Most U.S. adults who vape want to quit, study finds

The following news story was originally posted on MUSC Hollings Cancer Center’s newsroom. View the original story here.

More than 60% of U.S. adults who vape are interested in quitting, according to a study published today in JAMA Network Open by MUSC Hollings Cancer Center researchers. And among those who vape to help them quit smoking, some are successful while others continue smoking and using electronic cigarettes.

The study, which analyzed longitudinal survey data from more than 30,000 adults across the country, aimed to provide the most up-to-date estimate of how many Americans are interested in stopping their use of e-cigarettes or have made past attempts to quit.

According to the findings, former cigarette smokers had the highest intentions and interest in quitting. This is likely due to an increasing number of smokers using e-cigarettes to transition away from cigarettes, said the study’s authors.

While evidence has shown that switching to e-cigarettes can be as effective as medication-based treatments for smoking cessation in some cases, many people continue to vape even after they’ve quit smoking. Those who aren’t able to stop smoking often end up using both cigarettes and e-cigarettes simultaneously, increasing potential risks to their health.

“One of the best things you can do for your health is to stop smoking. While e-cigarettes may work for some people, they’re hindering quit attempts for other people,” said Amanda Palmer, Ph.D., a postdoctoral fellow in MUSC’s Department of Public Health Sciences and the study’s first author.

“What’s interesting about the people who keep using e-cigarettes after they’ve quit smoking is that we don’t really see that effect with other types of nicotine replacement drugs. It’s rare to see someone still using a nicotine patch or nicotine gum months or years after they’ve quit smoking, so there’s something special about e-cigarettes, even though they’re delivering the same drug.”

From one addictive habit to another

Unlike other nicotine replacement therapies, e-cigarettes are created to be addictive and have a similar nicotine curve to regular cigarettes, making it difficult for people to quit. People who use both cigarettes and e-cigarettes often report feeling more addicted and have trouble quitting either product.

To make matters worse, there are currently no evidence-based treatments that help people who want to quit vaping. Psychologists like Benjamin Toll, Ph.D., chief of Tobacco Cessation and Health Behaviors at Hollings and the study’s senior author, can only offer methods that are proven to help people quit smoking, which may not be relevant to adults who vape.

“I think we’re doing patients a disservice by not having rigorous research to give these patients appropriate evidence-based care,” said Toll, who also co-directs Hollings’ Lung Cancer Screening Program. “Many of my patients who have switched to e-cigarettes find it challenging to stop using them. I would like to have data supporting the methods I share with them, and we currently don’t have those in any of our clinical practice guidelines.”

Smoking cessation is best achieved through a combination of medication and behavioral counseling that helps people to break the habit with coping skills and substituted behaviors. But because there may be different reasons and situations that cause people to pick up an e-cigarette versus a cigarette, the methods that help people quit successfully may vary.

Palmer explained it this way. “If you use cigarettes, you’re probably smoking for a short duration 10 to 20 times per day, whereas a lot of our e-cigarette users are vaping continuously all day and in situations where they might not otherwise be smoking,” she said. “That’s evidence that there needs to be different behavioral treatments, because the coping strategies I would recommend to someone who smokes are not the same for someone using e-cigarettes.”

A growing need for data

Aside from uncovering how many people want to quit vaping, this study sheds light on the urgent need to better understand e-cigarette use among adults. Recent estimates show that roughly 3% of U.S. adults vape, but the popularity of these products may be rising.

“A lot of the press and attention around e-cigarette use has to do with youth and adolescents, but it feels like a lot of people older than 25 who use e-cigarettes tend to be left out of that conversation,” said Palmer, who noted that adults are likely vaping for different reasons than those age 18 and younger.

Young people are more likely to vape on an experimental basis, whereas adults — especially those who are using e-cigarettes to quit smoking — are often using them consistently, resulting in a need for tailored interventions.

Now that they know that most adults who vape want to quit eventually, Hollings researchers plan to focus on developing data-driven interventions to help people to achieve that goal.

Palmer is beginning a new pilot study to test basic self-help kits that combine tailored medications and behavioral support that providers can offer to patients who express interest in quitting e-cigarettes. The study will also solicit feedback from providers and adults who vape about what they think they may need to quit or to help their patients quit.

Until more data is available, Palmer and Toll recommend that people who want to use e-cigarettes as a method to stop smoking weigh the pros and cons of all available interventions before making that decision. They also urge patients to speak with their medical providers to determine which approach may be best for them.

“E-cigarettes are addictive and are not 100% safe,” said Palmer. “If you’re considering vaping as a method to quit smoking, consider some of the risks and benefits, and be aware that many people continue to vape after they quit smoking.”

For more information on tobacco cessation services at MUSC or resources to help you quit smoking, visit the Hollings Smoking Cessation website, or call the MUSC Health Tobacco Treatment Program at 843-792-9101 to make an appointment.

Study seeks to better understand how COVID-19 and cancer intersect

The following news story was originally posted on MUSC Hollings Cancer Center’s newsroom. View the original story here.

Researchers at MUSC Hollings Cancer Center have joined a nationwide study to look at the long-term outcomes of cancer patients who have been diagnosed with COVID-19.

The study, which is led by the National Cancer Institute (NCI) and involves the participation of cancer centers across the country, hopes to answer critical questions about how the two diseases intersect, including how often COVID-19 is diagnosed in people with cancer, how COVID-19 impacts cancer treatments and whether the risk of serious illness from COVID-19 is higher in certain cancer subtypes.

While evidence suggests that people who are undergoing cancer treatment are likely at a higher risk of developing a more severe form of COVID-19, little is known about the factors that may make certain patients more prone to COVID-19 infection or how the disease impacts cancer outcomes after a patient has recovered.

According to David Cachia, M.D., a neuro-oncologist at Hollings and the principal investigator for Hollings’ portion of the study, the data being collected will help providers make more informed decisions regarding cancer care for these patients in the future.

“This is a quickly evolving field, and not just when it comes to cancer patients. But specifically, in this population, we have limited data,” said Cachia. “The only way we’ll be able to better manage these patients and determine whether we need to make changes to our current protocols is if we collect this information and understand it better.”

The study, which is known as the NCI COVID-19 in Cancer Patients Study (NCCAPS), is a natural history study, meaning it doesn’t involve any specific treatment procedures and is based on observation. Researchers will simply collect medical records, scans and blood samples and ask participants questions about their symptoms, then follow them for up to two years to study their outcomes over time.

“Collaborating and networking with other institutions allows us to gather more information more quickly, enabling us to come to conclusions much faster and more efficiently than if any institution did this by itself.”

— Dr. David Cachia

Patients can be enrolled and seen via telemedicine to minimize risks associated with traveling to and from Hollings, and blood will be collected during draws that were already scheduled as a part of their cancer care to reduce their burden.

The study is enrolling patients of all ages, including children, across all cancer subtypes. To be eligible, adult participants must have had a positive COVID-19 test within 14 days of enrollment and must be receiving treatment for their cancer, whether that be chemotherapy, targeted therapy, immunotherapy and/or radiation.

Other questions the study hopes to help answer include:

  • Does COVID-19 affect how cancer grows or spreads?
  • Does cancer treatment affect a person’s ability to fight off COVID-19?
  • Are there genetic or immune-related biomarkers associated with severe symptoms or death from COVID-19?
  • Are cancer treatments being delayed when patients are diagnosed with COVID-19, and if so, how do these delays impact outcomes?

The nationwide goal is to enroll 2,000 patients of diverse backgrounds based on age, sex, race, ethnicity, diagnosis and location to be able to better generalize the results to all cancer patients. That’s one of the benefits of collaborating with the NCI and a wide range of health centers, said Cachia.

“We realized many years ago that doing things by yourself is not going to lead to gathering as much information as possible,” said Cachia. “Collaborating and networking with other institutions allows us to gather more information more quickly, enabling us to come to conclusions much faster and more efficiently than if any institution did this by itself.”

Outside of the NCCAPS study, Hollings is also participating in the COVID-19 and Cancer Consortium (CCC19), which is an international project designed to collect and disseminate data about people with cancer who have been diagnosed with COVID-19 as quickly as possible. Initial data released through the consortium’s research on May 28 showed a higher risk of infection among cancer patients when compared with the general population and revealed cancer-specific factors associated with increased mortality.

As researchers gather more information on how best to treat people with both cancer and COVID-19, Cachia recommends that cancer patients who receive a positive COVID-19 test result consult with their oncologist to determine next steps based on their treatment type and the severity of their disease. He also suggests patients reach out to their oncologist once they receive notification that they’re eligible for a COVID-19 vaccine to confirm whether they should proceed with vaccination and to determine the best time to receive it in relation to their oncological treatment.

Because neither of the vaccines (Pfizer and Moderna) that are currently authorized for use in the U.S. were tested in patients undergoing cancer treatment, it’s important to discuss the benefits and risks of vaccination to make an informed decision.

Vaccines aside, Cachia encourages cancer patients to continue following the general safety guidelines set forth for the rest of the population, including social distancing, hand hygiene, wearing a mask and avoiding large gatherings. These precautions are especially important for cancer patients, who are more susceptible to infections in general.

“Avoiding infection with COVID-19 is something that’s on everyone’s mind, especially with the introduction of vaccines that will hopefully help to change the landscape over the coming months as we’re able to vaccinate more people,” said Cachia. “The recommendations are the same for everyone, but cancer patients have to be especially careful about trying to minimize their risk of infection as much as possible.”

This research is supported by the NCI (grant UG1CA189848).

VUMC-led study set to explore risk factors for depression recurrence

The following release was written for Vanderbilt University Medical Center’s news center. View the original story here.

Almost 60% of older adults who have successfully been treated for depression experience a recurrence within four to five years, but little is known about why this happens or who may be at highest risk.

Backed by nearly $5 million in funding, Vanderbilt University Medical Center researchers are conducting a five-year multisite trial to explore potential methods for predicting which patients may have a worse course of depression or are most vulnerable to recurrent episodes.

The longitudinal study, conducted in collaboration with University of Illinois at Chicago and University of Pittsburgh, will enroll 300 adults over the age of 60 who are in remission from depression. Participants will be followed over two years to assess when depression recurs, how symptoms change over time and what factors may be predictive of a return of depression.

“Depression is insidious. It’s not like you wake up one morning and your ‘check engine’ light is on. Stress can build up, things gradually become harder, and over the course of weeks or months, you’ve now slipped into a serious depression,” said Warren Taylor, MD, MHSc, James G. Blakemore Professor of Psychiatry and lead investigator for the study. “Sometimes, it takes a while before a patient even realizes what is happening.”

Study visits will include an MRI to examine whether changes in the brain are associated with depression recurrence, memory testing to see if accelerated memory problems can be linked to long-term outcomes and clinical assessments to determine whether specific symptoms can serve as flags for impending recurrence.

Participants will also be asked to wear a Fitbit activity tracker at various points in the study to explore how physical activity level plays a role in recurrence.

Quick smartphone surveys to assess mood, symptoms and memory performance at different times of day will also be used to monitor patients outside of clinic visits. This will help determine whether using technology for day-to-day monitoring is viable for evaluating those at higher risk to help uncover early warning signs.

Taylor hopes the study will lead to more personalized treatment plans and earlier interventions for recurrent episodes, which currently can only be predicted based on a patient’s history and reported stress level.

“Right now, we know more about how to get someone better than how to keep someone better. We want to see if there are simple, minimally invasive ways to monitor how people are doing to see if we can find triggers,” he said.

“I can’t put a blood pressure cuff on someone and measure their depression, so it’d be nice to have a concrete way of determining an individual’s risk for recurrence. This could guide how we treat people.”

According to Taylor, also director of the Division of Geriatric Psychiatry at VUMC, depression in older adults can be more challenging to treat, as many patients have a lifetime history of depressive episodes and are more prone to medical illness or disability, putting them at higher risk.

Roughly 1 in 20 older adults has a diagnosis of depression, with many first having experienced symptoms in their teens or 20s.

“I always come back to what my patients care about. Once they get better, they become worried about whether they’ll have to go through this again. They ask me how they can avoid it. Beyond advising them to maintain a healthy lifestyle, I don’t have a good answer for them,” said Taylor.

Because depression severity is difficult to measure and bad days are a normal part of life, letting patients know when to be concerned about recurrence is difficult.

“I can’t put a blood pressure cuff on someone and measure their depression, so it’d be nice to have a concrete way of determining an individual’s risk for recurrence. This could guide how we treat people.”

The research is supported by the National Institute of Mental Health (grant MH121620).

Miscarriage risk increases each week alcohol is used in early pregnancy

The following release was written for Vanderbilt University Medical Center’s news center. View the original post here.

Each week a woman consumes alcohol during the first five to 10 weeks of pregnancy is associated with an incremental 8% increase in risk of miscarriage, according to a study published this week by Vanderbilt University Medical Center researchers.

The findings, published in the American Journal of Obstetrics and Gynecology, examine the timing, amount and type of alcohol use during pregnancy and how these factors relate to miscarriage risk before 20 weeks’ gestation.

Impact of alcohol use rises through the ninth week of pregnancy, and risk accrues regardless of whether a woman reported having fewer than one drink or more than four drinks each week. Risk is also independent of the type of alcohol consumed and whether the woman had episodes of binge drinking.

Though most women change their alcohol use after a positive pregnancy test, consuming alcohol before recognizing a pregnancy is common among both those with a planned or unintended pregnancy. Half of the 5,353 women included in the analysis reported alcohol use around conception and during the first weeks of pregnancy.

The median gestational age for stopping alcohol use was 29 days. Although 41% of women who changed their use did so within three days of a positive pregnancy test, those who stopped consumption near their missed period had a 37% greater risk of miscarriage compared to women who did not use alcohol.

“Abstaining from alcohol around conception or during pregnancy has long been advised for many reasons, including preventing fetal alcohol syndrome. Nonetheless, modest levels of consumption are often seen as likely to be safe,” said Katherine Hartmann, MD, PhD, vice president for Research Integration at VUMC and principal investigator for the Right from the Start cohort, from which participants were enrolled in the study.

“For this reason, our findings are alarming. Levels of use that women, and some care providers, may believe are responsible are harmful, and no amount can be suggested as safe regarding pregnancy loss.”

According to the researchers, one in six recognized pregnancies ends in miscarriage, which brings great emotional cost and leaves unanswered questions about why the miscarriage occurred.

Biologically, little is known about how alcohol causes harm during early pregnancy, but it may increase miscarriage risk by modifying hormone patterns, altering the quality of implantation, increasing oxidative stress or impairing key pathways.

Because alcohol use is most common in the first weeks — when the embryo develops most rapidly and lays down the pattern for organ development — understanding how timing relates to risk matters.

Risk did not peak in patterns related to alcohol use in specific phases of embryonic development, and there was no evidence that a cumulative “dose” of alcohol contributed to level of risk.

The study recruited women planning a pregnancy or in early pregnancy from eight metropolitan areas in Tennessee, North Carolina and Texas. Participants were interviewed during the first trimester about their alcohol use in a four-month window.

“Combining the facts that the cohort is large, comes from diverse communities, captures data early in pregnancy and applies more advanced analytic techniques than prior studies, we’re confident we’ve raised important concerns,” said Alex Sundermann, MD, PhD, the study’s first author and recent graduate of the Vanderbilt Medical Scientist Training Program.

To avoid increased risk of miscarriage, the researchers emphasize the importance of using home pregnancy tests, which can reliably detect pregnancy before a missed period, and ceasing alcohol use when planning a pregnancy or when pregnancy is possible.

This work was supported by the National Institutes of Health (grants HD043883, HD049675, HD094345, GM07347, TR000445 and TR002243) and the American Water Works Association Research Foundation. Follow-up is sustained by a VUMC internal fund.