A new study finds that the inevitable cognitive decline we all face starts earlier than we originally thought. Christie Nicholson reports.

Nicotine replacement therapies (NRTs) designed to help people stop smoking, specifically nicotine patches and nicotine gum, do not appear to be effective in helping smokers quit long-term, even when combined with smoking cessation counseling, according to a new study by researchers at Harvard School of Public Health (HSPH) and the University of Massachusetts Boston. The study appears January 9, 2012 in an advance online edition of Tobacco Control and will appear in a later print issue.

"What this study shows is the need for the Food and Drug Administration, which oversees regulation of both medications to help smokers quit and tobacco products, to approve only medications that have been proven to be effective in helping smokers quit in the long-term and to lower nicotine in order to reduce the addictiveness of cigarettes," said co-author Gregory Connolly, director of the Center for Global Tobacco Control at HSPH.

In the prospective cohort study the researchers, including lead author Hillel Alpert, research scientist at HSPH, and co-author Lois Biener of the University of Massachusetts Boston's Center for Survey Research, followed 787 adult smokers in Massachusetts who had recently quit smoking. The participants were surveyed over three time periods: 2001-2002, 2003-2004, and 2005-2006. Participants were asked whether they had used a nicotine replacement therapy in the form of the nicotine patch (placed on the skin), nicotine gum, nicotine inhaler, or nasal spray to help them quit, and if so, what was the longest period of time they had used the product continuously. They also were asked if they had joined a quit-smoking program or received help from a doctor, counselor, or other professional.

The results showed that, for each time period, almost one-third of recent quitters reported to have relapsed. The researchers found no difference in relapse rate among those who used NRT for more than six weeks, with or without professional counseling. No difference in quitting success with use of NRT was found for either heavy or light smokers. "This study shows that using NRT is no more effective in helping people stop smoking cigarettes in the long-term than trying to quit on one's own," Alpert said. He added that even though clinical trials (studies) have found NRT to be effective, the new findings demonstrate the importance of empirical studies [emphasis added] regarding effectiveness when used in the general population.

Biener said that using public funds to provide NRT to the population at large is of questionable value, particularly when it reduces the amount of money available for smoking interventions shown in previous studies to be effective, such as media campaigns, promotion of no smoking policies, and tobacco price increases. Smoking cessation medications have been available over the counter since 1996, yet U.S. Centers for Disease Control and Prevention statistics show that the previous adult smoking rate decline and quitting rates have stalled in the past five years.  

UCSF analysis suggests penny-per-ounce tax on sugary beverages would prevent heart disease, stroke and diabetes and save billions in healthcare costs

Every year, Americans drink 13.8 billion gallons of soda, fruit punch, sweet tea, sports drinks, and other sweetened beverages—a mass consumption of sugar that is fueling soaring obesity and diabetes rates in the United States. Now a group of scientists at the University of California, San Francisco (UCSF), San Francisco General Hospital and Trauma Center (SFGH) and Columbia University have analyzed the effect of a nationwide tax on these sugary drinks. They estimate slapping a penny-per-ounce tax on sweetened beverages would prevent nearly 100,000 cases of heart disease, 8,000 strokes, and 26,000 deaths every year. "You would also prevent 240,000 cases of diabetes per year," said Kirsten Bibbins-Domingo, an associate professor of medicine and of epidemiology and biostatistics at UCSF and acting director of the Center for Vulnerable Populations at SFGH.

In addition to $13 billion in direct tax revenue, Bibbins-Domingo and her colleagues estimated that such a tax would save the public $17 billion per year in healthcare-related expenses due to the decline of obesity-related diseases. "Our hope is that these types of numbers are useful for policy makers to weigh decisions," she said.

The High Cost of High Calorie Drinks
Consumption of beverages high in calories but poor in nutritional value is the number one source of added sugar and excess calories in the American diet. Sugar- sweetened drinks are linked to type 2 diabetes and weight gain. The U.S. Centers for Disease Control and Prevention listed reducing the intake of these beverages as one of its chief obesity prevention strategies in 2009, and several states and cities, including California and New York City, are already considering such taxes.

The analysis by Bibbins-Domingo and her colleagues is among the first study to generate concrete estimates of the health benefits and cost savings of such a tax. They modeled these benefits by taking into account how many sodas and sugary beverages Americans drink every year and estimating how much less they would consume if a penny-per-ounce tax were imposed on these drinks. Economists have estimated that such a tax would reduce consumption by 10 to 15 percent over a decade. They then modeled how this reduction would play out in terms of reducing the burdens of diabetes, heart disease and their associated healthcare costs.