NIH-funded research shows genetics can predict success of smoking cessation and need for medications

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Genetics can help determine whether a person is likely to quit smoking on his or her own or need medication to improve the chances of success, according to research published in today’s American Journal of Psychiatry. Researchers say the study moves health care providers a step closer to one day providing more individualized treatment plans to help patients quit smoking.

The study was supported by multiple components of the National Institutes of Health, including the National Institute on Drug Abuse (NIDA), the National Human Genome Research Institute, the National Cancer Institute, and the Clinical and Translational Science Awards program, administered by the National Center for Advancing Translational Sciences.

“This study builds on our knowledge of genetic vulnerability to nicotine dependence, and will help us tailor smoking cessation strategies accordingly,” said NIDA Director Nora D. Volkow, M.D. “It also highlights the potential value of genetic screening in helping to identify individuals early on and reduce their risk for tobacco addiction and its related negative health consequences.”

Researchers focused on specific variations in a cluster of nicotinic receptor genes, CHRNA5-CHRNA3-CHRNB4, which prior studies have shown contribute to nicotine dependence and heavy smoking. Using data obtained from a previous study supported by the National Heart Lung and Blood Institute, researchers showed that individuals carrying the high-risk form of this gene cluster reported a 2-year delay in the median quit age compared to those with the low-risk genes.  This delay was attributable to a pattern of heavier smoking among those with the high risk gene cluster. The researchers then conducted a clinical trial, which confirmed that persons with the high-risk genes were more likely to fail in their quit attempts compared to those with the low-risk genes when treated with placebo. However, medications approved for nicotine cessation (such as nicotine replacement therapies or bupropion) increased the likelihood of abstinence in the high risk groups. Those with the highest risk had a three-fold increase in their odds of being abstinent at the end of active treatment compared to placebo, indicating that these medications may be particularly beneficial for this population.

“We found that the effects of smoking cessation medications depend on a person’s genes,” said first author Li-Shiun Chen, M.D., of the Washington University School of Medicine, St. Louis. “If smokers have the risk genes, they don’t quit easily on their own and will benefit greatly from the medications. If smokers don’t have the risk genes, they are likely to quit successfully without the help of medications such as nicotine replacement or bupropion.”

According to the Centers for Disease Control and Prevention, tobacco use is the single most preventable cause of disease, disability, and death in the United States. Smoking or exposure to secondhand smoke results in more than 440,000 preventable deaths each year — about 1 in 5 U.S. deaths overall. Another 8.6 million live with a serious illness caused by smoking. Despite these well-documented health costs, over 46 million U.S. adults continue to smoke cigarettes.

The study can be found at: http://ajp.psychiatryonline.org/article.aspx?articleID=1169679. For information on tobacco addiction, go to: www.drugabuse.gov/drugs-abuse/tobacco-addiction-nicotine. For more information on tools and resources to help quit smoking, go to: www.smokefree.gov/.

Technorati Tags: Genetics, Nicotine, Quit Smoking

by Shantanu Nundy, MD

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At 3am on Jan 1st 2010 my cousin-brother stubbed his last cigarette. New Year’s resolutions to quit smoking, lose weight, or change another bad habit are certainly not uncommon. Having tried — and failed — to quit a number of times before, my cousin took a bold, new approach to quitting.

Whether a cleverly devised plan, or just a whim, he decided to post his quitting on Facebook.

On January 4th, four days after smoking his last cigarette, he updated his status: “bring it on day 5!” Within hours, three people responded that they “Like” his comment; five others commented favorably with messages such as “Good for you!!!” and “Keep it going, bro.”

Encouraged by the support he received, my cousin posted another update three days later. Using his iPhone he wrote that he ”is one week non-smoking!!!” Again, within hours, eight people responded that they liked his comment and another two offered congratulatory remarks.

Though he didn’t necessarily realize it at the time, my cousin was creating a community of supporters through Facebook. The scientific literature is filled with evidence on the value of peer support for behavior modification. The “T” in the START mnemonic for quitting endorsed by www.smokefree.gov is to “Tell family, friends, and coworkers that you plan to quit.” This recommendation is based on the notion that smoking is not purely a chemical addiction; it has important environmental, social, and cultural elements, too.

Our peers do not only provide support for quitting on good days; they are equally invaluable on bad days. Three days after his last post, my cousin started feeling lousy. He posted having “a crazy head cold. Never felt this crappy in several years.” While he may have had caught a cold, it is more likely that he was going through nicotine withdrawal. Was this a simple update or a call for help? Seven of his friends responded offering home remedies and supportive messages. The next day he was feeling better and posted, “Twelfth smoke free day!,” garnering nine “Like”’s and seven enthusiastic comments. He responded, “Thanks for all the support everyone. Really helps me to stay on the path.”

People who quit often benefit from the support of a physician and other health care providers. Whether it be in the form of counseling, pharmacologic support, or referrals studies show that people who quit with the support of a health care provider have a much higher chance of success.

The problem is that assistance is often needed in real-time. I once shadowed a tobacco cessation counselor at my hospital who offered his cell phone number to every patient he saw, but this kind of dedication is rare. My cousin’s next post read, ”19th smoke-free day in a row. Maybe enjoy a cigar on the 30th day…let me ask my doctor…?” Here, too, surprisingly Facebook offered a solution. I immediately responded applauding him for his progress but also gently suggesting that it was probably too early for a celebratory puff.

Real-time support is critical because the decision to quit smoking isn’t made once. It’s made every day – in fact multiple times a day – whenever the nicotine craving hits. This is a major reason why social networks are so critical. Week 3 he posted that he ”… is wondering why day 21 is harder than 3,4,5 and 6 combined.” While my cousin could have called up 10 of his friends and told them that he was having a difficult time that day, it was clearly easier and perhaps more effective to post about it instead. After seeing his post, I called him to get his mind off of smoking.

Research in smoking cessation and behavior modification has demonstrated the importance of social networks. In recent years, there has been fascinating research showing, for example, that overweight people are more likely to have overweight friends and that happiness is contagious. The challenge in modern day society is how to activate these social networks to affect good.

Previous generations made greater use of formal networks such as religious gatherings, town hall meetings, and social clubs. While these avenues are still important today, increasingly technology is playing a role in defining our communities. While e-networks are less personal, this is not necessarily always a bad thing, especially when it comes to changing bad habits. They also benefit from a wider reach, being more real-time, and increasingly more dynamic.

Whether by design or accident, my cousin stumbled on an innovative approach to leverage social networks to quit smoking. And quitting smoking is just one application of e-social networks. Imagine the analogy for weight loss: “I lost 2 lbs this week!” soliciting responses of “Way to go!”, and “Feeling too lazy to go to the gym” being met with “You can do it! The hardest part is getting there!!”

Finally, though it is not as readily apparent, my cousin is not the only one benefiting from his Facebook posts. The positive effects of social networks go both ways. Friends following his posts are no doubt taking note of his success and being motivated to better themselves. His last post reads: “Still at it 41 days now. Feeling great and about to start a kick ass work out regimen.” Who knows? If he starts posting about his work outs on Facebook, I may just go to the gym more often.

Shantanu Nundy is an internal medicine physician who blogs at BeyondApples.org.

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Technorati Tags: Facebook, Quit Smoking, smoking

By the time I got home from Vietnam I was a confirmed smoker. I went back to college and finished my pharmacy degree. Whenever I was in a situation where I couldn’t smoke, I wouldn’t. But I would make up for it later that night. I always ended up at the end of the day with my full quota of smokes.

After my first son was born, I quit smoking for about a year. I didn’t want to subject him to all of the crud in the cigarette smoke. I did all right until my brother-in-law came home from Vietnam also. He would come over to my house just about every night. He had a lot of things to get out of his system. He had been the door gunner on a helicopter. We would drink beer and talk about his experiences, etc. After a couple of weeks of that I bummed a cigarette. You know what that led to!

As a pharmacist I would see people every day with lung cancer, emphysema and all sorts of smoking related illnesses. It just didn’t register that I was susceptible also.

I admit that I am a control freak. I don’t like surprises. Everything has to be done at the right time and at the right place. The socks have to match the shirt. The belt and the shoes must match. You get the idea. I even tried hypnosis to quit smoking. The doctor said he couldn’t put me under because I wouldn’t relinquish control to him.

A patient of mine, who knew that I was a control freak, because she was one also, asked me why I smoked. She mentioned that she considered it to be a control issue, that the cigarettes were controlling me, not the other way around.

That did it! I looked at that little cigarette in my hand. I realized for the first time who was in charge. That damned little cigarette that wasn’t any bigger than my “pinkie” finger was running my life and ruining my health. I tore up the pack that was in my pocket, just as I had done several times before. Only, this time, I knew it was for good. All the other times that I had tried to quit I had tried to quit for other people. This time I was quitting for me. I was not going to let that little sucker run my life any more!

About twelve hours later, I realized that this was it. I struggled a little once in a while when I would walk through someone else’s puff of smoke. I realized that I missed smoking, but I was not going to let it take over again. That was twenty-five years ago. The smell of cigarettes actually makes me sick now. I even choke when someone smokes next to me outdoors. I don’t complain, because I used to do that to other people.

If you are a smoker, who do you think is in charge, you or your cigarette?

I hope the answer to that question helps you as much as it did me. Realizing that that little cigarette was running my life helped me to end my eight-year quest to quit smoking.

I want you to be in charge!

Technorati Tags: education, health care, health care information, Quit Smoking