US study finds cannabis use increases among parents with children in the home

New research from scientists at Columbia University’s Mailman School of Public Health and City University of New York indicates that parents who smoke cigarettes in the home are also up to four times more likely to smoke cannabis than parents who do not smoke cigarettes (via Science Daily).


A paper based on the research has been published online in the June version of Pediatrics, where the full article may be read

Background: In this study, we investigated trends in cannabis use among parents with children at home in the United States and estimated changes in prevalence of any cannabis use and daily cannabis use among parents who identified as cigarette smokers and nonsmokers with children in the home from 2002 to 2015.

Methods: The National Survey on Drug Use and Health is an annual, nationally representative, cross-sectional study conducted in the United States. Using logistic regression models, associations between cigarette smoking and any past-month and daily past-month cannabis use among parents with children in the home from 2002 to 2015 were estimated. Moderation of these associations by demographics and trends over time was examined.

Results: Past-month cannabis use among parents with children in the home increased from 4.9% in 2002 to 6.8% in 2015, whereas cigarette smoking declined from 27.6% to 20.2%. Cannabis use increased from 11.0% in 2002 to 17.4% in 2015 among cigarette-smoking parents and from 2.4% to 4.0% among non–cigarette-smoking parents (P value for trends less than .0001). Cannabis use was nearly 4 times more common among cigarette smokers versus nonsmokers, as was daily cannabis use . The overall percentage of parents who used either cigarettes and/or cannabis decreased from 29.7% in 2002 to 23.5% in 2015.

Conclusions: Efforts to decrease secondhand smoke exposure via cigarette smoking cessation may be complicated by increases in cannabis use. Educating parents about secondhand cannabis smoke exposure should be integrated into public education programs on secondhand tobacco smoke exposure.

Full reference:

Goodwin, R. D.,  et al | Trends in Cannabis and Cigarette Use Among Parents With Children at Home: 2002 to 2015Pediatrics| 2018| e20173506 | DOI: 10.1542/peds.2017-3506

New study finds online ads may encourage pregnant smokers to quit

NIHR | April 2018 | Online ads effective at helping pregnant women stop smoking 

An NIHR funded study has found that an online advertising campaign may be more effective in encouraging expectant mothers to quit smoking, than a clinic based intervention. The study was part of a collaboration between the University of Cambridge, University of East Anglia (UEA), and the University of Nottingham (via UEA).

One of the researchers, Dr Felix Naughton, developed MiQuit, which is a text-messaging intervention specifically for pregnant smokers. As it is automated, the women could use it without health professional’s involvement. In tandem with this the research team also  advertised links to a website providing MiQuit information on Google and Facebook, which incurred a cost. Adverts were also placed on the National Childbirth Trust and NHS Choices websites free of charge.

The team found that the Facebook advert generated initiations throughout pregnancy, around 50 per cent of those who initiated MiQuit via Google were within their first five weeks’ gestation. Adverts attached to online search engines may therefore be a useful way to reach women when they are first pregnant and looking for support or information about smoking during pregnancy. Currently, the earliest cessation interventions tend to target pregnant smokers at their antenatal booking appointment, at around 8-12 weeks’ gestation.

Lead author of the study, Dr Joanne Emery, Research Associate at the University of Cambridge, said: “This study shows that online advertising appears to be a valuable means of promoting health interventions to hard-to-reach groups.

“We found that a significant minority of pregnant smokers were willing to initiate an automated text messaging intervention when offered this online. Given the high reach of the internet this could translate into substantial numbers of pregnant smokers supported to quit.” As a result of this study’s findings, a more definitive trial is now underway.

An article based on this study has been published in the Journal of Medical Internet Research


Background: Smoking in pregnancy is a major public health concern. Pregnant smokers are particularly difficult to reach, with low uptake of support options and few effective interventions. Text message–based self-help is a promising, low-cost intervention for this population, but its real-world uptake is largely unknown.

Objective: The objective of this study was to explore the uptake and cost-effectiveness of a tailored, theory-guided, text message intervention for pregnant smokers (“MiQuit”) when advertised on the internet.

Methods: Links to a website providing MiQuit initiation information (texting a short code) were advertised on a cost-per-click basis on 2 websites (Google Search and Facebook; £1000 budget each) and free of charge within smoking-in-pregnancy webpages on 2 noncommercial websites (National Childbirth Trust and NHS Choices). Daily budgets were capped to allow the Google and Facebook adverts to run for 1 and 3 months, respectively. We recorded the number of times adverts were shown and clicked on, the number of MiQuitinitiations, the characteristics of those initiating MiQuit, and whether support was discontinued prematurely. For the commercial adverts, we calculated the cost per initiation and, using quit rates obtained from an earlier clinical trial, estimated the cost per additional quitter.

Results: With equal capped budgets, there were 812 and 1889 advert clicks to the MiQuitwebsite from Google (search-based) and Facebook (banner) adverts, respectively. MiQuitwas initiated by 5.2% (42/812) of those clicking via Google (95% CI 3.9%-6.9%) and 2.22% (42/1889) of those clicking via Facebook (95% CI 1.65%-2.99%). Adverts on noncommercial webpages generated 53 clicks over 6 months, with 9 initiations (9/53, 17%; 95% CI 9%-30%). For the commercial websites combined, mean cost per initiation was £24.73; estimated cost per additional quitter, including text delivery costs, was £735.86 (95% CI £227.66-£5223.93). Those initiating MiQuit via Google were typically very early in pregnancy (median gestation 5 weeks, interquartile range 10 weeks); those initiating via Facebook were distributed more evenly across pregnancy (median gestation 16 weeks, interquartile range 14 weeks).

Conclusions: Commercial online adverts are a feasible, likely cost-effective method for engaging pregnant smokers in digital cessation support and may generate uptake at a faster rate than noncommercial websites. As a strategy for implementing MiQuit, online advertising has large reach potential and can offer support to a hard-to-reach population of smokers.
Full reference: Emery, J.L, Coleman, T., Sutton, S., Cooper, S., Leonardi-Bee, J., Jones, M., & Naughton F. | Uptake of Tailored Text Message Smoking Cessation Support in Pregnancy When Advertised on the Internet (MiQuit): Observational Study | J Med Internet Res |2018| Vol. 20 |4| e146| DOI: 10.2196/jmir.8525|PMID: 29674308
Related: University of East Anglia Online ads help pregnant smokers quit

40 % of smokers (and general population) ignorant about cause of most smoking- related cancer

Public Health England | March 2018 |  Four in 10 smokers incorrectly think nicotine causes cancer

To mark No Smoking Day (14 March 2018)  Public Health England (PHE) emphasise that going ‘cold turkey’ is the least effective approach to quit cigarette smoking.  Despite this more than half (58%) of smokers still try to quit without using an aid. Although smoking rates are at their lowest ever level, there are still nearly 7 million smokers in England.  A PHE report highlights that public misunderstanding of the harmfulness of nicotine containing products, such as nicotine replacement therapy (NRT) and e-cigarettes, may be linked to inaccurate and confused perception of the risks of nicotine.


40 per cent of smokers and ex-smokers incorrectly think that nicotine in cigarettes is the cause of most of the smoking-related cancer. Understanding of the harms of nicotine among the general population is also poor.  In actuality the risks of nicotine use are likely to be very low or negligible but it is the cocktail of deadly chemicals in cigarette smoke, including tar and carbon monoxide, which causes almost all of the harm of smoking. Nicotine replacement therapy (NRT)  is safe and licenced for use in pregnancy and for people with cardiovascular disease. There is also wide international consensus that e-cigarettes are far less harmful than smoking.

The use of quit aids can greatly increase smokers chances of quitting successfully. Research shows that:

  • using NRT as a quit aid, such as patches and gums, or e-cigarettes makes it one and a half times as likely they’ll succeed
  • Their chances of quitting are doubled if using a stop smoking medicine prescribed by a GP, pharmacist or other health professional
  • expert support from a local stop smoking service gives the best chance of quitting successfully
  • combining quit aids with expert support quadruples the likelihood an individual will stop smoking successfully

The full press release is at Public Health England 

Related resources:

Local Tobacco Control Files are available from PHE 

PHE’s e-cigarette review can be read here 

Smoking Prevalence Figures can be found at NHS Digital

Low cigarette consumption and risk of coronary heart disease and stroke: meta-analysis of 141 cohort studies in 55 study reports

A team of researchers led by Professor Allan Hackshaw at the UCL Cancer Institute at University College London analysed the results of 141 studies and estimated the relative risks for smoking one, five, or 20 cigarettes per day. (Science Daily)



Objective To use the relation between cigarette consumption and cardiovascular disease to quantify the risk of coronary heart disease and stroke for light smoking (one to five cigarettes/day).

Design Systematic review and meta-analysis.

Data sources Medline 1946 to May 2015, with manual searches of references.

Eligibility criteria for selecting studies Prospective cohort studies with at least 50 events, reporting hazard ratios or relative risks (both hereafter referred to as relative risk) compared with never smokers or age specific incidence in relation to risk of coronary heart disease or stroke.

Data extraction/synthesis MOOSE guidelines were followed. For each study, the relative risk was estimated for smoking one, five, or 20 cigarettes per day by using regression modelling between risk and cigarette consumption. Relative risks were adjusted for at least age and often additional confounders.

The main measure was the excess relative risk for smoking one cigarette per day (RR1_per_day−1) expressed as a proportion of that for smoking 20 cigarettes per day (RR20_per_day−1), expected to be about 5% assuming a linear relation between risk and consumption (as seen with lung cancer). The relative risks for one, five, and 20 cigarettes per day were also pooled across all studies in a random effects meta-analysis. Separate analyses were done for each combination of sex and disorder.

Results The meta-analysis included 55 publications containing 141 cohort studies. Among men, the pooled relative risk for coronary heart disease was 1.48 for smoking one cigarette per day and 2.04 for 20 cigarettes per day, using all studies, but 1.74 and 2.27 among studies in which the relative risk had been adjusted for multiple confounders.

In women, the pooled relative risks were 1.31 and 2.16 for smoking one or 20 cigarettes per day (1.46 and 2.42 using relative risks adjusted for multiple factors). The excess risk for stroke associated with one cigarette per day (in relation to 20 cigarettes per day) was 41% for men and 34% for women (or 64% and 36% using relative risks adjusted for multiple factors). Relative risks were generally higher among women than men.

Conclusions Smoking only about one cigarette per day carries a risk of developing coronary heart disease and stroke much greater than expected: around half that for people who smoke 20 per day. No safe level of smoking exists for cardiovascular disease. Smokers should aim to quit instead of cutting down to significantly reduce their risk of these two common major disorders.


Full reference: Hackshaw, A. et al.| Low cigarette consumption and risk of coronary heart disease and stroke: meta-analysis of 141 cohort studies in 55 study reports| BMJ| Vol. 360,  2018, p.1-15, j5855

Story available from Science Daily

View the full journal article here

Related editorial  Johnson, K. | Just one cigarette a day seriously elevates cardiovascular riskBMJ 2018  | Vol. 360, 2018,  p. 1-2, k167

Professionals trained to help smokers quit

Public Health England (PHE) has confirmed that nearly 40,000 healthcare professionals have been trained to offer quit smoking advice as part of a drive to make the NHS smoke-free by 2019. In support of the plan, PHE is urging all NHS frontline staff to take advantage of free online training to help them give ‘very brief advice on smoking’ (VBA). The evidence shows that giving VBA to patients makes them 68% more likely to quit if they’re offered stop smoking medication.  

Quit rates for smoking at their highest for a decade

Success rates for quitting smoking are at their highest level for a decade, according to new figures. Experts suggest the use of e-cigarettes may be an important factor. | via OnMedica

Nearly one in five (19.8%) quit attempts were successful in the first half of 2017, up from an average of 15.7% over the last decade. The figures come from researcher carried out by University College London, with support from Cancer Research UK.

The researchers collected data from over 18,000 participants using cross-sectional household surveys from January 2007 to June 2017. The findings reveal that quit smoking success rates in England in the first six months of 2017 were higher than the average rate during the preceding decade.

Full report: Quit success rates in England 2007-2017