A necklace that could help you stop smoking is now on the horizon. Northwestern Medicine researchers have developed a smart neck-worn device resembling a lapis blue pendant that detects a user’s smoking much more reliably than previous systems. It does so by capturing heat signatures from thermal sensors. 

The necklace, called SmokeMon, completely maintains a smoker’s privacy, only tracking heat, not visuals — which is a critical factor for people to feel comfortable wearing it.

“This goes way beyond how many cigarettes a person smokes per day,” said senior investigator Nabil Alshurafa, associate professor of preventive medicine at Northwestern University Feinberg School of Medicine. “We can detect when the cigarette is being lit, when the person holds it to their mouth and takes a puff, how much they inhale, how much time between puffs and how long they have the cigarette in their mouth.”

All these details are called smoking topography, which is important for two reasons. The first is that it allows scientists to measure and assess harmful carbon monoxide exposure among smokers and understand more deeply the relationship between chemical exposure and tobacco-related diseases including cancer, heart disease, stroke, lung disease, diabetes, COPD, emphysema and chronic bronchitis. 

The second is to help people in their efforts to quit smoking by understanding how smoking topography relates to relapse (going back to smoking regularly), which happens frequently in people who quit. 

Say a former smoker takes a few puffs of a cigarette. Do five puffs or five entire cigarettes send them into a full relapse? This information can be used to predict when a person will relapse and when to intervene with a phone call from a health coach, for example, or even a smartphone text or video message to help encourage them to prevent a relapse. The scientists also plan to study the effectiveness of the device in detecting smoking puffs and topography from electronic cigarettes. 

“We want to catch them before they completely fall off the wagon,” Alshurafa said. “Once they do, it’s much harder for them to quit again.

“For many people who attempt to quit smoking, a slip is one or two cigarettes or even a single puff. But a slip is not the same as a relapse (going back to smoking regularly). A person can learn from slips, by gaining awareness that they did not fail, they just had a temporary setback. To avoid a relapse, we can then begin to shift their focus on how we handle their triggers and deal with cravings.”  

The study establishing the accuracy of the device and people’s willingness to wear it will be published Feb. 13 in Proceedings of the ACM on Interactive, Mobile, Wearable, and Ubiquitous Technologies 

“Now we can begin to test the effectiveness of this device in improving the success rate of smoking cessation programs by preventing relapse in smokers who are planning to quit,” Alshurafa said. “We will be able to test whether real-time feedback and interventions can be more effective than usual care. “

Globally, more than 8 million deaths are attributed to smoking each year. Smoking remains a leading cause of preventable disease, disability and death in the U.S., accounting for more than 480,000 deaths every year (or one in five deaths). It was estimated to cost the U.S. more than $600 billion in 2018 (combining health care spending and lost productivity). In the U.S., 12.5% of adults smoke. 

Existing devices that track smoking topography must be attached to the cigarette, which changes how a person smokes and makes the data less reliable. Some researchers have investigated non-obtrusive ways to measure smoking behavior, including the use of wrist-worn inertial measurement unit sensors in smartwatches. However, such approaches are often confounded by non-smoking hand-to-mouth gestures and consequently, generate many false positives. Another option, wearable video cameras, creates privacy and stigma concerns, limiting the applicability of camera-based approaches in natural settings.

Nineteen participants were recruited for the study. They took part in 115 smoking sessions in which scientists examined their smoking behavior in controlled and free-living experiments.  

As smokers wore the device, scientists trained a deep learning-based machine model to detect smoking events along with their smoking topography, including things like timing of a puff, number of puffs, puff duration, puff volume, inter-puff interval and smoking duration. They also ran three focus groups with18 tobacco-treatment specialists to understand how they felt about the device.

One smoking cession specialist commented, “These real-time measurements can really help us understand the depth a person is at in their smoking habits and treat the patient accordingly.”  

A review of clinical trials has found that higher vitamin D intake was associated with a 15 percent decreased likelihood for developing type 2 diabetes in adults with prediabetes. The review is published in Annals of Internal Medicine.

Vitamin D is a fat-soluble vitamin available in or added to some foods, as a supplement, or produced by the body when ultraviolet rays from sunlight strike the skin. Vitamin D has many functions in the body, including a role in insulin secretion and glucose metabolism. Observational studies have found an association between having a low level of vitamin D in the blood and high risk for developing diabetes.

Researchers from Tufts Medical Center conducted a systematic review and meta-analysis of three clinical trials comparing vitamin D supplement impacts on diabetes risk. The authors found that over a three-year follow-up period, new-onset diabetes occurred in 22.7 percent of adults who received vitamin D and 25 percent of those who received placebo, which is a 15 percent relative reduction in risk. According to the authors, extrapolating their findings to the more than 374 million adults worldwide who have prediabetes suggests that inexpensive vitamin D supplementation could delay the development of diabetes in more than 10 million people.

In an accompanying editorial, authors from University College Dublin and Food Safety Authority of Ireland, highlight that previous data have demonstrated significant adverse effects for high vitamin D intake. They argue that professional societies promoting vitamin D therapy have an obligation to warn physicians about both required vitamin D intake and safe limits. They advise that this very-high-dose vitamin D therapy might prevent type 2 diabetes in some patients but may also cause harm.

A new study by scientists in the Columbia University Mailman School of Public Health’s Built Environment and Health Research Group finds that higher neighbourhood walkability is associated with a lower risk of gestational diabetes (GD). The study results are published in the peer-reviewed journal Paediatric and Perinatal Epidemiology.

GD increases infants’ risk of being large for gestational age, may increase the risk of unhealthy weight gain during childhood, and increases the pregnant individual’s risk for future type 2 diabetes.

Working with the New York City Department of Health and Mental Hygiene, the researchers analyzed the relationships between neighbourhood walkability for pregnant New Yorkers. The Neighborhood Walkability Index they used to measure walkability includes data on residential density, land use mix, street connectivity, and access to public transit.  They analyzed city data from more than 109,000 births in 2015.

They found that the risk of GD decreased with increases in Neighborhood Walkability Index score by as much as 20 per cent between areas in the highest and lowest quartiles of walkability. Similarly, when the researchers assessed the density of walkable destinations, another measure of neighbourhood walkability, pregnant individuals in the highest quartile of walkable destinations had a 23 per cent lower risk of GD than those living in the lowest quartile. The analyses adjusted for the pregnant individual’s age, race and ethnicity, parity, education, place of birth, marital status, and the neighbourhood’s poverty rate.

An earlier study by a research team found that neighbourhood walkability is associated with a lower risk of excess weight gain during pregnancy; almost 50 per cent of pregnant individuals gain more weight than is recommended for healthy pregnancies.  The researchers theorize that neighbourhood walkability is associated with higher levels of walking and physical activity in pregnant individuals, reducing the risk of GD and excess weight gain during pregnancy. Pregnant individuals are known to favour lower-intensity forms of exercise such as walking during pregnancy, and in New York City neighborhood walkability is positively associated more walking and total physical activity.

“The study highlights the importance of urban planning, particularly neighbourhood walkability, in promoting health,” says study co-first author Andrew Rundle, DrPH, an epidemiology professor at Columbia Mailman. “Creating opportunities for pregnant individuals to meet recommendations for healthy physical activity during pregnancy is expected to have long-lasting positive benefits for both parent and child.”

Rundle says “We plan to continue our research on how urban design can support health during pregnancy so that these benefits are included in cost-benefit analyses and decision-making for how we design new neighbourhoods and re-design existing neighbourhoods.”

Some antidepressant drugs are effective for some pain conditions. Still, most are either ineffective, or the evidence is inconclusive, despite being used for a range of pain conditions, finds an overview of the latest evidence published by The BMJ today.

Researchers call for a more nuanced approach when prescribing antidepressants for pain.

The use of antidepressants doubled in OECD countries from 2000 to 2015. Their off-label (unapproved) use to treat everyday pain conditions such as fibromyalgia, persistent headaches, and osteoarthritis is considered part of this increase.

To explore this further, a team of researchers led by Giovanni Ferreira at the University of Sydney carried out an overview of the effectiveness, safety, and tolerability of antidepressants for pain according to condition.

They searched databases for systematic reviews comparing any antidepressant with placebo for any pain condition in adults. They found 26 eligible evidence reviews published between 2012 and 2022 involving 156 separate trials and over 25,000 participants.

These reviews reported on the effectiveness of eight classes of antidepressants covering 22 pain conditions (42 distinct antidepressants versus placebo comparisons). Almost half (45%) of the trials in these reviews had ties to the industry.

Using data from each review, the researchers estimated relative risks of pain or average differences in pain between groups on a 0-100 point scale, considering dose, treatment duration, and the number of trials and participants.

They also assessed safety and tolerability (withdrawals due to adverse events), the certainty of the evidence, and the risk of bias. Findings were then classified from each comparison as practical, not compelling, or inconclusive.

No review provided high certainty evidence on the effectiveness of antidepressants for pain for any condition. 

Nine reviews proved that some antidepressants were effective compared with placebo for nine conditions in 11 distinct comparisons.

For example, moderate certainty evidence suggested that serotonin-norepinephrine reuptake inhibitors (SNRIs) were effective for back pain (average 5.3 points lower on the pain scale than placebo), postoperative pain, fibromyalgia, and neuropathic pain.

Low certainty evidence suggested that SNRIs were effective for pain linked to breast cancer treatment, depression, knee osteoarthritis, and pain related to other underlying conditions.

Low certainty evidence also suggested that selective serotonin reuptake inhibitors (SSRIs) were effective for people with depression and pain related to other conditions. Tricyclic antidepressants (TCAs) were effective for irritable bowel syndrome, neuropathic pain, and chronic tension-type headache.

For the other 31 comparisons, antidepressants were either not effective (five comparisons) or the evidence was inconclusive (26 comparisons).

Most safety and tolerability data were imprecise, indicating that the safety of antidepressants for several conditions is still uncertain.

This was a well-designed review based on a thorough literature search. The researchers took steps to minimise the impact of differences in study design and quality, imprecision, and publication bias.

But they acknowledge that most comparisons had a limited number of trials, and results may not apply to antidepressants prescribed for symptoms linked to pain conditions, such as fatigue or sleep disturbance. They add that caution is also needed in interpreting these findings because 45% of the trials forming the evidence for this review had ties to industry.

In conclusion, they say: “Some antidepressants were efficacious for some pain conditions; however, efficacy appears to depend on the condition and class of antidepressant. The findings suggest that a more nuanced approach is needed when prescribing antidepressants for pain.”

These findings suggest that for most adults living with chronic pain, antidepressant treatment will be disappointing, say researchers in a linked editorial.

They acknowledge that clinicians continue to prescribe medicines for which the evidence is poor because they see that some people respond to them, albeit modestly, but say other less potentially harmful options, such as exercise and support with mobility and social isolation, can help people to live well with pain. 

For people with pain, compassionate and consistent relationships with clinicians remain the foundations of successful care, they write. 

Studies must also involve people living with pain to ensure, among many other things, that pain research is meaningful to those living with pain and helps them and their clinicians make better-shared decisions about treatments, they conclude.

Fathers exposed to chemicals in plastics can affect the metabolic health of their offspring for two generations, a University of California, Riverside, mouse study reports.

Plastics, which are now ubiquitous, contain endocrine disrupting chemicals, or EDCs, that have been linked to increased risk of many chronic diseases; parental exposure to EDCs, for example, has been shown to cause metabolic disorders, including obesity and diabetes, in the offspring.

Most studies have focused on the impact of maternal EDC exposure on the offspring’s health. The current study, published in the journal Environment International, focused on the effects of paternal EDC exposure.

Led by Changcheng Zhou, a professor of biomedical sciences in the School of Medicine, the researchers investigated the impact of paternal exposure to a phthalate called dicyclohexyl phthalate, or DCHP, on the metabolic health of first-generation (F1) and second-generation (F2) offspring in mice. Phthalates are chemicals used to make plastics more durable.

The researchers found paternal DCHP exposure for four weeks led to high insulin resistance and impaired insulin signaling in F1 offspring. The same effect, but weaker, was seen in F2 offspring.

“We found paternal exposure to endocrine disrupting phthalates may have intergenerational and transgenerational adverse effects on the metabolic health of their offspring,” Zhou said. “To the best of our knowledge, our study is the first to demonstrate this.”

In the case of paternal exposure in the study, intergenerational effects are changes that occur due to direct exposure to a stressor, such as exposure to DCHP of fathers (F0 generation) and his developing sperm (F1 generation). Transgenerational effects are changes passed down to offspring that are not directly exposed to the stressor (for example, F2 generation).

Zhou’s team focused on sperm, specifically, its small-RNA molecules that are responsible for passing information down generations. The researchers used “PANDORA-seq method,” an innovative method that showed DCHP exposure can lead to small-RNA changes in sperm. These changes are undetected by traditional RNA-sequencing methods, which lack the comprehensive overview of the small-RNA profile that PANDORA-seq provides. 

The study used only F1 males to breed with unexposed female mice to generate F2 offspring. The team found that paternal DCHP exposure induced metabolic disorders, such as impaired glucose tolerance, in both male and female F1 offspring, but these disorders were seen only in female F2 offspring. The study did not examine F3 offspring.

“This suggests that paternal DCHP exposure can lead to sex-specific transgenerational effects on the metabolic health of their progenies,” Zhou said. “At this time, we do not know why the disorders are not seen in male F2 offspring.”

Zhou stressed that the impact of exposure to DCHP on human health is not well understood, even though DCHP is widely used in a variety of plastic products and has been detected in food, water, and indoor particulate matter. DCHP has also been found in human urinary and blood samples. Indeed, the U.S. Environmental Protection Agency recently designated DCHP as one of 20 high-priority substances for risk evaluation.

“It’s best to minimize our use of plastic products,” Zhou said. “This can also help reduce plastic pollution, one of our most pressing environmental issues.”

Zhou, whose earlier mouse study showed exposure to DCHP leads to increased plasma cholesterol levels, was joined in the current study by Jingwei Liu, Junchao Shi, Rebecca Hernandez, Xiuchun Li, Pranav Konchadi, Yuma Miyake, and Qi Chen of UCR; and Tong Zhou of University of Nevada, Reno School of Medicine.

The study was partially supported by grants from the National Institutes of Health and American Heart Association. Hernandez was supported by a National Institutes of Health training grant and an American Heart Association predoctoral fellowship.

The title of the paper is “Paternal phthalate exposure-elicited offspring metabolic disorders are associated with altered sperm small RNAs in mice.”