inflammatory response to the liver and other organ systems in the body,” Shukla said.

“If those organs work at a lower level of function, then a whole host of physiological processes can be affected. It is important for us to understand the extent of damage caused by alcohol abuse, which also can lead to other health issues such as diabetes, cardiovascular disease and some forms of cancer.”

The study, “In Vivo Acute on Chronic Ethanol Effects in Liver: A Mouse Model Exhibiting Exacerbated Injury, Altered Metabolic and Epigenetic Responses,” recently was published in Biomolecules, a peer-reviewed journal on biogenic substances published by the Multidisciplinary Digital Publishing Institute.

Tuesday, December 1, 2015

NYU Study Finds Adults Aged 50-59 Now Largest Age Group in Opioid Treatment Programs

Notable shifts found in demographic background including gender and ethnicity among older adults

Newswise, December 1, 2015 — Recent years have seen a change in drug use patterns, especially for older adults, with an increase in their admission to substance abuse treatment and increased injection drug use among those over the age of 50. 

Yet, there has been little research regarding the epidemiology, health status, and functional impairments in the aging population of adults accessing opioid treatment.

Of the few studies on this population to date, most have been based off of a limited dataset that only accounts for treatment admissions, and therefore may not fully capture the utilization of substance abuse treatment over time. 

Furthermore the treatment episode dataset (TEDS), defines an older adult as aged over 50 or 55, and may not fully demonstrate how the population is aging.
Given the gaps in existing data, researchers affiliated with New York University's Center for Drug Use and HIV Research (CDUHR), and NYU’s School of Medicine (NYUSoM) sought to elucidate age trends for opioid treatment programs, with an emphasis on older adults, in a new study published in the Journal of Substance Use & Misuse

The investigation focuses on such trends in New York City, as it has one of the largest methadone treatment systems in the U.S. and consistently provides access to treatment in the public system.

The study, “Demographic Trends of Adults in New York City Opioid Treatment Programs- An Aging Population,” used data collected by New York State's Office of Alcoholism and Substance Abuse Services (OASAS). OASAS provides more detailed information on the treatment population than what is available nationally through the TEDS dataset, allowing the NYU researchers to characterize basic demographic, self-reported other substance use, and self-reported physical impairments.

“Most notably,” says Benjamin Han, MD, MPH, an instructor at NYUSoM and the study’s principle investigator, “we found a pronounced age trend in those utilizing opioid treatment programs from 1996 to 2012, with adults aged 50 and older becoming the majority treatment population.”

Specifically, individuals aged 50-59 which made up 7.8% (N= 2,892) of the total patient population in 1996, accounted for 35.9% (N= 12,301) of the population in 2012. Patients aged 60-69, also saw a dramatic increase in numbers, originally constituting 1.5% of patients (N= 558) to 12.0% of patients (N= 4,099).

“These increases are especially striking, considering there was about a 7.6% decrease in the total patient population over that period of time, and suggests that we are facing a never before seen epidemic of older adults with substance use disorders and increasing numbers of older adults in substance abuse treatment. 

Unfortunately there is a lack of knowledge about the burden of chronic diseases and geriatric conditions or the cognitive and physical function of this growing population” says Dr. Han.

During the same period, those age 40 and below, who in 1996 accounted for 56.2% of patients (N= 20,804), were a fraction of that in 2012, responsible for 20.5% of total patients (N= 7,035).

There were also notable shifts with regards to race and ethnicity. During this period older adults over the age of 60 were increasingly white, with a 10.3% increase in representation, while there was a 13.8% decrease in the percentage of black patients. 

There was a small increase in the Hispanic constituency from 35.0% in 1996 to 38.8% in 2012. These trends, however, were different for those aged 50-59. In this age group there were smaller decreases in both the white (3.5%) and black (5.9%) populations, and a larger increase in Hispanic patients (9.2%). 

However, when looking at all age groups during this period, the overall white population remained steady (-0.4%), with a slight decrease in black patients (3.5%) and a slight increase in Hispanic patients (3.4%).

Researchers believe the increase in older adults utilizing opioid treatment programs is likely to continue into the next decade. Further studies are required to better understand the specific and unique health needs of this growing population from a geriatric perspective. 

More research is also need to understand how other substance use can complicate care and how to address the changing ethnic and racial demographics of this population in New York City.

Researcher Affiliations: Benjamin H. Han, MD, MPH1*; Soteri Polydorou, MD2; Rosie Ferris, MPH1; Caroline Blaum, MD, MS1; Stephen Ross, MD2; Jennifer McNeely, MD, MS3.
1 NYU School of Medicine, Department of Medicine, Division of Geriatrics.
2 NYU School of Medicine, Division of Alcoholism and Substance Abuse
3 NYU School of Medicine, Department of Population Health and the Department of
Declaration of Interest: Gail Dorn, MS1 and Dawn Lambert-Wacey, MA1 provided the aggregated dataset used in this study, and assisted in the editing of the article.
1NYS Office of Alcoholism and Substance Abuse Services
Division of Outcome Management and System Information
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