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

Report launch: New issues and age-old challenges: a review of young people’s relationship with tobacco | 27/02/17

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Join Prof Amanda Amos and Prof Marcus Munafo to discuss the current landscape, challenges and opportunities including a focus on young people, tobacco and mental health.

Please book your free please here>

The face of youth smoking in the UK is evolving.  Young people are growing up in a society radically disrupted by new technologies and societal norms, which are reshaping their perceptions of personal health, image, and values.

New issues and age-old challenges: a review of young people’s relationship with tobacco, brings together the available evidence on youth smoking and articulates a clear demand for action across the system.

Martin Dockrell from Public Health England will chair the panel session.

Full agenda is available here>

MAJOR NEW REPORT  – UK HOSPITALS FAIL TO MEET NATIONAL STANDARDS IN EITHER HELPING PATIENTS QUIT SMOKING OR PROVIDING ‘SMOKE-FREE ENVIRONMENTS’

 

According to a major new report launched today (7/12/16) by the British Thoracic Society (BTS), NHS hospitals across UK are falling ‘woefully short’ of national standards on helping patients to quit smoking and enforcing smoke-free premises.

Experts f1-mediumpresenting the findings at the British Thoracic Society (BTS) Winter Meeting, will state that many NHS hospitals are missing out on a ‘golden opportunity’ to provide what is often the most effective front-line treatment for smoking patients who are sick  –  support and medication to help them quit tobacco.

The BTS Report ‘Smoking cessation: policy and practice in NHS hospitals’ is
unique in its scope and size; reviewing the smoking cessation & smoke-free policies and practices of 146 hospitals across UK between April and May 2016 – including the analysis of 14,750 patient records.

The main findings of the report are as follows:

  • Over 7 in 10 (72%) hospital patients who smoked were not asked if they’d like to stop
  • Only 1 in 13 (7.7%) hospital patients who smoked were referred for hospital-based or community treatment for their tobacco addiction
  • Over 1 in 4 (27%) hospital patients were not even asked if they smoke
  • Only 1 in 10 hospitals completely enforce their fully smoke-free premises. Rates of enforcement were even lower for hospitals which provided areas where smoking was allowed. The report highlights the importance of a smoke-free NHS – to trigger and support quit smoking attempts for patients and reduce second hand smoke exposure for children, staff and the public
  • Provision of nicotine replacement therapies and other smoking cessation treatments were ‘poor’ in hospital pharmacy formularies
  • Only 26% of hospitals had an identified consultant ‘lead’ overseeing their smoke-free and smoking cessation plans
  • 50% of frontline healthcare staff in hospitals were not offered training in smoking cessation

In the study, 25% of hospital patients were recorded as being ‘current smokers’ – which is higher than rates in the general adult population (19%)   Other studies have shown that approximately 1.1 million smokers are admitted to NHS hospitals a year.

The Society is using the report findings to call for all hospitals to deliver NICE Guidelines in this area (PH48) and that national regulators such as the Care Quality Commission (CQC) hold Hospital Boards accountable for the delivery of smoke-free and smoking cessation hospital policies.

The report also highlights a number of key activities that all NHS hospitals should deliver to help more of their patients quit smoking:

  1. Offer a prescription for Nicotine Replacement Therapy to all patients who smoke to help them cope with their tobacco dependence whilst in hospital
  1. Refer all patients who smoke in hospital to specialised stop smoking support services to explore the option of quitting smoking. Patients can opt out if they like – but the NHS should try to offer the most effective treatment and support whatever the illness – and with many smoking-related conditions such as chronic obstructive pulmonary disease (COPD), support and medication to help people quit smoking are the best front line treatments
  1. Employ an appropriately skilled senior clinician within the hospital to oversee, drive forward, and be accountable for the hospital’s smoking cessation service
  1. Employ smoking cessation practitioners in every hospital – this was recommended by NICE in 2013 but the report shows patchy delivery across the country
  1. Hospital Board involvement in delivering plans is key. Delivering smoke-free hospital grounds – as part of a wider smoking cessation policy – requires Hospital Boards to work together including the chief executive, director of human resources, director of facilities and the medical and nursing directors – in partnership with the ‘smoking cessation lead’ at the hospital

The Society is also encouraging more health professionals to become BTS ‘Stop Smoking Champions’ in their hospital. There are over 160 at present and they deliver a range of vital activities to champion stop smoking service provision.

For further information, contact stopsmokingchampions@brit-thoracic.org.uk or to see a video about the initiative go to: https://www.brit-thoracic.org.uk/standards-of-care/quality-improvement/smoking-cessation/bts-stop-smoking-champions/

Dr Sanjay Agrawal, Consultant Lung Specialist & Chair of the British Thoracic Society’s Tobacco Group, who led the audit said:

“Our report shows that many NHS hospitals are woefully failing to meet national guidance on delivering smoking cessation services and smoke-free premises. This is a dangerous situation that is costing the country dear in both health and economic terms. We must do better. Critically, hospitals are missing out on a golden opportunity to help supply often THE most effective treatment for illnesses that smokers are admitted with – support and treatment for their tobacco dependence.  If patients in other disease areas were not offered, by default, the most effective way to treat their condition – there would probably be an uproar. Nevertheless, this happens all too frequently with people with smoking-related illnesses. Many hospital boards need to sort out their leadership, plans and resources on this issue – so they can deliver some simple but life-changing steps: identify patients who smoke, ask them if they’d like to quit – and give effective treatment and support to help them stop.”

Dr Lisa Davies, Consultant Respiratory Physician at Aintree University Hospital and Chair of the British Thoracic Society Board, said:

“Being admitted to hospital should be a real window of opportunity for smokers to quit – given that smoking should be prohibited on the premises, tobacco use may be linked to their health condition, and expert stop smoking advice and therapies are potentially ‘on tap.’ This report shows, however, that we need to fund, plan and deliver smoking cessation work in hospitals far better – so we can fully deliver on this opportunity for our patients.

At a wider level, there is a real fight going on for the future of stop smoking support services in this country.  Many local authorities, facing overall budget reductions, have cut funding for community-based stop smoking services – meaning that people who need support may have nowhere to go.

The NHS must urgently work together, alongside local authorities, to plan and fund these vital services – to ensure no-one who needs treatment and support to stop smoking falls through the net.”

British Thoracic Society – UK hospitals fail to meet national standards in helping patients to quit smoking

British Thoracic Society, Smoking Cessation Audit Report:

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External news sources:

AOL – Hospitals ‘woefully failing’ to crack down on smoking

The Guardian – A third of children hospitalised with asthma ‘exposed to cigarette smoke’

Birmingham Mail – Number of patients forced to wait for hospital bed ‘rockets in five years’

NHE – All STPs urged to help patients quit smoking

The BMJ – NHS hospitals must help patients quit smoking, says British Thoracic Society

Experts say WHO needs better understanding of the evidence on e-cigs to inform its international tobacco control treaty.

A new WHO report fails to properly evaluate the evidence on e-cigarettes and could even undermine international efforts to reduce smoking, says a group of UK based academics.

UK academics are calling for better understanding of the potential benefits of e-cigarettes to reducing the smoking pandemic ahead of an international gathering of countries that have signed the World Health Organisation’s Framework Convention for Tobacco Control.

The 7th session of the Conference of the Parties (COP) of the Framework Convention on Tobacco Control (FCTC), a global public health treaty, will be held in Delhi, India from 7th-12th November 2016. At this meeting, Parties to the treaty (countries and other jurisdictions) will discuss whether similar policy measures recommended to reduce tobacco use should be applied to e-cigarettes.

In advance of the COP the World Health Organisation published a report about Electronic Nicotine Delivery Systems (ENDS) and Electronic Non-Nicotine Delivery Systems (ENDDS), also known as e-cigarettes. This aimed to summarise the evidence about these devices.

Academics from the UK Centre for Tobacco and Alcohol Studies, a UKCRC Public Health Research Centre of Excellence, have today published a robust critique of the WHO report setting out a series of concerns about the content of the document which, in their view, screen-shot-2016-10-26-at-12-37-14does not fairly represent existing evidence on e-cigarettes. Their critique examines each element of the WHO report and identifies flaws in the way the evidence is presented and problems with how the report could be interpreted, potentially encouraging countries to adopt excessive restrictions on e-cigarettes which could undermine efforts to reduce smoking.

The UKCTAS critique points to evidence set out in the recent Royal College of Physician’s’ report ‘Nicotine without Smoke’ and subsequent research which recognise that e-cigarettes are far less harmful than smoking and that smokers who find it difficult to stop should be encouraged to use them.

The WHO report fails to accurately present what is already known about e-cigarettes. In particular, it: positions e-cigarettes as a threat rather than an opportunity to reduce smoking; fails to accurately quantify any risks of e-cigarettes compared with smoking; misrepresents existing evidence about any harms to bystanders; discounts the fact that e-cigarettes are helping smokers to quit; does not recognise the place of some promotion of e-cigarettes to encourage smokers to switch to these less harmful products; fails to understand that the flavours in e-cigarettes are useful for people trying to stop smoking; mischaracterises the current e-cigarette market screen-shot-2016-10-26-at-12-39-18and appears to support very restrictive policies on e-cigarettes without including any good policy analysis. In addition, the WHO report does not acknowledge that significant restrictions on e-cigarettes could lead to unintended consequences, including increases in smoking.

Finally, the researchers point out that the WHO briefing is based on four unpublished papers which are still undergoing peer review, which does not allow for open, transparent scrutiny of the evidence. This does not, therefore, provide a good basis for policy making and risks undermining rather than promoting the aims of the FCTC, which is a treaty that was designed to help countries reduce smoking rates and save lives.

To read the full report click here.

Continue reading

Cheap alcohol: the price we pay and the road to Minimum Unit Pricing!

It has been five years since alcohol partners from across the UK carried out their last comprehensive price survey. A lot has happened in that time. The Coalition Government committed to introduce a minimum unit price (MUP) to tackle the harm caused by the cheapest alcohol. Then, with encouragement from sections of the alcohol industry, they decided to postpone its introduction until the outcome of a legal challenge to minimum unit pricing in Scotland had been resolved. The alcohol duty escalator – which increased duty by 2% above inflation – was scrapped. Wider duty rates were cut. And alcohol harm continued to rise.

Four member organisations of the Alcohol Health Alliance (AHA) – the Institute of Alcohol Studies; Alcohol Focus Scotland; Balance, the North East Alcohol Office; and Healthier Futures – decided to check how those changes had affected the price of alcohol that is available in communities across England and Scotland.

As part of the survey, the partners visited a range of off-sales premises looking for the nation’s cheapest booze. Almost 500 products were examined and the conclusion is clear – alcohol continues to be sold at pocket money prices in supermarkets and off-licences across the UK.

Chairman of the AHA and former president of the Royal College of Physicians, Professor Sir Ian Gilmore, said:

“In spite of a government commitment to tackle cheap, high-strength alcohol, these products are still available at pocket money prices. Harmful drinkers and children are still choosing the cheapest products – predominantly white cider and cheap vodka.

We need to make excessively cheap alcohol less affordable through the tax system, including an increase in cider duty. It’s not right that high strength white cider is taxed at a third of the rate for strong beer. 

In addition, we need minimum unit pricing. This would target the cheap, high strength products drunk by harmful drinkers whilst barely affecting moderate drinkers, and it would leave pub prices untouched.”

Each year, there are almost 23,000 deaths and more than 1 million hospital admissions related to alcohol in England.

More than two-thirds of alcohol sold in the UK is purchased in supermarkets and off-licences.

Headline Findings

  • Alcohol continues to be sold at pocket money prices, with white cider dominating the market for cheap, high-strength drinks.
  • High-strength white cider products, which are predominantly drunk by dependent and underage drinkers, are sold for as little as 16p per unit of alcohol.
  • For the cost of a standard off-peak cinema ticket you can buy seven and a half litres of 7.5% ABV white cider, containing as much alcohol as 53 shots of vodka.
  • Recent cuts in alcohol taxes allow shops and supermarkets to sell alcohol at pocket money prices but have done little to benefit pubs and their customers.
  • High-strength white cider is taxed at the lowest rate of all alcohol products. A can of 7.5% ABV white cider attracts less than one-third of the duty on a can of beer that is the same strength.

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Recommendations

The Government needs to:

  1. Increase duty on high-strength cider
  2. Reinstate the alcohol duty escalator
  3. Upon leaving the EU, tax all alcoholic drinks categories in proportion to strength
  4. Implement a minimum unit price for all alcoholic drinks.

Minimum unit pricing and tax – dispelling the myths

A minimum unit price would only target the highest strength drinks that cause the most harm. There are many myths surrounding minimum unit pricing, which the alcohol industry uses to dissuade people from supporting it. We have included here just a few of those myths and our responses.

Myth: An MUP would affect moderate drinkers too.
Moderate drinkers would experience very little impact from minimum unit pricing, which makes it one of the most effective measures, as it only targets the most harmful drinks of the kind deliberately sought out in this survey. The price of a pint of beer in a pub, for example, would not be affected by minimum unit pricing.
Myth: Taxation would be more effective than an MUP.
Recent research from the University of Sheffield found that, to achieve the same level of impact as an MUP of 50p, a 28% increase in all alcohol duty would be needed, which is outside the realms of possibility when it comes to what the Government will do. Everyone would be affected by these measures, whereas minimum unit pricing only targets the cheapest, strongest drinks.
Myth: Tax and minimum unit pricing cannot be used together.
Increasing duty and introducing an MUP are often presented as alternative solutions, when they can in fact be used to complement each other. Minimum unit pricing is targeted at the cheapest alcohol that is consumed by the most harmful drinkers but there are limits to its impact on wider population alcohol consumption and health, which increases to duty overall would help to tackle.

Tax rises and tougher rules on alcohol promotions work well,
but they will always work better when combined with minimum unit pricing.

Read the full report here.

Are recent attempts to quit smoking associated with reduced drinking in England? | Research report

 

This study sought to address the following research questions:

  • What is the association among smokers in England between a recent attempt to quit smoking and alcohol consumption?
  • What is the association among smokers with higher risk alcohol consumption in England between a recent attempt to stop smoking and a current attempt to cut down on their drinking?

The researchers looked at the association among smokers in England between a recent attempt to quit smoking and alcohol consumption. They identified smokers as light or heavy drinkers (light was indicated with an Audit-C score below 5 and heavy was indicated with an Audit-C score greater than 5) and analysed their recent attempt to stop smoking (identified by those who had attempted to quit in the last week with those who had not) and a current attempt to cut down on their drinking.

This was an observational study which means that it cannot demonstrate cause and effect. It may be that smokers choose to restrict their alcohol consumption when attempting to quit smoking to reduce the chance of relapse. Alternatively, it could be that people who drink less are more likely to quit smoking. If this is the case, smokers with higher alcohol consumption may need further encouragement to quit smoking.

Jamie Brown said “We can’t yet determine the direction of causality. Further research is needed to disentangle whether attempts to quit smoking precede attempts to restrict alcohol consumption or vice versa. We’d also need to rule out other factors which make both more likely. Such as the diagnosis of a health problem causing attempts to cut down on both drinking and smoking.”

This study is part of an ongoing Smoking Toolkit Study and Alcohol Toolkit Study, designed to provide tracking information about smoking, alcohol consumption and related behaviors in England. Each month a new sample of approximately 1700 adults aged 16 and over complete a face-to-face computer assisted survey. The Smoking Toolkit Study and the Alcohol Toolkit Study are primarily funded by Cancer Research UK and the NIHR School for Public Health Research respectively.

Background

Alcohol consumption during attempts at smoking cessation can provoke relapse and so smokers are often advised to restrict their alcohol consumption during this time. This study assessed at a population-level whether smokers having recently initiated an attempt to stop smoking are more likely than other smokers to report i) lower alcohol consumption and ii) trying to reduce their alcohol consumption.

Method

Cross-sectional household surveys of 6287 last-year smokers who also completed the Alcohol Use Disorders Identification Test consumption questionnaire (AUDIT-C). Respondents who reported attempting to quit smoking in the last week were compared with those who did not. Those with AUDIT-C≥5 were also asked if they were currently trying to reduce the amount of alcohol they consume.

Results

After adjustment for socio-demographic characteristics and current smoking status, smokers who reported a quit attempt within the last week had lower AUDIT-C scores compared with those who did not report an attempt in the last week (βadj = −0.56, 95 % CI = −1.08 to −0.04) and were less likely to be classified as higher risk (AUDIT-C≥5: ORadj  = 0.57, 95 % CI = 0.38 to 0.85). The lower AUDIT-C scores appeared to be a result of lower scores on the frequency of ‘binge’ drinking item (βadj  = −0.25, 95 % CI = −0.43 to −0.07), with those who reported a quit attempt within the last week compared with those who did not being less likely to binge drink at least weekly (ORadj = 0.54, 95 % CI = 0.29 to 0.999) and more likely to not binge drink at all (ORadj  = 1.70, 95 % CI = 1.16 to 2.49). Among smokers with higher risk consumption (AUDIT-C≥5), those who reported an attempt to stop smoking within the last week compared with those who did not were more likely to report trying to reduce their alcohol consumption (ORadj = 2.98, 95 % CI = 1.48 to 6.01).

Conclusion

Smokers who report starting a quit attempt in the last week also report lower alcohol consumption, including less frequent binge drinking, and appear more likely to report currently attempting to reduce their alcohol consumption compared with smokers who do not report a quit attempt in the last week.

Lead author Jamie Brown, from University College London, England, said:

“These results go against the commonly held view that people who stop smoking tend to drink more to compensate. It’s possible that they are heeding advice to try to avoid alcohol because of its link to relapse.”

   Who was involved?

Jamie Brown, Robert West, Emma Beard, Alan Brennan, Colin Drummond, Duncan Gillespie, Matthew Hickman, John Holmes, Eileen Kaner, Susan Michie.

BMC Public Health, 2016; 16 (1) DOI: 10.1186/s12889-016-3223-6

Read the full report on BMC here!

 

 

Unravelling the alcohol harm paradox: a population-based study of social gradients across very heavy drinking thresholds | Research report

 

Who was involved?

Dan Lewer – Imperial College Healthcare NHS Trust, Charing Cross Hospital

Petra Meier – ScHARR, University of Sheffield

Emma Beard – Department of Epidemiology & Public Health and Department of Clinical, Educational and Health Psychology, University College London

Sadie Boniface – National Addications Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London

Eileen Kaner – Institute of Health and Society, Newcastle University

Background to the research:

There is consistent evidence that individuals in higher socioeconomic status groups are more likely to report exceeding recommended drinking limits, but those in lower socioeconomic status groups experience more alcohol-related harm. This has been called the ‘alcohol harm paradox’. Such studies typically use standard cut-offs to define heavy drinking, which are exceeded by a large proportion of adults. Our study pools data from six years (2008–2013) of the population-based Health Survey for England to test whether the socioeconomic distribution of more extreme levels of drinking could help explain the paradox.

Methods used:

The study included 51,498 adults from a representative sample of the adult population of England for a cross-sectional analysis of associations between socioeconomic status and self-reported drinking. Heavy weekly drinking was measured at four thresholds, ranging from 112 g+/168 g + (alcohol for women/men, or 14/21 UK standard units) to 680 g+/880 g + (or 85/110 UK standard units) per week. Heavy episodic drinking was also measured at four thresholds, from 48 g+/64 g + (or 6/8 UK standard units) to 192 g+/256 g + (or 24/32 UK standard units) in one day. Socioeconomic status indicators were equivalised household income, education, occupation and neighbourhood deprivation.

Results of the study:

Lower socioeconomic status was associated with lower likelihoods of exceeding recommended limits for weekly and episodic drinking, and higher likelihoods of exceeding more extreme thresholds. For example, participants in routine or manual occupations had 0.65 (95 % CI 0.57–0.74) times the odds of exceeding the recommended weekly limit compared to those in ‘higher managerial’ occupations, and 2.15 (95 % CI 1.06–4.36) times the odds of exceeding the highest threshold. Similarly, participants in the lowest income quintile had 0.60 (95 % CI 0.52–0.69) times the odds of exceeding the recommended weekly limit when compared to the highest quintile, and 2.30 (95 % CI 1.28–4.13) times the odds of exceeding the highest threshold.

Conclusions

Low socioeconomic status groups are more likely to drink at extreme levels, which may partially explain the alcohol harm paradox. Policies that address alcohol-related health inequalities need to consider extreme drinking levels in some sub-groups that may be associated with multiple markers of deprivation. This will require a more disaggregated understanding of drinking practices.

Read the full report here.