Hidden Consequence E-cigs

By R. Ryan S Patel DO, FAPA OSU-CCS Psychiatrist

Electronic cigarettes or E-cigs, have become popular in recent years for a variety of reasons.
Some tout the tobacco free alternative as a way to lower cancer risk.  Others claim it’s less addictive and less risk of lung disease.  These claims have been investigated via long term studies.

There are also risks of much higher nicotine ingestion than traditional (tobacco based) cigarettes leading to nicotine toxicity (1).
A recent small study, by Barrington-Trimis and colleagues, suggest another unexpected consequence of e-cigarette use (2).
Who was studied?
300 students,  in the 11th or 12th grade (2).
What was the study design? (2)
  • Questionnaires were given in the 11th or 12th grade, and again after they turned 18 years old.
  • Some questions included whether they use e-cigarettes, traditional (tobacco) cigarettes, whether they  smoke tobacco based cigarettes now or intend to do so in the future.
What were the results?  (2)
  • 40% of participants who reported e-cigarette use at the beginning of the study ended up using traditional (tobacco) cigarettes by age 18, vs only 11% of students who never used e-cigarettes.
  • After adjusting for different variables,  e-cigarette users were over 5 times as likely to initiate traditional smoking as those who had never used e-cigarettes.
  • The e-cigarette users who reported having no intention of smoking traditional (tobacco) cigarettes at the beginning of the study had a 9.7 x odds ratio of using traditional cigarettes by the end of the study.
What do the results mean?
  • According to this study, smoking e-cigarettes might increase your chances of smoking tobacco based cigarettes.
  • This is concerning because of the variety of negative mental health and physical consequences of tobacco use.
  • Smoking cigarettes can increase depression and anxiety (3,4).
Is e-cigarettes worth the feelings of anxiety, depression, and tiredness? Will you feel better if you exchange it for healthier ways of living?
What are some resources regarding tobacco use?
Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.
References:
1. Ordonez J, Forrester MB, Kleinschmidt K. Electronic cigarette exposures reported to poison centers. Clin Toxicology 2013;51:685
2. Barrington-Trimis JL, Urman R, Berhane K, et al. E-Cigarettes and Future Cigarette Use. Pediatrics. 2016; 138(1):e20160379
3. https://u.osu.edu/emotionalfitness/2015/04/15/does-smoking-increase-anxiety-and-depression-if-i-quit-will-i-feel-better/
4. Taylor G, et al. Change in mental health after smoking cessation: systematic review and meta-analysis. OPEN ACCESS. BMJ 2014;348:g1151 doi: 10.1136/bmj.g1151 (Published 13 February 2014)

Study: Smoking might increase your alcohol intake

By R. Ryan S Patel DO, FAPA, OSU-CCS Psychiatrist    alcohol and smokes (3)

Over 26 studies show (4) that smoking contributes to anxiety and depression and that you can feel good and increase happiness by quitting tobacco.
Students might also know about smoking cigarettes raising your risk of cancer, stroke, heart disease, breathing problems (1) and that quitting smoking can reduce these risks (2-3).
A recent study suggests smoking might increase your alcohol consumption (5-6).

What was the study?
In this animal study (5-6), rats were trained to press a bar to obtain alcohol and were exposed to nicotine or saline in different experimental designs.

What did the study show?
This study showed that, in alcohol-dependent animals, nicotine increased:
• The speed at which alcohol was ingested,
• The amount of work that animals would do to obtain alcohol (i.e., the number of times they would press a bar to get one dose), and
• The amount of drinking despite adverse consequences

What do the results suggest?
Quitting smoking might help you drink less or quit alcohol completely. Further study is needed.

How can I quit smoking?
http://swc.osu.edu/alcohol-tobacco-other-drugs/quit-tobacco/
http://tobaccofree.osu.edu/resources/
http://smokefree.gov/
http://www.cancer.org/healthy/stayawayfromtobacco/guidetoquittingsmoking/index
http://www.cancer.org/cancer/cancercauses/tobaccocancer/smokelesstobaccoandhowtoquit/index

Where can I learn more about alcohol?
How much is too much, Strategies for cutting down, quitting can be found here:
http://www.ccs.osu.edu/self-help/alcohol/
http://rethinkingdrinking.niaaa.nih.gov/default.asp

Take the OSU Free Anonymous Mental health Screen

Is smoking impacting your alcohol intake? Could you stand to feel better? Perform better academically? What other consequences are you experiencing from smoking or alcohol or both?

Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.

References
1. US Department of Health and Human Services. The health consequences of smoking: a
report of the Surgeon General. US Department of Health and Human Services, 2004.
2. US Department of Health and Human Services. The health benefits of smoking cessation.
US Department of Health and Human Services, 1990.
3. Pirie K, Peto R, Reeves G, Green J, Beral V. The 21st century hazards of smoking and
benefits of stopping: a prospective study of one million women in the UK. Lancet
2013;381:133-41.
4. Taylor G, et al. Change in mental health after smoking cessation: systematic review and meta-analysis. OPEN ACCESS. BMJ 2014;348:g1151 doi: 10.1136/bmj.g1151 (Published 13 February 2014).

5. Leão RM et al. Chronic nicotine activates stress/reward-related brain regions and facilitates the transition to compulsive alcohol drinking. J Neurosci 2015 Apr 15; 35:6241. (http://dx.doi.org/10.1523/JNEUROSCI.3302-14.2015);
6. May 4, 2015. Want to Stop Drinking? Don’t Smoke. Steven Dubovsky MD reviewing Leão RM et al. J Neurosci 2015 Apr 15. http://www.jwatch.org/na37661/2015/05/04/want-stop-drinking-dont-smoke?query=etoc_jwpsych#sthash.94sXS2T4.dpuf

Does smoking increase anxiety and depression? If I quit, will I feel better?

By R. Ryan S Patel DO, FAPA, OSU-CCS Psychiatristrainbow cigarette (3)

Most students know about harmful effects of smoking cigarettes including the risk of cancer, stroke, heart disease, breathing problems (1). Students may also know that stopping smoking reduces these health risks (2-3).

Most people may not know that smoking contributes to anxiety and depression and that you can feel good and increase happiness by quitting smoking.

 

This study (4) analyzed mental health inforation across 26 studies and looked at positive and negative changes in mental health before and after quitting smoking cigarettes.

What did the study show?
When compared to smokers, 7 weeks to 9 years after quitting smoking, those who quit smoking reported a DECREASE in:
• Anxiety
• Depression
• Mixed anxiety and depression
• Stress
When compared to smokers, 7 weeks to 9 years after quitting smoking, those who quit smoking reported an INCREASE in:
• Psychological quality of life 0.22 Positive affect significantly 0.40
• This improvement occurred whether or not participants had anxiety or depression before quitting smoking.

But I thought people smoke to be less anxious and depressed?
• When they have not smoked for a while, smokers experience irritability, anxiety, and depression (6, 7)
• These feelings are relieved by smoking (5) thus creating the perception that smoking has psychological benefits, while in fact it is smoking that caused these psychological disturbances in the first place.

How can I quit smoking?

http://swc.osu.edu/alcohol-tobacco-other-drugs/quit-tobacco/

http://tobaccofree.osu.edu/resources/

http://smokefree.gov/
http://www.cancer.org/healthy/stayawayfromtobacco/guidetoquittingsmoking/index
http://www.cancer.org/cancer/cancercauses/tobaccocancer/smokelesstobaccoandhowtoquit/index

You may want to talk to your doctor/prescriber about medications and nicotine replacement as additional options that can help you quit.

Is smoking worth anxiety, depression and feeling bad? Is it zapping your energy level? How good will you feel after you stop smoking for good?

Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.
References
1. US Department of Health and Human Services. The health consequences of smoking: a
report of the Surgeon General. US Department of Health and Human Services, 2004.

2. US Department of Health and Human Services. The health benefits of smoking cessation.
US Department of Health and Human Services, 1990.

3. Pirie K, Peto R, Reeves G, Green J, Beral V. The 21st century hazards of smoking and
benefits of stopping: a prospective study of one million women in the UK. Lancet
2013;381:133-41.

4. Taylor G, et al. Change in mental health after smoking cessation: systematic review and meta-analysis. OPEN ACCESS. BMJ 2014;348:g1151 doi: 10.1136/bmj.g1151 (Published 13 February 2014)
5. Parrott AC. Does cigarette smoking cause stress? Am Psychol 1999;54:817-20.

6. Hughes JR. Effects of abstinence from tobacco: valid symptoms and time course. Nicotine
Tob Res 2007;9:315-27.

7. Guthrie SK, Ni L, Zubieta JK, Teter CJ, Domino EF. Changes in craving for a cigarette
and arterial nicotine plasma concentrations in abstinent smokers. Prog
NeuroPsychopharmacol Biol Psychiatry 2004;28:617-23.