The Cochrane Tobacco Addiction Group’s 20th anniversary priority setting project report.

Cochrane TAG anniversary Twitter banner
The Cochrane Tobacco Addiction Group (TAG) conducts and facilitates systematic reviews and meta-analyses of the research evidence for tobacco cessation and prevention interventions. The group was founded in 1996 and in 2016 they conducted a stakeholder engagement project to celebrate the 20th anniversary of TAG and to identify future research priorities for the group and the wider tobacco control community.
 
 

The objective of the project was to:

  • Raise awareness of Cochrane TAG and what has been achieved so far.
  • Identify areas where further research is needed in the areas of tobacco control and smoking cessation.
  • Identify specific goals for Cochrane TAG
  • To explore novel ways to disseminate the findings of tobacco research, and Cochrane TAG’s findings.

The survey and workshop resulted in 183 unanswered research questions in the areas of tobacco, quitting smoking and eight priority research areas, including:

  • ‘addressing inequalities’
  • ‘treatment delivery’
  • electronic cigarettes’
  • ‘initiating quit attempts’
  • ‘young people’
  • ‘mental health and substance abuse’
  • ‘population-level interventions’
  • ‘pregnancy’

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Stakeholders who attended the workshop also discussed ways that the public health community and Cochrane TAG could act to move the field of tobacco control forward.

Through this report, Cochrane TAG want to share the identified unanswered questions with the wider tobacco research community to help them to decide the most important research to focus on in the future, and to decide the most important things to work on for Cochrane TAG.

This will involve updating existing reviews, beginning reviews on new topics, and looking in more detail at Cochrane TAG’s research methods.

Contrary to popular belief there are still many important unanswered questions in the field of tobacco control. In addition, it has been noted that many of the results of tobacco control questions are not always reaching their intended targets. Tobacco control stakeholders provide a rich source of information on how these uncertainties should be prioritised; by using this resource the likelihood that the findings of research are useful and will be implemented is much greater. The project was carried out with the hope that researchers and research funders will be able to use the priorities identified to inform their future practice, in the same way that Cochrane TAG are using them to inform new review topics, updates of reviews and methods development.

Cochrane TAG’s findings and implementation suggestions should be considered alongside the existing evidence base and clinical expertise.

 
Here is the full report of the CTAG taps project!
 
You can open the report and the appendices by clicking on the covers below:
ctag_taps_final_reportctag_taps_final_report_appendices
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Discussing the future of tobacco addiction research with the Cochrane Tobacco Addiction Group:

The CTAG taps project ran from January-December 2016. Activities carried out from April 2016-December 2016 were funded by the NIHR School for Primary Care Research (SPCR)

Alcohol and breast cancer – How big is the risk? ~ Report from the World Cancer Research Fund

Half a glass of wine a day increases breast cancer‘ was just one of the headlines this WCRF_main-150x150week, which discussed a report that reinforced the evidence that alcohol can increase a woman’s risk of developing breast cancer.

The report from the World Cancer Research Fund outlined the latest evidence on how we can reduce that risk – focusing on weight, physical activity and drinking.

The WCRF studies all the evidence on a potential risk and decides whether it’s strong enough to be a basis for making recommendations to the public.

Breast cancer is the most common cancer in the UK, and 1 in 8 women will be diagnosed with breast cancer at some point in their lives. And since we know that almost a third of breast cancer cases in the UK could be prevented, largely by changes to lifestyle, this is important stuff.

While the cause of an individual’s cancer can never be certain, there are still things you can do to reduce your risk. And evidence like this is the first step to helping women to do just that.

So what exactly does the report say?

Alcohol

The report backs up previous research showing that drinking alcohol can cause 7 types of cancer  including breast cancer. Even though it’s in the headlines, this is nothing new.

While the reports may sound alarming, we also know that the more you cut down, the more you’re reducing your risk.

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Although most women don’t regularly drink very large amounts of alcohol, thousands of cases of cancer – including breast – are linked to alcohol each year.

There are 3 good theories on the link between alcohol and cancer which we’ve written about before.

  • When we drink alcohol, it’s broken down into a toxic chemical called acetaldehyde. Acetaldehyde can damage the DNA inside our cells, and then prevent damage from being repaired. This is important because it allows cancer to develop.
  • Alcohol can increase the levels of certain hormones in the body, including oestrogen. We know that high levels of oestrogen can fuel the development of breast cancer, so this might be particularly important here.
  • Alcohol also makes it easier for cells in the mouth and throat to absorb other cancer-causing chemicals. This is probably more important for other cancer types linked to alcohol rather than breast cancer.

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Physical activity

The evidence on the link between breast cancer risk and both weight and physical activity is a bit more complicated. This is because there is evidence that the causes of breast cancer that occur in women before the menopause, compared to after the menopause, are different.

But overall there is strong evidence that keeping a healthy weight and being physically active, can help prevent breast cancer.

Unlike its previous report, this time WCRF says that some forms of physical activity probably reduce the risk for pre-menopausal breast cancer But the finding is only true for ‘vigorous’ activity – exercise which gets you breathing hard and your heart beating fast, so that you won’t be able to say more than a few words without pausing for breath.

The report also adds to the existing evidence that physical activity at any age is related to a lower risk of breast cancer in women after the menopause. This can be anything that gets you a bit hot and out of breath – from fast walking, to cycling, or even heavy housework. And the more you do the better.

Body weight

The evidence on weight and breast cancer is also complicated: as your risk changes depending on the ages at which you were overweight.

But overall the report agrees with previous work showing that being overweight or obese throughout adulthood causes postmenopausal breast cancer, something that is already well established.

Bringing it all together

Other things that affect a woman’s breast cancer risk are less easy to control. As with most cancers, the risk of developing the disease increases with age. Having a family history of the disease can increase a woman’s risk, and breastfeeding can reduce it.

All the different things that can increase the risk of breast cancer are held together by a common thread: they all affect the hormones circulating around in the body in some way.

Hormones help control what happens inside our bodies by sending messages from one place to another – including instructing cells when to stop and start multiplying.

If this system goes wrong, cells can get too many messages telling them to make more cells. And that can lead to cancer.

Overall the best advice is the same as at the start of the week: to keep active, keep a healthy weight throughout life, and limit alcohol.

Originally posted on CRUK, taken from Cancer Research UK Cambridge Institute

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Study finds poorest of us at greater risk of harm from heavy drinking.

Drinking heavily is more harmful to the poorest people in society, who are at greater risk of illness or death because of alcohol consumption, according to a recent medical study. Published in medical journal The Lancet Public Health on Wednesday, it found there is a marked link between socio-economic status and the harm caused by drinking alcohol excessively.

Researchers taking part in the study found increased alcohol consumption was “disproportionately harmful” to the poorest in society. Compared with light drinkers in advantaged areas, excessive drinkers were seven times at risk of an increase in alcohol harm.

This contrasted with excessive drinkers in deprived areas, who were 11 times at risk of an increase. Harmful impacts of alcohol are higher in socio-economically disadvantaged communities. However, until now it was unclear whether those were as a result of
differences in drinking or as a result of other factors.

Lead author Dr Vittal Katikireddi, of the University of Glasgow, said:

“Our study finds that the poorest in society are at greater risk of alcohol’s harmful impacts on health, but this is not because they are drinking more or more often binge drinking.

“Experiencing poverty may impact on health, not only through leading an unhealthy lifestyle but also as a direct consequence of poor material circumstances and psychosocial stresses. Poverty may, therefore, reduce resilience to disease, predisposing people to greater health harms of alcohol.

The authors linked different sets of data to bring together information from Scottish Health Surveys with electronic health records, studying more than 50,000 people.
It suggested that even when other factors are accounted for, including smoking and obesity, living in deprived areas was consistently associated with higher alcohol-related harms. Researchers defined harm from alcohol consumption based on deaths, hospital visits and prescriptions that were attributable to alcohol.

Study co-author Dr Elise Whitley said:

“Heavier drinking is associated with greater alcohol-related harm in all individuals. However, our study suggests that the harm is greater in those living in poorer areas or who have a lower income, fewer qualifications or a manual occupation.

Responding to the study published on Wednesday in The Lancet Public Health which found that drinking heavily is more harmful to the poorest people in society. Professor Sir Ian Gilmore, chair of the Alcohol Health Alliance UK (AHA), said:

“The findings in this study are worrying if not altogether surprising. It is clear that the way alcohol is being sold and promoted in Scotland and elsewhere in the UK is harming some of the most vulnerable people in society. On the other hand, we know what needs to be done, in particular to tackle the scourge of cheap alcohol. In real terms, alcohol is 60% cheaper than it was in 1980 and measures like strength based pricing would disproportionately benefit the poorest groups, in terms of reduced deaths, illness and hospital admissions.

Studies have shown that 82% of the lives saved through minimum unit pricing would come from the lowest income groups. Overall, in the first year alone minimum unit pricing in Scotland is expected to save 60 lives and lead to 1,600 fewer hospital admissions and 3,500 fewer crimes, yet its introduction has been held up for years by alcohol industry legal challenges.

Importantly, minimum unit pricing would leave pub prices untouched, and moderate drinkers would spend only about £2.25 extra per year with a 50p minimum price.”

This is even more evidence of the Alcohol Harm Paradox, which refers to observations that lower socioeconomic status (SES) groups consume less alcohol but experience more alcohol-related problems. However, SES is a complex concept and its observed relationship to social problems often depends on how it is measured and the demographic groups studied. A study published in 2016 hoped to deconstruct this idea and assessed socioeconomic patterns of alcohol consumption and related harm using multiple measures of SES and examined moderation of this patterning by gender and age. You can read the research article here: Deconstructing the Alcohol Harm Paradox: A Population Based Survey of Adults in England



Citation of original research article:

Socioeconomic status as an effect modifier of alcohol consumption and harm: analysis of linked cohort data. 

Dr Srinivasa Vittal Katikireddi, Elise Whitley, Jim Lewsey, Linsay Gray, Prof Alastair H Leyland. Published: 10 May 2017 – Open Access DOI: http://dx.doi.org/10.1016/S2468-2667(17)30078-6


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Alcohol-related Hospital Admissions are at a Record High!

New figures released this week shows that hospital admissions due to alcohol are at their highest ever levels.

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The data, summarised in a release from NHS Digital, shows that alcohol-related hospital admissions in England have increased by 64% over the last decade, with an extra 430,000 people being admitted due to alcohol-related causes in 2015/16 compared with 2005/06.

This takes the total number of alcohol-related hospital admissions to over 1.1 million in 2015/16.

alcohol

Alcohol is linked to over 60 illnesses and diseases, including heart disease, liver disease and cancer. Figures from the local alcohol profiles for England show that admissions due to liver disease have gone up 57% over the last decade, and that the number of people diagnosed with alcohol-related cancer has increased 8%.

In contrast, separate data released today by the Office of National Statistics shows that the proportion of adults drinking is at its lowest level since 2005, with younger people more likely to be abstaining from alcohol. However, 7.8 million people admit to binge drinking on their heaviest drinking day.

In response to the figures, alcohol health experts called for more to be done in the UK to tackle the health harm done by alcohol.

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Professor Sir Ian Gilmore, chair of the Alcohol Health Alliance UK (AHA), said:

“These figures show that the UK continues to have a dysfunctional relationship with alcohol. We know that over the long term, rates of binge drinking are falling, and more people are choosing to abstain from alcohol. Worryingly, however, these trends do not appear big enough to stop alcohol harm from continuing to rise, and the sharp increase in alcohol-related hospital admissions over the last few years means hundreds of thousands more people each year are experiencing the misery associated with harmful alcohol consumption.

“The data released today should be sobering reading for whoever wins the upcoming general election, and we would urge the next government to make tackling alcohol harm an immediate priority to save lives, reduce harm, and reduce the pressure on the NHS.”

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 The data is available via the following links.

New evidence finds standardised cigarette packaging may reduce the number of people who smoke as UK legislation bans the use of branding on all cigarette packets from May 2017.

A Cochrane Review published today finds standardised tobacco packaging may lead to a reduction in smoking prevalence and reduces the appeal of tobacco.

According to the World Health Organisation, tobacco use kills more people worldwide than any other preventable cause of death. Global health experts believe the best way to reduce tobacco use is by stopping people starting to use tobacco and encouraging and helping existing users to stop.

plain-packs-620-x-348-heroThe introduction of standardised (or ‘plain’) packaging was recommended by the World Health Organisation, Framework Convention on Tobacco Control (WHO FCTC) guidelines. This recommendation was based on evidence around tobacco promotion in general and studies which examined the impact of changes in packaging on knowledge, attitudes, beliefs and behaviour. Standardised tobacco packaging places restrictions on the appearance of tobacco packs so that there is a uniform colour (and in some cases shape) with no logos or branding apart from health warnings and other government-mandated information, and the brand name appears in a prescribed uniform font, colour and size.

From next month, UK legislation on standardised packaging for all tobacco packs comes into full effect.

Australia was the first country in the world to implement standardised packaging of tobacco products.  The laws, which took full effect there in December 2012, also required enlarged pictorial health warnings.

A team of Cochrane researchers from the UK and Canada have summarised results from studies that examine the impact of standardised packaging on tobacco attitudes and behaviour. They have today published their findings in the Cochrane Library.

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A randomised controlled trial of a complex intervention to reduce children’s exposure to secondhand smoke in the home.

Exposing children to secondhand tobacco smoke (SHS) causes significant harm and occurs predominantly through smoking by caregivers in the family home. Researchers from UKCTAS at the University of Nottingham trialed a complex intervention designed to reduce secondhand smoke exposure of children whose primary caregiver feels unable or unwilling to quit smoking.

This was an open-label, parallel, randomised controlled trial carried out in deprived communities around Nottingham City and County.

The trial worked with caregivers who live in Nottingham City and County in England who were at least 18 years old, the main caregiver of a child aged under 5 years living in their household, and reported that they were smoking tobacco inside their home.

The research compared a complex intervention that combined personalised feedback on home air quality, behavioural support and nicotine replacement therapy for temporary abstinence with usual care.

The primary outcome was change in air quality in the home, measured as average 16–24 hours levels of particulate matter of <2.5 µm diameter (PM2.5), between baseline and 12 weeks. Secondary outcomes included changes in maximum PM2.5, proportion of time PM2.5 exceeded WHO recommended levels of maximum exposure of 25 µg/mg3, child salivary cotinine, caregivers’ cigarette consumption, nicotine dependence, determination to stop smoking, quit attempts and quitting altogether during the intervention.

Geometric mean PM2.5 decreased significantly more (by 35.2%; 95% CI 12.7% to 51.9%) in intervention than in usual care households, as did the proportion of time PM2.5 exceeded 25 µg/mg3, child salivary cotinine concentrations, caregivers’ cigarette consumption in the home, nicotine dependence, determination to quit and likelihood of having made a quit attempt.

The team concluded that by reducing exposure to SHS in the homes of children who live with smokers unable or unwilling to quit, this intervention offers huge potential to reduce children’s’ tobacco-related harm.

Read the full research report in the BMJ here.

This trial was funded by the UK National Institute for Health Research.

To find more information about this trial and the Smoke Free Homes project click here.

Cigarette smoking increases coffee consumption: findings from a Mendelian randomisation analysis

Marcus Munafò and his colleagues at the University of Bristol, have looked into the smoking and drinking habits of about 250,000 people. They found that smoking makes you drink more caffeinated drinks, possibly by changing your metabolism so that you break down caffeine quicker, pushing you to drink more to get the same hit.

It’s impossible to do a randomised controlled trial (the most rigorous kind of scientific trial) when it comes to smoking, because it would be unethical to ask a randomly selected group of people to smoke. The next best thing is to study huge biobanks of health data. These biobanks contain information about people’s genes, diets and lifestyles.
coffee-cigarettes-smoking-400x400.jpgTo explore the relationship between smoking and caffeine, Munafo and his colleagues analysed data from biobanks in the UK, Norway and Denmark. They were particularly interested in people who had inherited a variant of a gene that has already been shown to increase cigarette smoking.

Chain drinking

The team found that people who had this gene variant also consumed more coffee – but only if they smoked. British people with the same variant also drank more tea, although their Danish and Norwegian counterparts didn’t. This is probably due to cultural differences, says Munafò. “People in Norway and Denmark don’t chain drink tea in the same way that people in the UK do,” he says.

The genetic variant seems to influence how much nicotine a person consumes. You can have zero, one or two copies – and each additional copy is linked to an increase in smoking of about one cigarette per day. Each copy also appears to increase coffee consumption by 0.15 cups per day.

“You could extrapolate from that and say that if you smoked 10 cigarettes per day more than the next person, you would be drinking the equivalent of about one and a half extra cups of coffee per day,” says Munafò. He is wary of doing so, though, because the amount of nicotine a person gets from a cigarette will depend on the type of cigarette and the way it is smoked.

The gene variant codes for a nicotine receptor, which is not known to directly interact with caffeine. This suggests that cigarette smoking increases caffeine consumption and not the other way around.

“The team have used a rather clever technique to establish causality, which normally you wouldn’t stand a cat in hell’s chance of doing with an epidemiological study,”

Robert West – University College London.

What’s the link?

There’s a chance that cigarette smoking and caffeine consumption are linked through habit – that smokers tend to pair the two. But Munafò thinks that the nicotine in cigarettes might also influence the way a person metabolises caffeine. “It’s possible that smokers metabolise caffeine more quickly,” he says. If that is the case, smokers might need to consume more caffeine to get the same effects that a non-smoker would experience.

It’s also possible that the apparent link between smoking and coffee drinking could be down to some unknown function of the genetic variant, says West. “It evolved for a purpose, and it wasn’t to smoke,” he says.

A relationship between smoking and coffee might make it harder for smokers to quit, says Munafò. If a smoker stops smoking, but continues to drink plenty of coffee, they might start to experience unpleasant side effects, such as jitteriness. This might be misinterpreted as a symptom of smoking withdrawal, says Munafò. His team plans to investigate this.

newscience
By Jessica Hamzelou

Journal reference: bioRxiv, DOI: 10.1101/107037