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March 17th, 2020:

British American Tobacco circumventing ad ban, experts say

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Secondhand smoke kills one person for every 52 smokers

Secondhand smoke kills one person for every 52 smokers, study says. That’s a million people worldwide each year

https://edition.cnn.com/2020/03/17/health/deaths-secondhand-smoke-wellness/index.html

(CNN)It took a mere 52 smokers to kill one person via secondhand smoke in 2016, according to a new analysis of worldwide statistics on the impact of smoking.

Considering there are an estimated billion smokers in the world, that means a million people die each year simply by inhaling the smoke around them, according to the study published Tuesday in the journal JAMA Network Open.

“There’s a sense of secondhand smoke being benign, or not as damaging as the actual smoking is,” said study co-author Dr. Jagat Narula, associate dean of global affairs at the Icahn School of Medicine at Mount Sinai in New York City.

“But it’s truly deadly,” Narula added.

“This study confirms what other research has shown: That nonsmokers are at risk from secondhand smoke and that no one should be exposed to it,” said Dr. Albert Rizzo, chief medical officer for the American Lung Association, who was not involved in the study.

“While it may be called ‘secondhand,’ the health effects of those exposed are truly firsthand,” Rizzo said.

Role of smokers

Secondhand smoke is defined as the mixture of the smoke breathed out by the smoker combined with the smoldering end of a cigarette, cigar or pipe. According to the United States National Library of Medicine, secondhand smoke contains more than 7,000 chemicals, 70 of which are known to cause cancer and hundreds more are toxic.

Even a low dose of secondhand smoke can contribute to sudden infant death and cause ear infections and asthma attacks in children while causing cancer and heart disease in adults.

“In 2006 the US Surgeon General declared there was no safe level of exposure to secondhand smoke,” Rizzo said.

While the harmful effects of secondhand smoke have been known for years, no one knew the full impact on deaths on a global basis, Narula said.

“We wanted to calculate how many smokers are needed to kill one innocent nonsmoker,” he said.

The Mount Sinai researchers worked in tandem with colleagues at the Amsterdam Medical Center, Amsterdam UMC, to analyze a number of datasets from the World Health Organization, the Global Burden of Disease Reports, International Mortality and Smoking Statistics and others.

They looked at the number of active smokers and secondhand smoke victims over a 26-year period from 1990 to 2016.

They developed a “secondhand smoke index” and applied it to North America; South Asia; Middle East and North Africa; East Asia and Pacific; Europe and Central Asia; Sub-Saharan Africa; Latin America and the Caribbean.

Globally, in 1990 it took only 31 smokers to kill one person; in 2016 that number rose to 52 smokers, the study found — an improvement due to smoking bans in restaurants, business and the like in some countries.

North America had the most favorable secondhand smoke index: around 86 smokers for each death. The Middle East and Southeast Asia had least favorable numbers due to few protective measures — around 43 smokers to one death.

More protections needed, study says

Despite the advances in some countries, the absolute number of people who smoked between 1990 and 2016 has been on the rise, the study says. That’s mostly due to the increase in smoking in China and India and other low-to-middle income countries, a trend which is expected to continue.

“This study demonstrates the devastating effect of secondhand smoke,” Narula said. By putting the blame for deaths directly at the feet of smokers, he added, this study will hopefully “influence public opinion against secondhand smoke exposure” and encourage governments to pass and enforce “stringent” anti-tobacco controls.

While developing countries need to step up their game, there is still much to be done in the US and other developed countries, said lead author Dr. Leonard Hofstra, a professor of cardiology at Amsterdam UMC.

“There is a lot to gain when it comes to strengthening policies to protect nonsmokers, especially children,” he said. “For example, it should not be allowed for parents to smoke inside their cars with them.”

Twenty-two states in the US have “not yet passed comprehensive laws protecting their citizens — and the Lung Association calls on them to do so,” Rizzo said, adding that the public can also make use of online tools provided by the American Lung Association “to end their addiction.”

CNN reached out to various tobacco companies for their response but did not hear back before our publication deadline.

Even One THC Hit Carries Risk for Inducing Psychosis

Meta-Analysis: Even One THC Hit Carries Risk for Inducing Psychosis
— Evidence suggested adding CBD does not ameliorate these effects

https://www.medpagetoday.com/psychiatry/generalpsychiatry/85472?xid=nl_mpt_morningbreak2020-03-18&eun=g220600d0r

The psychoactive components of cannabis were linked to new-onset psychotic symptoms even at low doses, according to a systematic review and meta-analysis.

Across nine studies involving 196 healthy young adults, tetrahydrocannabinol (THC) was associated with significantly increased total symptom severity on the Brief Psychiatric Rating Scale compared with placebo (standardized mean change 1.10, 95% CI 0.92-1.28, P<0.0001) even at low doses, ranging from 1.25 mg to 10 mg, reported Oliver Howes, MD, PhD, of King’s College London, and colleagues.

Also, just one of four studies in which cannabidiol (CBD) was administered concurrently with THC found CBD administration reduced these symptoms, they wrote in the Lancet Psychiatry.

“Our findings highlight the risk of psychiatric symptoms after even a single dose of some THC-containing cannabis products,” Howes told MedPage Today in an email.

These findings add to the “growing scientific consensus” in support of the psychosis-cannabis link, an association that appears to be bidirectional, wrote Carsten Hjorthøj, PhD, and Christine Merrild Posselt, PhD, both of the University of Copenhagen in Denmark, in an accompanying commentary.

“In some people, cannabis leads to incident psychosis, whereas in other people, psychosis leads to incident cannabis use,” they wrote.

Hjorthøj and Posselt cautioned against extrapolating these findings to assume “single doses of THC will eventually lead to schizophrenia,” but also emphasized that “caution should not be thrown to the wind.”

For example, CBD in particular has been touted as a potential “wonder drug” with antipsychotic, anxiety-reducing effects, but the findings here suggest the usefulness of CBD and other cannabis extracts “might be somewhat exaggerated compared with what we can expect in clinical practice,” they continued.

This meta-analysis involved double-blind, placebo-controlled studies of healthy participants administered IV, oral, or inhaled THC with or without CBD. Individuals were generally in their mid-20s and predominantly male.

Of the 15 studies included, 13 were considered to have a “low” risk of bias and two studies had a “moderate” risk, as measured through the Newcastle Ottawa Scale. The authors calculated the SMR scores for “positive (including delusions and hallucinations), negative (such as blunted affect and amotivation), and general (including depression and anxiety) symptoms,” they explained.

Compared with placebo, THC was associated with significantly increased positive symptom severity scores in 14 studies (SMC 0.91, 95% CI 0.68-1.14, P<0.0001), negative symptom severity scores in 12 studies (SMC 0.78, 95% CI 0.59-0.97, P<0.0001), and general symptoms in eight studies (SMC 1.01, 95% CI 0.77-1.25, P<0.0001), researchers reported.

THC was also associated with increased total symptom severity versus placebo regardless of whether it was administered intravenously or inhaled (P=0.37), and regardless of whether participants were frequent or current cannabis users (P=0.73, P=0.95, respectively), the authors noted.

However, intravenous THC was associated with slightly “more pronounced” increased symptoms than inhalation, although this may be confounded by dose, they added.

The induction of psychotic symptoms was also lower in people with higher versus lower tobacco use, suggesting tobacco use may be a “protective factor,” the authors noted, although they cautioned against using tobacco to “counter” THC effects.

Howes told MedPage Today that “[another] possibility suggested by other evidence is that tobacco reduces the levels of the protein in the brain that THC binds to so it has less effect. This needs testing, and it is important that people don’t think tobacco will protect against the effects of THC containing cannabis.”

Many of the meta-regression analyses used involved fewer than 10 studies and were underpowered to detect small or moderate effects, which is a limitation, the authors noted. More participants were male than female, so the generalizability of these findings is also limited, they added. Researchers were additionally unable to differentiate the effects of THC on specific symptoms, like hallucinations or delusions.

Smoking or Vaping May Increase the Risk of a Severe Coronavirus Infection

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