Research news from Ohio State


Staff Reports



Social smoking carries same heart-disease risks as everyday habit

One in 10 Americans screened said they sometimes smoked, study found

COLUMBUS – Social smokers’ risk for high blood pressure and high cholesterol is identical to those who light up every day, new research has found.

This large, nationally representative study is the first to look at blood pressure and cholesterol in social smokers. More than 10 percent of 39,555 people surveyed said they were social smokers, meaning they didn’t smoke every day. That’s on top of the 17 percent who called themselves current smokers.

Among current and social smokers (after researchers adjusted for differences in factors including demographics and obesity), about 75 percent had high blood pressure and roughly 54 percent had high cholesterol.

“Not smoking at all is the best way to go. Even smoking in a social situation is detrimental to your cardiovascular health,” said lead author Kate Gawlik, assistant professor of clinical nursing at The Ohio State University.

“One in 10 people in this study said they sometimes smoke, and many of them are young and already on the path to heart disease,” she said.

Smoking is a risk factor for unhealthy blood pressure and cholesterol and both are significant contributors to cardiovascular disease, the leading killer of men and women worldwide.

The study appears online in the American Journal of Health Promotion.

“These are striking findings and they have such significance for clinical practice and for population health,” said study senior author Bernadette Melnyk, dean of Ohio State’s College of Nursing and chief wellness officer for the university.

Melnyk said doctors and nurses should strive to identify social smokers and offer them advice and tools to quit smoking.

“This has been a fairly neglected part of the population. We know that regular smoking is an addiction, but providers don’t usually ask about social smoking,” Melnyk said.

“The typical question is ‘Do you smoke or use tobacco?’ And social smokers will usually say ‘No’.”

Participants in the study were screened from February 2012 to February 2016 as part of Ohio State’s Million Hearts educational program. The U.S. Department of Health and Human Services in 2012 launched Million Hearts, a five-year initiative to improve cardiovascular health co-led by the Centers for Disease Control and Prevention and the Centers for Medicare & Medicaid Services. Ohio State was the first university-wide partner.

During the screenings, participants identified themselves as nonsmokers, current smokers or social smokers. The screenings also included measures of blood pressure and total cholesterol.

Social smokers in the study were more likely to be younger (between 21 and 40 years old), male and Hispanic. After the researchers took into account demographic and biometric differences between the smokers and social smokers in the study, they found no difference in the risk of hypertension or high cholesterol.

Social smokers were defined as those who do not smoke cigarettes daily, but who smoke in certain social situations regularly.

The good news about this study is there’s plenty of room for intervention and prevention of future death and disease, the researchers said.

“Simple healthy lifestyle behavior changes including appropriate aspirin therapy, blood pressure control, cholesterol management, stress management and – very importantly – smoking cessation can do away with much of the risk of chronic disease,” Melnyk said.

The percentage of participants who called themselves “current smokers” was in line with estimates from the CDC, which reports that 17.8 percent of U.S. adults identify as smokers.

Gawlik and Melnyk said those who consider themselves social smokers should be aware that the toll on their cardiovascular health could be just as great as if they smoked every day.

And this study should prompt clinicians to rethink how they ask patients about smoking, they said.

“Are you a smoker?” isn’t likely to work with social smokers, because they don’t think of themselves as addicted, Gawlik said.

In the study, the researchers advise asking “Do you ever smoke cigarettes or use tobacco in social situations such as at bars, parties, work events or family gatherings?”

Another option: “When was the last time you had a cigarette or used tobacco with friends?”

Furthermore, clinicians working with smokers should be aware that cutting back on smoking isn’t a good answer from a heart-health perspective.

“Doctors and nurses need to educate patients that social smoking is still a major health risk and is not a long-term healthy choice,” Gawlik said.

Limitations of the study include the fact that the researchers don’t have information about prior smoking behavior, just what the participants reported at the screenings. In addition, the screenings were open to people who chose to participate, meaning the study subjects were self-selected.

Gawlik said she’d like to know more about how many of those who smoke socially go on to become everyday smokers.

“That’s a huge area for clinical intervention because you might be able to reach them before they’re completely and totally addicted,” she said.

Ohio State has led a national effort through Million Hearts, which now has over 150 participating organizations and universities, to provide free education and support to health care providers, students and community members looking to reduce cardiovascular death and disease. More information is available at https://millionhearts.osu.edu/

— Written by Misti Crane

Surprising link between blood sugar and brain cancer found

Diabetes raises risk for many cancers, but not most common malignant brain tumor

COLUMBUS – New research further illuminates the surprising relationship between blood sugar and brain tumors and could begin to shed light on how certain cancers develop.

While many cancers are more common among those with diabetes, cancerous brain tumors called gliomas are less common among those with elevated blood sugar and diabetes, a study from The Ohio State University has found.

The discovery builds on previous Ohio State research showing that high blood sugar appears to reduce a person’s risk of a noncancerous brain tumor called meningioma. Both studies were led by Judith Schwartzbaum, an associate professor of epidemiology and a researcher in Ohio State’s Comprehensive Cancer Center. The new glioma study appears in the journal Scientific Reports.

“Diabetes and elevated blood sugar increase the risk of cancer at several sites including the colon, breast and bladder. But in this case, these rare malignant brain tumors are more common among people who have normal levels of blood glucose than those with high blood sugar or diabetes,” Schwartzbaum said.

“Our research raises questions that, when answered, will lead to a better understanding of the mechanisms involved in glioma development,” she said.

Glioma is one of the most common types of cancerous tumors originating in the brain. It begins in the cells that surround nerve cells and help them function. The disease is typically diagnosed in middle age. At present, there is no treatment that ensures long-term survival, but several potential options are being studied.

The Scientific Reports paper included data from two large long-term studies. One, called AMORIS, included 528,580 Swedes. The second, Me-Can, consisted of 269,365 Austrians and Swedes. In all, 812 participants developed gliomas.

Schwartzbaum and her collaborators evaluated blood sugar and diabetes data and its relationship to subsequent development of brain cancer and found that those with elevated blood sugar and diabetes had a lower risk of developing glioma.

“This really prompts the question, ‘Why is the association between blood glucose levels and brain cancer the opposite of that for several other cancerous tumors?” she said.

The researchers found that this relationship was strongest within a year of cancer diagnosis.

“This may suggest that the tumor itself affects blood glucose levels or that elevated blood sugar or diabetes may paradoxically be associated with a protective factor that reduces brain tumor risk,” Schwartzbaum said.

“For example, insulin-like growth factor is associated with glioma recurrence and is found in lower levels in people with diabetes than those who don’t have the disease.”

The brain accounts for only about 2 percent of body weight, but consumes about 20 percent of the body’s available glucose, Schwartzbaum said.

The body of research on restrictive diets and their effect on brain cancer development has shown mixed results and more work is needed to determine if there’s something about the sugar/tumor relationship that can be modified in a way that’s beneficial to brain cancer patients, she said.

The research was supported by the National Cancer Institute.

Schwartzbaum’s collaborators included co-lead author Michael Edlinger of the Medical University of Innsbruck in Austria and Grzegorz Rempala of Ohio State’s College of Public Health.

— Written by Misti Crane

Half of Breast Cancer Patients Pursue Reconstructive Surgery Without Understanding of Risks

New data show most mastectomy patients choose treatment that does not align with personal goals

COLUMBUS – More than half of breast cancer patients (57 percent) undergoing mastectomy lack the necessary medical knowledge to make a high-quality decision about reconstructive surgery that aligns with their personal goals, suggesting a trend toward over-treatment, according to a new study conducted by researchers at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James).

“High-quality” decisions were defined as those that demonstrated adequate medical knowledge of treatment choices – including associated risks – and that also matched with the patient’s specific goals and preferences for choosing whether or not to pursue reconstructive surgery.

Researchers say shared decision-making tools are needed to help women make decisions based on a full understanding of treatment choices and associated risks alongside their personal goals for surgery.

Researchers report the findings online first in the medical journal JAMA Surgery May 3, 2017.

Study Design and Methods

In this observational, single-institution study, researchers sought to evaluate the quality of 126 adult breast cancer patients’ decisions about breast reconstruction after mastectomy. All patients had stage I-III invasive ductal/lobular breast cancer, ductal carcinoma in situ (DCIS) or were having preventive mastectomies. The majority of patients (73 percent) had early-stage disease.

Researchers measured study participants’ medical knowledge about mastectomy and mastectomy with reconstruction — for example, effects of surgery on appearance and associated risks. They also measured individual preferences of what mattered most to patients. Key preference factors included breast appearance/shape post treatment, length of recovery time and risk for complications.

“We found that less than half of the women had adequate medical knowledge about breast reconstruction and made a choice that aligned with their personal preferences. This is very concerning to us, because it means that some women did not get the treatment they truly preferred, and quite a few had more treatment than they preferred,” says Clara Lee, MD, principal investigator of the study and a breast reconstructive surgeon at The OSUCCC – James. Lee holds a dual associate professor appointment in the colleges of medicine and public health at Ohio State.

“Many women were quite concerned about complication risks, but they didn’t actually know how high the risk was. This may explain some of the overtreatment that we saw,” she adds.

Researchers found that only 43 percent of the patients in the study demonstrated an understanding of at least half of the important facts about reconstruction and made a choice that was consistent with their preferences. Understanding of surgical complications was particularly low, with only 14 percent of patients demonstrating strong knowledge of associated risks.

“As breast cancer providers, we need to talk about the pros and cons of surgery to help women make treatment choices. Shared decision-making between the surgeon and patient would be particularly useful for this decision. We need to connect patients with decision aids to help them really think through what is most important to them,” Lee adds.

Collaborators in this National Cancer Institute-funded study include Allison Deal, MD, and Ruth Huh, BA, of Lineberger Comprehensive Cancer Center at University of North Carolina Chapel Hill; Michael Pignone, MD, MPH, of University of Texas at Austin; and Peter Ubel, MD, of Duke University.

Patient-Doctor Communication Research Underway

Lee and colleagues in Ohio State’s colleges of engineering, communication and public health are working on a study to evaluate treatment decisions in early-stage breast cancer patients to assess how communication with their providers affects their decision-making. This ongoing study examines patients’ knowledge, preferences, and expectations about future well-being. Information from this study is expected to help clinicians develop tools to aid patients in making an informed decision about their care.

About the OSUCCC – James

The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute strives to create a cancer-free world by integrating scientific research with excellence in education and patient-centered care, a strategy that leads to better methods of prevention, detection and treatment. Ohio State is one of only 47 National Cancer Institute (NCI)-designated Comprehensive Cancer Centers and one of only a few centers funded by the NCI to conduct both phase I and phase II clinical trials on novel anticancer drugs sponsored by the NCI. As the cancer program’s 308-bed adult patient-care component, The James is one of the top cancer hospitals in the nation as ranked by U.S. News & World Report and has achieved Magnet designation, the highest honor an organization can receive for quality patient care and professional nursing practice. At 21 floors and with more than 1.1 million square feet, The James is a transformational facility that fosters collaboration and integration of cancer research and clinical cancer care. Learn more at cancer.osu.edu.

Ohio Sea Grant Research Continues Development of Sediment Cleanup Technique Using Ultrasound

COLUMBUS – Ohio Sea Grant researchers are continuing to work on a method to remove contamination from Lake Erie rivers and streams, using ultrasound and chemical agents that bind to contaminants and render them inactive on the river bottom. The eventual goal is to treat contaminated sediments right where they are, instead of having to dredge them up for treatment or disposal.

Dr. Linda Weavers and her team at The Ohio State University have built a basic model of a river cross-section in their lab, and are moving from experiments where the contaminated sediment samples are mixed into water to one where the sediment has settled into the bottom of a glass column, closer to how they would find contamination in an actual river or lake.

The ultrasound treatment creates cavitation bubbles in the water around sediment particles that carry contaminants. As those bubbles form and collapse, the tiny shock waves produced in the process act a little like a pressure washer, pushing heated water against the sediment particles and removing stuck-on contaminants. In addition, the pressure waves created by the ultrasound also spread apart the sediment particles.

“When we looked at our bromide tracer in the water, we saw it spread through the sediment more with ultrasound than without,” said Weavers, professor in the Department of Civil, Environmental and Geodetic Engineering at Ohio State. “So if you think about the bigger picture, if we look at our contaminants, we have a better ability to reach more spaces within the contaminated sediment and are able to affect a larger area.”

Currently, Weavers and her students are working on sediment samples that were provided by the Ohio Environmental Protection Agency (OEPA). Those samples contain polycyclic aromatic hydrocarbons (PAHs, for short), which are a major problem for Lake Erie and its tributaries.

“We have these contaminated sediments from a former creosote facility, which is one of the sources of PAH contamination,” Weavers said. “If you think of wood telephone poles, they don’t decay even though they’re made of wood, and that’s because they’re treated with creosote, which is heavy in PAHs.” Another example of creosote compounds is the black tarry sealant used on many driveways.

More information, including details on a potential way to inactivate contaminants once they’re removed from the sediment particles, is available in the Winter/Spring 2017 issue of Ohio Sea Grant’s Twine Line magazine, available directly at ohioseagrant.osu.edu/p/l0ewl/view#page=10 (PDF link) or at ohioseagrant.osu.edu/products/twineline.

Ohio State University’s Ohio Sea Grant College Program is part of NOAA Sea Grant, a network of 33 Sea Grant programs dedicated to the protection and sustainable use of marine and Great Lakes resources. For more information, visit ohioseagrant.osu.edu.

For richer or poorer, we all eat fast food

Study debunks myth that fast food is mostly eaten by the poor

COLUMBUS – Whether rich or poor, one thing unites Americans of all economic classes: Our love for fast food.

A new nationwide study of young baby boomers contradicts the popular belief that fast-food consumption is concentrated among the poor.

Results showed that middle-income Americans were most likely to eat fast food, although the differences from other groups was relatively small. Even the richest people were only slightly less likely to report fast food consumption than others.

“It’s not mostly poor people eating fast food in America,” said Jay Zagorsky, co-author of the study and research scientist at The Ohio State University’s Center for Human Resource Research.

“Rich people may have more eating options, but that’s not stopping them from going to places like McDonald’s or KFC.”

Zagorsky, who also has an appointment with the Ohio Education Research Center, conducted the study with Patricia Smith of the University of Michigan-Dearborn. Their study was recently published online and will appear in the November 2017 issue of the journal Economics and Human Biology.

The researchers used data from the National Longitudinal Survey of Youth, which has questioned the same group of randomly selected Americans since 1979. The NLSY is conducted by Ohio State’s Center for Human Resource Research.

In the study, Zagorsky and Smith used data from about 8,000 people who were asked about their fast-food consumption in the 2008, 2010 and 2012 surveys. Participants, who were in their 40s and 50s at the time of the surveys, were asked how many times in the past seven days they had eaten “food from a fast-food restaurant such as McDonald’s, Kentucky Fried Chicken, Pizza Hut or Taco Bell.”

Results were compared with the participants’ answers to questions about their wealth and income. While there were some slight differences in how wealth and income were related to fast-food consumption, Zagorsky said the results were similar.

Overall, 79 percent of respondents ate fast food at least once and 23 percent ate three or more meals during any one of the weeks recorded in the study.

In one analysis, the researchers divided the participants into 10 groups based on income. About 80 percent of those in the lowest 10 percent of income ate at least once at a fast-food restaurant, compared to about 85 percent of those who were ranked near the middle (40 to 50 percent) in terms of income. Of the richest 10 percent, about 75 percent reported eating at least one fast-food meal.

The number of fast-food meals eaten during the three weeks of the study showed a similar pattern. The lowest 10 percent in terms of income ate about 3.6 fast-food meals during the three weeks of the survey, compared to about 4.2 meals for middle-income people and three meals for the richest 10 percent of participants.

Another key finding was that people whose income or wealth changed dramatically during the four years of the study – either going way up or way down – didn’t change their eating habits.

“If you became richer or poorer, it didn’t change how much fast food you ate,” Zagorsky said.

One hallmark of the heavy users of fast food was a lack of time.

The study found that fast-food eaters tended to have less leisure time because they were more likely to work and work more hours than non-fast-food eaters.

The researchers also found an interesting tidbit that should be of interest to people who saw the 2004 documentary Supersize Me. In the movie, Morgan Spurlock documented what happened to his body when he ate nothing but McDonald’s for 30 days.

“I thought that was just a publicity stunt, but we found real people out there who seem to eat all their meals at fast-food restaurants,” Zagorsky said.

In 2008, 10 respondents claimed to eat three times a day at fast-food restaurants, as did five people in 2010 and two in 2012.

Given that about 8,000 people participated in the survey, that suggests there may be quite a few people in the United States who go through periods of time during which they eat only fast food, Zagorsky said.

Zagorsky cautioned that there are some limitations to the study. For one, the participants were not asked what they ate at the fast-food restaurants. Some may choose healthier options such as salads, or they may sometimes just go for a cup of coffee.

Also, this study included only people in their 40s or 50s. Consumption habits may be different for people at different ages.

Zagorsky said he hopes the results of this study can help guide policymakers when they come up with laws regarding how to prevent obesity or guide nutritional choices for Americans.

“If government wants to get involved in regulating nutrition and food choices, it should be based on facts. This study helps reject the myth that poor people eat more fast food than others and may need special protection,” he said.

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Staff Reports