Smoking is one of the leading causes of death in the world. About 80% of smokers start smoking before the age of 18. In the Appalachian area and the South in the United States, smoking percentages among adults and adolescents are higher than in other regions. Female smoking shows a variety of different trends from male smoking, and smoking brings particular health problems related to production to female smokers. These findings highlighted the importance of studying female teenage smokers in southwest Virginia. The initial project aimed to identify risk factors that might prevent smoking in an early stage. Dr. Helen Crawford led the Cognitive Neuroscience Lab at Virginia Tech in discovering the psychophysiological vulnerabilities of female teenage smokers. Toward this end, event-related potential (ERP), personality, and behavioral data were collected in teenage female smokers and non-smokers. These data were analyzed to examine possible psychophysiological vulnerabilities in female teenage smokers such as deficits in brain and cognitive function, personality traits, and environment influences. The purpose of this dissertation is to further analyze these data to elaborate and clarify the relationships among these vulnerabilities toward understanding teenage smoking behavior. Participants were 49 teenage girls (smokers and non-smokers) with age from 14 to 18. The measures included sensory gating, platelet MAO-B activity, attention, memory, temperament, schizotypal personality, recognition of facial expressions, taste and smell. The initial set of analyses compared smokers and non-smokers, including those classified as high and low dependent, on all dependent measures. The results suggested some psychophysiological vulnerabilities in female teenage smokers, which have been used as support for the self-medication and the orbito-frontal dysfunction models of why teenagers smoke (Crawford et al., 2004). Further examination of these factors may help teenagers to reduce the smoking dependency and possibly improve cognitive function. Specifically, this dissertation focused on the role of the variable of monoamine oxidase-B (MAO-B) in the correlations among sensory gating, MAO and other cognitive and personality measures. All smokers were divided into high and low MAO groups first. Comparison analyses were conducted between them. The high MAO group showed better sensory gating function than the low MAO group. Correlation analyses were conducted among all of the measures. The significant linear relationships between MAO and sensory gating, MAO and CO level and MAO and temperament were demonstrated. MAO activity positively correlated with the sensory gating function and negatively correlated with CO level and temperament characteristics. Finally, to explore the mechanisms of the relationship between MAO and sensory gating, the neurotransmitter systems related to MAO and sensory gating were discussed. / Ph. D.

Cigarette smoking is prevalent worldwide and has consistently been the top preventable cause of many serious diseases., which result in huge mortality, morbidity, and economic loss, in recent decades. In recent years, nicotine vaccines that can induce production of nicotine specific antibodies in human have emerged as a promising medicine to treat tobacco addiction. In the past decade, there have been numerous nicotine vaccine candidates evaluated in human clinical trials, including NicVaxNicVAX®, TA-NICTA-NIC®, Nic002NIC002®, NiccineNiccine®, and SEL-068SEL-068®. . However, traditional nicotine vaccine designs haves many disadvantages, including low immunogenicity, low specificity, difficulty in integration of molecular adjuvants, and short immune response persistence. To overcome the above limitations, in this study, various nanoparticle-based vaccine delivery systemsvaccine componentss have been developed and evaluated as potential delivery vehicles for vaccines against nicotine addiction. Firstly, a nicotine vaccine was synthesized by conjugating bovine serum albumin (BSA)-nicotine complex to the surface of nano-sized cationic liposome. Significantly higher anti-nicotine antibody titer was achieved in mice by liposome delivered nicotine vaccine compared with nicotine-BSA vaccine. Secondly, a novel nanoparticle (NP)-based delivery platform was constructed by incorporating a negatively charged nanohorn into cationic liposome to improve the stability of liposome and reduce nanoparticle flocculation. Subsequently, nicotine vaccine was constructed by conjugating nicotine-BSA complex to the surface of the nanohorn supported liposome (NsL). Marked improvement in stability in vitro and significant increase in titer of anti-nicotine antibodies were detected in nanohorn supported liposome ( NsL) delivered vaccine than liposome delivered vaccine. In addition, NsL nicotine vaccine exhibited good safety in mice after multiple injections. Thirdly, lipid- poly(lactic-co-glycolic acid) (PLGA) hybrid NPs were constructed as vaccine delivery system. due to the fact that nanohorn is not currently approved for clinical use, we substituted the nanohorn with poly(lactic-co-glycolic acid) (PLGA) nanoparticles and constructed PLGA-lipid hybrid nanoparticles. Preliminary results showed that PLGA-lipid hybrid NPs nanoparticles exhibited improved stability, better controlled release of antigens, as well as enhanced uptake by dendritic cell (DC). A lipid-PLGA hybrid NPnanoparticle was also developed that was structurally responsive to low pH challenge. The lipid shell of the hybrid nanoparticle was rapidly disintegrated under a low pH challenge, which resembles the acidic environment of endosomes in DCsdendritic cells. The hybrid NPs exhibited minimal antigen release in human serum at physiological pH, but a faster release of antigen from this NP compared to non-pH sensitive NPs was observed in DC. In the final study, hybrid NPnanoparticles with various cholesterol concentrations were constructed. Slower and more controlled release of antigens in both human serum and phosphate buffered saline were detected in nanoparticles with higher cholesterol content. However, nanoparticles containing higher cholesterol showed poorer stability due to increase fusion among NPnanoparticles. It was later found that PEGylation of NPs can effectively minimize fusion caused size increase after long term storage, leading to improved cellular uptake. The findings from this study on the nanohorn-lipids based nicotine vaccine as well as lipid-PLGA hybrid NPs may provide solid basis for future development of lipid-PLGA based nicotine vaccine. / Ph. D.

No / In 2013, the World Health Organization referred to tobacco smoking as an epidemic and a great threat to human health. Despite the obvious exposures from first- and secondhand smoking contributing to illnesses, an increased cancer risk, and death, there is a hidden risk to the next generation(s) from transgenerational mutations. In human populations, paternal preconceptional germ cell damage leading to genomic instability in offspring has always been difficult to evaluate as preconceptional and gestational exposures usually cannot be analyzed independently. Clear indications have been found that the effect of pre- and periconceptional paternal smoking may have been transmitted to the offspring via the spermatozoal genome and epigenome. Hence, cigarette smoke has to be considered a human germ cell mutagen due to its potential of inducing transgenerational DNA alterations in the unexposed F1 offspring of smoking-exposed fathers. For cohort studies, the practice of almost exclusively employing mother–childbirth pairs for the evaluation of lifestyle factors, such as smoking, while excluding the fathers’ contribution has to be reconsidered. Evidence now strongly points to the necessity of including the fathers in order not to miss paternal transgenerational damage in the offspring. This applies for genetic, epigenetic, and other transmissible effects.

Although considerable literature can be found concerning the etiology of cigarette smoking, research suggests that a major gap exists pertaining to predictors of adolescent smoking for rural populations. The purpose of this study is to compare risk and protective factors for adolescents living in rural and urban environments. An ecological framework was used to examine variables from the individual, family, peer, school, and community contexts. The influence of these variables was assessed on a sample of (n=3,166) 8th, 10th, and 12th grade students from Virginia public schools. Linear regression analyses revealed that parental attitudes and best friends' smoking behavior was influential in the smoking behavior of both rural and urban adolescents. School and community level variables were only influential in smoking behavior among the urban adolescents. / Master of Science

Yes / Smokers attend preferentially to cigarettes and other smoking-related cues in the environment, in what is known as an attentional bias. There is evidence that attentional bias may contribute to craving and failure to stop smoking. Attentional retraining procedures have been used in laboratory studies to train smokers to reduce attentional bias, although these procedures have not been applied in smoking cessation programmes. This trial will examine the efficacy of multiple sessions of attentional retraining on attentional bias, craving, and abstinence in smokers attempting cessation. This is a double-blind randomised controlled trial. Adult smokers attending a 7-session weekly stop smoking clinic will be randomised to either a modified visual probe task with attentional retraining or placebo training. Training will start 1 week prior to quit day and be given weekly for 5 sessions. Both groups will receive 21 mg transdermal nicotine patches for 8–12 weeks and withdrawal-orientated behavioural support for 7 sessions. Primary outcome measures are the change in attentional bias reaction time and urge to smoke on the Mood and Physical Symptoms Scale at 4 weeks post-quit. Secondary outcome measures include differences in withdrawal, time to first lapse and prolonged abstinence at 4 weeks post-quit, which will be biochemically validated at each clinic visit. Follow-up will take place at 8 weeks, 3 months and 6 months post-quit. This is the first randomised controlled trial of attentional retraining in smokers attempting cessation. This trial could provide proof of principle for a treatment aimed at a fundamental cause of addiction. / National Institute for Health Research (NIHR) Doctoral Research Fellowship (DRF) awarded to RB (DRF-2009-02-15)

The content of the Diploma "Analysis of Communication Anti-Smoking Campaigns" is firstly the introduction of the issue of social campaigns, its marketing principle and also important elements and aspects which are typical for these campaigns. There is also the presentation of tobacco policy in the Czech Republic and the environment in which we operate. Another important part of the Diploma shows the specific anti-tobacco campaigns and projects that have been realized both in the Czech Republic and the other states and presents analysis of their communication and the key elements and forms which are used in campaigns. Then there is presented a research, which was conducted through a questionnaire and which was answered by 256 respondents. Its main objective was to determine the attitudes and opinions of Czech public towards antismoking policies, their personal experience with specific campaigns and also the perception of policy and consumption of tobacco in the country. Many interesting results emerged from the research. Most of the respondents do not consider anti- smoking policy in the Czech Republic too intense, they also do not trust the effects of anti- smoking campaigns, and they would appreciate harsher and more naturalistic advertising and stricter rules on the use of tobacco and cigarettes.

Approximately 135,000 Brazilians die from smoking-related diseases every year (ERIKSEN et al., 2015). Due to the relevance of smoking as a public health problem, some states and municipalities implemented restrictive smoke-free environments from 2008 onwards. The national regulation became effective only in 2014. In this paper we explore the regional differences in the adoption of this policy to evaluate its impacts on cigarette consumption in Brazil. We propose a difference-in-differences approach to estimate the effects throughout the years on the smoking behavior of two age groups: adults and youths. We also estimate the impacts according to different levels of enforcement among states. We have built our panel using micro data from the National Health Research, collected by the Brazilian Bureau of Statistics (IBGE) in 2013. Our results indicate that smoking bans reduced daily cigarette consumption among young individuals in 7% on average, by reducing smoking initiation. This impact increases to 10% when considering higher enforced smoking bans and vanishes when the law is not enforced. In absolute values, it represents from 64 to 80 thousand less smokers among young individuals in the treated capitals. No impacts were found on smoking initiation and on smoking prevalence among adults, but high enforced smoking bans are related to 1.2% smoking cessation rate. Robustness tests show that the results are consistent. Our paper contributes to the literature providing evidences to developing countries on the effects of tobacco control policies / Aproximadamente 135.000 brasileiros morrem por doenças relacionadas ao tabagismo anualmente (ERIKSEN et al., 2015). Devido à relevância do tabagismo como um problema de saúde, alguns estados e municípios adotaram áreas totalmente livres de fumo a partir de 2008. A legislação nacional passou a vigorar apenas a partir de dezembro de 2014. Nesse estudo, exploramos a variação regional da adoção dessa política para avaliar seus impactos no consumo de cigarro no Brasil. Para tanto, adotamos uma abordagem de diferenças-em-diferenças para estimar os efeitos ao longo dos anos de introdução das leis no comportamento de fumantes em dois grupos etários: adultos e jovens. Os impactos também foram estimados considerando diferentes níveis de aplicação das leis entre os estados. Construímos um painel utilizando micro dados da Pesquisa Nacional da Saúde (PNS), coletada pelo Instituto Brasileiro de Geografia e Estatística (IBGE) em 2013. Os resultados indicam que a criação de áreas livres de fumo reduziu, na média, em 7% o consumo de cigarro entre jovens, e isso ocorreu através do desincentivo à iniciação ao tabagismo. Esse impacto aumenta para 10% quando consideramos leis efetivamente aplicadas e desaparecem quando a aplicação é baixa. Em valores absolutos, esse efeito representa de 64 mil a 80 mil menos fumantes entre jovens nas capitais tratadas. Não foram encontrados efeitos em iniciação ao tabagismo e em consumo de cigarro entre adultos, mas leis fortemente aplicadas estão relacionadas a uma taxa de cessação do fumo de 1,2%. Testes de robustez mostram que os resultados são consistentes. Esse estudo contribui para a literatura sobre os efeitos das políticas de controle do tabagismo ao apresentar evidências para países em desenvolvimento

Approximately 135,000 Brazilians die from smoking-related diseases every year (ERIKSEN et al., 2015). Due to the relevance of smoking as a public health problem, some states and municipalities implemented restrictive smoke-free environments from 2008 onwards. The national regulation became effective only in 2014. In this paper we explore the regional differences in the adoption of this policy to evaluate its impacts on cigarette consumption in Brazil. We propose a difference-in-differences approach to estimate the effects throughout the years on the smoking behavior of two age groups: adults and youths. We also estimate the impacts according to different levels of enforcement among states. We have built our panel using micro data from the National Health Research, collected by the Brazilian Bureau of Statistics (IBGE) in 2013. Our results indicate that smoking bans reduced daily cigarette consumption among young individuals in 7% on average, by reducing smoking initiation. This impact increases to 10% when considering higher enforced smoking bans and vanishes when the law is not enforced. In absolute values, it represents from 64 to 80 thousand less smokers among young individuals in the treated capitals. No impacts were found on smoking initiation and on smoking prevalence among adults, but high enforced smoking bans are related to 1.2% smoking cessation rate. Robustness tests show that the results are consistent. Our paper contributes to the literature providing evidences to developing countries on the effects of tobacco control policies / Aproximadamente 135.000 brasileiros morrem por doenças relacionadas ao tabagismo anualmente (ERIKSEN et al., 2015). Devido à relevância do tabagismo como um problema de saúde, alguns estados e municípios adotaram áreas totalmente livres de fumo a partir de 2008. A legislação nacional passou a vigorar apenas a partir de dezembro de 2014. Nesse estudo, exploramos a variação regional da adoção dessa política para avaliar seus impactos no consumo de cigarro no Brasil. Para tanto, adotamos uma abordagem de diferenças-em-diferenças para estimar os efeitos ao longo dos anos de introdução das leis no comportamento de fumantes em dois grupos etários: adultos e jovens. Os impactos também foram estimados considerando diferentes níveis de aplicação das leis entre os estados. Construímos um painel utilizando micro dados da Pesquisa Nacional da Saúde (PNS), coletada pelo Instituto Brasileiro de Geografia e Estatística (IBGE) em 2013. Os resultados indicam que a criação de áreas livres de fumo reduziu, na média, em 7% o consumo de cigarro entre jovens, e isso ocorreu através do desincentivo à iniciação ao tabagismo. Esse impacto aumenta para 10% quando consideramos leis efetivamente aplicadas e desaparecem quando a aplicação é baixa. Em valores absolutos, esse efeito representa de 64 mil a 80 mil menos fumantes entre jovens nas capitais tratadas. Não foram encontrados efeitos em iniciação ao tabagismo e em consumo de cigarro entre adultos, mas leis fortemente aplicadas estão relacionadas a uma taxa de cessação do fumo de 1,2%. Testes de robustez mostram que os resultados são consistentes. Esse estudo contribui para a literatura sobre os efeitos das políticas de controle do tabagismo ao apresentar evidências para países em desenvolvimento

O objetivo deste estudo foi avaliar o efeito de um programa antitabágico e do tratamento periodontal não-cirúrgico na perda dentária em fumantes portadores de periodontite crônica. Fumantes que desejavam parar de fumar se inscreveram no serviço oferecido pelo Programa de Cessação de Tabagismo do Hospital Universitário em São Paulo. Eles se submeteram a tratamento periodontal não cirúrgico concomitantemente à terapia de cessação de tabagismo. Manutenção periodontal foi realizada a cada três meses até 24 meses de acompanhamento. Um examinador calibrado e cego para o hábito de fumar realizou exame periodontal completo na inclusão dos pacientes e após 3, 6, 12 e 24 meses após o término do tratamento periodontal. Este examinador verificou a perda dentária durante o período de acompanhamento. Durante os 24 meses no estudo, a decisão da extração dentária era tomada por um consenso de três periodontistas do grupo de pesquisa. Dos 1.214 pacientes inscritos, 306 foram examinados, 112 foram incluídos e 59 continuaram no estudo por dois anos. Destes, 18 (31%) pararam de fumar e 41 (69%) continuaram fumando ou oscilaram. A média geral do número de dentes perdidos foi 0,63 (±1,4). Após ajustar para as extrações realizadas durante a fase de tratamento periodontal, a média diminuiu para 0,42 (± 1,2), sendo 0,39 ± 0,8 no grupo dos que pararam de fumar e 0,44 ± 1,3 no grupo que continuou fumando (p = 0.88). Apesar de a extensão cumulativa e a média dos dentes ausentes terem sido semelhantes nos dois grupos durante o acompanhamento, houve uma tendência de maior perda dentária no grupo fumante no primeiro ano de acompanhamento. Com estes resultados, verificou-se que a cessação to tabagismo não promoveu um benefício adicional na perda dentária em fumantes 24 meses após parar de fumar. / The aim of this study was to evaluate the effect of a smoking cessation program and non surgical periodontal treatment on tooth loss in smokers with chronic periodontitis. Smokers willing to quit smoking enrolled in the service offered by the Smoking Cessation Program at the University Hospital in São Paulo. They have undergone non surgical periodontal treatment concomitantly to smoking cessation therapy. Periodontal maintenance was performed every 3 months until 24 months of followup. A calibrated examiner, blinded to smoking status, performed complete periodontal examination on baseline and after 3, 6, 12 and 24 months after periodontal treatment. The examiner assessed tooth loss during follow-up. During the 24 months of follow-up, the decision to extract a tooth was taken by a consensus of 3 periodontists of the study group. Of the 1,214 enrolled patients, 306 were examined, 112 were included and 59 remained in the study for two years. Of these, 18 (31%) quit smoking and 41 (69%) continued to smoke or oscillated. The mean number of tooth lost was 0.63 (±1.4). After adjusting for the extractions performed during the treatment phase, the mean number decreased to 0.42 (±1.2), being 0.39 ± 0.8 in the quitters group and 0.44 ± 1.3 in the group the continued to smoke (p=0.88). Even though the cumulative extent and mean number of missing teeth were similar in both groups during follow-up, there was a tendency for a higher tooth loss in the smokers group in the first year of follow-up. It was concluded that smoking cessation did not promote an additional benefit on tooth loss in smokers 24 months after smoking cessation.

O objetivo deste estudo foi avaliar o efeito de um programa antitabágico e do tratamento periodontal não-cirúrgico na perda dentária em fumantes portadores de periodontite crônica. Fumantes que desejavam parar de fumar se inscreveram no serviço oferecido pelo Programa de Cessação de Tabagismo do Hospital Universitário em São Paulo. Eles se submeteram a tratamento periodontal não cirúrgico concomitantemente à terapia de cessação de tabagismo. Manutenção periodontal foi realizada a cada três meses até 24 meses de acompanhamento. Um examinador calibrado e cego para o hábito de fumar realizou exame periodontal completo na inclusão dos pacientes e após 3, 6, 12 e 24 meses após o término do tratamento periodontal. Este examinador verificou a perda dentária durante o período de acompanhamento. Durante os 24 meses no estudo, a decisão da extração dentária era tomada por um consenso de três periodontistas do grupo de pesquisa. Dos 1.214 pacientes inscritos, 306 foram examinados, 112 foram incluídos e 59 continuaram no estudo por dois anos. Destes, 18 (31%) pararam de fumar e 41 (69%) continuaram fumando ou oscilaram. A média geral do número de dentes perdidos foi 0,63 (±1,4). Após ajustar para as extrações realizadas durante a fase de tratamento periodontal, a média diminuiu para 0,42 (± 1,2), sendo 0,39 ± 0,8 no grupo dos que pararam de fumar e 0,44 ± 1,3 no grupo que continuou fumando (p = 0.88). Apesar de a extensão cumulativa e a média dos dentes ausentes terem sido semelhantes nos dois grupos durante o acompanhamento, houve uma tendência de maior perda dentária no grupo fumante no primeiro ano de acompanhamento. Com estes resultados, verificou-se que a cessação to tabagismo não promoveu um benefício adicional na perda dentária em fumantes 24 meses após parar de fumar. / The aim of this study was to evaluate the effect of a smoking cessation program and non surgical periodontal treatment on tooth loss in smokers with chronic periodontitis. Smokers willing to quit smoking enrolled in the service offered by the Smoking Cessation Program at the University Hospital in São Paulo. They have undergone non surgical periodontal treatment concomitantly to smoking cessation therapy. Periodontal maintenance was performed every 3 months until 24 months of followup. A calibrated examiner, blinded to smoking status, performed complete periodontal examination on baseline and after 3, 6, 12 and 24 months after periodontal treatment. The examiner assessed tooth loss during follow-up. During the 24 months of follow-up, the decision to extract a tooth was taken by a consensus of 3 periodontists of the study group. Of the 1,214 enrolled patients, 306 were examined, 112 were included and 59 remained in the study for two years. Of these, 18 (31%) quit smoking and 41 (69%) continued to smoke or oscillated. The mean number of tooth lost was 0.63 (±1.4). After adjusting for the extractions performed during the treatment phase, the mean number decreased to 0.42 (±1.2), being 0.39 ± 0.8 in the quitters group and 0.44 ± 1.3 in the group the continued to smoke (p=0.88). Even though the cumulative extent and mean number of missing teeth were similar in both groups during follow-up, there was a tendency for a higher tooth loss in the smokers group in the first year of follow-up. It was concluded that smoking cessation did not promote an additional benefit on tooth loss in smokers 24 months after smoking cessation.