Simon Thornley

Effect of an electronic nicotine delivery device (e cigarette) on desire to smoke and withdrawal, user preferences and nicotine delivery: randomised cross-over trial

Objectives To measure the short-term effects of an electronic nicotine delivery device (“e cigarette”, ENDD) on desire to smoke, withdrawal symptoms, acceptability, pharmacokinetic properties and adverse effects. Design Single blind randomised repeated measures cross-over trial of the Ruyan V8 ENDD. Setting University research centre in Auckland, New Zealand. Participants 40 adult dependent smokers of 10 or more cigarettes per day. Interventions Participants were randomised to use ENDDs containing 16 mg nicotine or 0 mg capsules, Nicorette nicotine inhalator or their usual cigarette on each of four study days 3 days apart, with overnight smoking abstinence before use of each product. Main outcome measures The primary outcome was change in desire to smoke, measured as “area under the curve” on an 11-point visual analogue scale before and at intervals over 1 h of use. Secondary outcomes included withdrawal symptoms, acceptability and adverse events. In nine participants, serum nicotine levels were also measured. Results Over 60 min, participants using 16 mg ENDD recorded 0.82 units less desire to smoke than the placebo ENDD (p=0.006). No difference in desire to smoke was found between 16 mg ENDD and inhalator. ENDDs were more pleasant to use than inhalator (p=0.016) and produced less irritation of mouth and throat (p<0.001). On average, the ENDD increased serum nicotine to a peak of 1.3 mg/ml in 19.6 min, the inhalator to 2.1 ng/ml in 32 min and cigarettes to 13.4 ng/ml in 14.3 min. Conclusions The 16 mg Ruyan V8 ENDD alleviated desire to smoke after overnight abstinence, was well tolerated and had a pharmacokinetic profile more like the Nicorette inhalator than a tobacco cigarette. Evaluation of the ENDD for longer-term safety, potential for long-term use and efficacy as a cessation aid is needed. Trial registration No.12607000587404, Australia and New Zealand Clinical Trials Register

National prevalence of gout derived from administrative health data in Aotearoa New Zealand

OBJECTIVE Previous small studies in Aotearoa New Zealand have indicated a high prevalence of gout. This study sought to determine the prevalence of gout in the entire Aotearoa New Zealand population using national-level health data sets. METHODS We used hospitalization and drug dispensing claims for allopurinol and colchicine for the entire Aotearoa New Zealand population from the Aotearoa New Zealand Health Tracker (ANZHT) to estimate the prevalence of gout in 2009, stratified by age, gender, ethnicity and socio-economic status (n = 4 295 296). RESULTS were compared with those obtained from an independent large primary care data set (HealthStat, n = 555 313). Results. The all-ages crude prevalence of diagnosed gout in the ANZHT population was 2.69%. A similar prevalence of 2.89% was observed in the HealthStat population standardized to the ANZHT population for age, gender, ethnicity and deprivation. Analysis of the ANZHT population showed that gout was more common in Māori and Pacific people [relative risk (RR) 3.11 and 3.59, respectively], in males (RR 3.58), in those living in the most socio-economically deprived areas (RR 1.41) and in those aged >65 years (RR >40) (P-value for all <0.0001). The prevalence of gout in elderly Māori and Pacific men was particularly high at >25%. CONCLUSION Applying algorithms to national administrative data sets provides a readily available method for estimating the prevalence of a chronic condition such as gout, where diagnosis and drug treatment are relatively specific for this disease. We have demonstrated high gout prevalence in the entire Aotearoa New Zealand population, particularly among Māori and Pacific people.

Conspicuity and bicycle crashes: preliminary findings of the Taupo Bicycle Study.

Objective: To describe the methods, characteristics of participants, and report on the preliminary findings of a longitudinal study of cyclists. Design: Web-based survey to establish a cohort of cyclists. Setting: Participants in the largest mass-participation bicycle event in New Zealand, the Wattyl Lake Taupo Cycle Challenge. Participants: 2469 riders who had enrolled online in the 2006 Wattyl Lake Taupo Cycle Challenge. Main outcome measures: Self-reported crashes in preceding 12 months. Results: Of 5653 eligible riders, 2469 (44%) completed the study questionnaire. Mean age was 44 years, 73% were male, and the average number of kilometers cycled per week in the preceding 12 months was 130. The annual incidence of crashes leading to injury that disrupted usual daily activities for at least 24 h was 0.5 per cyclist/year. About one-third of these crashes resulted in presentation to a health professional. The mean number of days absent from work attributable to bicycle crashes was 0.39 per cyclist/year. After adjustment for potential confounders and exposure (kilometers cycled per year), the rate of days off work from bicycle crash injury was substantially lower among riders who reported always wearing fluorescent colors (multivariate incidence rate ratio 0.23, 95% CI 0.09 to 0.59). Conclusions: Low cyclist conspicuity may increase the risk of crash-related injury and subsequent time off work. Increased use of high-visibility clothing is a simple intervention that may have a large impact on the safety of cycling.

Statin use in COPD patients is associated with a reduction in mortality: a national cohort study.

AIMS To assess whether statin use is associated with reduced mortality in patients with chronic obstructive pulmonary disease (COPD). METHODS Hospitalisation, drug dispensing, and mortality records were linked for New Zealanders aged 50-80 years discharged from hospital with a first admission with COPD in 2006. Patients were classified according to whether or not they were prescribed statins prior to admission. Baseline characteristics were compared and hazard ratios calculated for statin users versus statin non-users for all-cause mortality over follow-up of up to 4 years. RESULTS A total of 1,687 patients (mean age 70.6 years) were followed, including 596 statin users and 1,091 non-users. There were more men in the statin user group (58.4% vs. 48.5%), and statin users were more likely to have a history of cardiovascular disease (58.6% vs. 25.1%), prescription for frusemide as a proxy for heart failure (47.7% vs. 24.5%) or diabetes (35.4% vs.11.6%) than statin non-users (p<0.001). A total of 671 deaths occurred during the follow-up period. After adjustment for age, sex, ethnic group, history of cardiovascular disease, diabetes, and prescription for frusemide, the hazard ratio for statin users vs. statin non-users for all-cause mortality was 0.69 (95% CI 0.58 to 0.84). CONCLUSIONS Statin use is associated with a 30% reduction in all-cause mortality at 3-4 years after first admission for COPD, irrespective of a past history of cardiovascular disease and diabetes.

Reduced acute hospitalisation with the healthy housing programme

Background This study investigated the impact of the Healthy Housing Programme in reducing acute hospitalisations in South Auckland, New Zealand. The programme involved house modifications to reduce overcrowding, insulation and ventilation improvements, and health and social service assessments, referrals and linkages. Methods An intervention evaluation was used. Participants in the programme were considered cases following their houses intervention and counterfactuals/controls prior to the intervention. Rigorous age-censoring was used to construct a case-counterfactual comparison. 9736 residents of 3410 homes were involved in the programme from September 2001 to December 2007. All lived in areas of relative deprivation (NZDep01=decile 10) and almost all self-identified as Pacific ethnic group. The main outcome measure was acute hospitalisation rates before, during and after a health and housing intervention. Hospital data were gathered from July 1999 to January 2009. Results In the post-intervention group, people aged 5–34 years had a HR of 0.77 (95% CI 0.70 to 0.85) for acute hospitalisations compared to the counterfactual (pre-intervention). For children aged 0–4 years the HR was 0.89 (95% CI 0.79 to 0.99); a non-significant increase occurred in adults aged 35 years plus. When the causes of hospitalisation were restricted to those related to housing, further falls in the HRs were seen: 0.88 (95% CI 0.74 to 1.05) for 0–4 year olds and 0.73 (95% CI 0.58 to 0.91) for 5–34 year olds. Conclusion A package of care that addresses housing conditions that impact on health and improves access to health and social services is associated with a reduced acute hospitalisation rate for 0–34 year olds.

The obesity epidemic: is glycemic index the key to unlocking a hidden addiction?

High body mass index (BMI) is an important cause of a range of diseases and is estimated to be the seventh leading cause of death globally. In this paper we discuss evidence that food consumption shows similarities to features of other addictive behaviours, such as automaticity and loss of control. Glycemic index is hypothesised to be the element of food that predicts its addictive potential. Although we do not have substantive evidence of a withdrawal syndrome from high glycemic food abstinence, anecdotal reports exist. Empirical scientific and clinical studies support an addictive component of eating behaviour, with similar neurotransmitters and neural pathways triggered by food consumption, as with other drugs of addiction. The public health implications of such a theory are discussed, with reference to tobacco control. Subtle changes in the preparation and manufacturing of commonly consumed food items, reducing glycemic index through regulatory channels, may break such a cycle of addiction and draw large public health benefits.

A randomized trial of the effects of two novel nicotine replacement therapies on tobacco withdrawal symptoms and user satisfaction

AIMS To determine effects on craving, user satisfaction, and consumption patterns of two new nicotine replacement therapies (NRT) used for eight hours after overnight tobacco abstinence. DESIGN In a within-subject, cross-over trial participants were randomly assigned Zonnic nicotine mouth spray (1 mg/spray), Zonnic nicotine lozenge (2.5 mg), Nicorette gum (4 mg) and placebo lozenge on each of four study days. SETTING University research unit. PARTICIPANTS Forty-seven dependent adult smokers. MEASUREMENTS Participants rated their urges to smoke, irritability, concentration and restlessness before and during the first hour of product use on a 100-point scale. A subsample of 11 participants provided blood samples for nicotine analysis. FINDINGS All active products reduced craving significantly more than placebo (mean reductions of 28.6, 25.8, 24.7 and 8.9 points for mouth spray, gum, lozenge and placebo). Mouth spray relieved craving faster than placebo and gum with significant reductions within five minutes of use (mean differences of -14.5 (95% CI: -23.0 to -6.0) and -10.6 (95% CI: -19.1 to -2.1) with placebo and gum respectively. Mouth spray produced a faster time to maximum plasma nicotine concentration (14.5 minutes, 95% CI: 8.0 to 21.0) compared to the lozenge (30.3 minutes, 95% CI: 21.1 to 39.5) and gum (45.8 minutes, 95% CI: 36.2 to 55.4). Maximum concentrations of blood nicotine were higher with mouth spray (10.0 ng/ml) and lozenge (10.8 ng/ml) compared to gum (7.8 ng/ml). Both lozenge and mouth spray were well tolerated. CONCLUSIONS The mouth spray and lozenge are at least as effective as 4 mg nicotine gum in relieving craving suggesting that they are likely to be effective in aiding smoking cessation. The mouth spray may be particularly useful for acute craving relief.

Indoor Air Pollution Levels Were Halved as a Result of a National Tobacco Ban in a New Zealand Prison

INTRODUCTION Few studies have measured the effect of tobacco bans on secondhand smoke (SHS) exposure in prisons. From June 1, 2011, the sale of tobacco was prohibited in New Zealand prisons. One month later, the possession of tobacco was banned. We studied the indoor air quality before and after this policy was enforced. METHODS We measured indoor-fine-particulate (PM(2.5)) concentrations using a TSI SidePak photometer. The instrument was placed in a staff base of a New Zealand maximum-security prison, adjacent to four 12-cell wings. Measurements were made before the sales restriction, during this period, and after the ban. Data were summarized using daily geometric means and generalized least squares regression. RESULTS A total of 7,107 observations were recorded at 5-min intervals, on 14 days before and 15 days after implementation, between 24 May and 5 August. Before the policy was implemented, the geometric mean was 6.58 μg/m(3) (95% CI = 6.29-6.58), which declined to 5.17 μg/m(3) (95% CI = 4.93-5.41) during the sales ban, and fell to 2.44 μg/m(3) (95% CI = 2.37-2.52) after the smoking ban. Regression analyses revealed an average 57% (95% CI = 42-68) decline in PM(2.5) concentrations, comparing the before and after periods. CONCLUSIONS Our study showed a rapid and substantial improvement in indoor air quality after tobacco was banned at a prison. We conclude that prisoners have reduced their smoking in line with the ban, and that a significant health hazard has been reduced for staff and prisoners alike.

Regional variations in pedal cyclist injuries in New Zealand: safety in numbers or risk in scarcity?

Objective: To assess regional variations in rates of traffic injuries to pedal cyclists resulting in death or hospital inpatient treatment, in relation to time spent cycling and time spent travelling in a car.

Per capita sugar consumption is associated with severe childhood asthma: an ecological study of 53 countries.

AIMS To examine the ecological association between population asthma symptom prevalence in six to seven year-old children and per capita sugar consumption seven years earlier (during the perinatal period). METHODS The asthma data (from the International Study of Asthma and Allergies in Childhood [ISAAC] study) were collected between 1999 and 2004 from 53 countries, and per capita sugar consumption data (seven years before the asthma prevalence) were extracted from United Nations Food and Agriculture (UNFAO) food balance sheets. Linear regression and Spearmans rank coefficient were used to evaluate the relationship between exposure and disease outcome. RESULTS Per capita sugar consumption varied more than six fold-between countries. A log-linear relationship was found between severe asthma symptoms (%) and per capita added sugar consumption in kg/capita/year (exponentiated beta coefficient 1.020; 95% CI 1.005 to 1.034; P = 0.012). Spearmans rank correlation coefficient was 0.34 (P= 0.015), which indicates moderate correlation. CONCLUSIONS We have demonstrated an ecological association between sugar consumption during the perinatal period and subsequent risk of severe asthma symptoms in six and seven year-olds.