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Researching abroad: Cannabis and decision making in the Big Apple

Posted on May 21, 2015 by meryemgrabski

Setting off for TARGs 2013 annual retreat to Cumberland Lodge in Great Windsor Park, I was looking forward to hearing a talk from an invited guest speaker. Gill had flown in from Columbia University to talk to the group about a recent drug administration study her lab group had completed. The research being conducted by their lab was very different to the epidemiological research that I am used to. Now don’t get me wrong, I thoroughly enjoy the research that I do, but these studies sounded new and exciting. After listening to the talk, the evening activities began with dinner and a quiz. Luckily, I ended up on the same quiz team as Gill, giving me the opportunity to ask more about her research. I decided to grab the bull by the horns and offer my help in one of her future studies, and so my trip to the Big Apple began…

central park 1 Nine months later I was on my way to Heathrow for a two month stint collecting data on a cannabis administration study. I was both excited and apprehensive. I have never lived more than a 3 hour drive away from family, and have always been in a city where I have known people. I didn’t know whether I would get homesick, or whether I would make friends on my trip abroad. These feelings of apprehension soon disappeared in the first few hours of my first day at the New York Psychiatric Institute. Everyone I met was so friendly and welcoming, even the many morning commuters who stopped to help the lone Brit who was obviously puzzled by the subway map at 7.30am.

yankees I was to spend the next six weeks collecting data for a study examining the neuro-behavioural mechanisms of decisions to smoke cannabis at the Substance Use Research Center in the New York Psychiatric Institute at Columbia University. This research centre is unique; it is one of the largest drug administration centre in the world and has licenses to administer a wide variety of drugs, including cannabis, cocaine and heroin. This means that much of the research conducted here is cutting edge. The aim of the study that I would be working on was to shed light on how and why drug abusers repeatedly make decisions to take drugs despite substantial negative consequences. The study used brain imaging (fMRI) to examine the neural and behavioural processes involved in decisions to self-administer cannabis, compared to decisions to eat food, in regular cannabis users. We also examined the influence of drug and food cues on the processes underlying these decisions. To do this, participants were recruited as inpatients and stayed with us in the lab for a week. Data collection for this study is still ongoing, but I will be sure to write another blog post with what we found when the results are available.

I found this research fascinating and it was a pleasure to be involved in the work carried out in this department. The experience was made even more enjoyable by the people I was working with. There were many office conversations about the British and American slang that was being used, many lunchtime trips to Chipotle (an American fast food restaurant that I am definitely missing since my return to the UK), and several Friday evening trips to the local Irish bar. One office memory that will always stick in my mind was meeting a very accomplished researcher in the field of my PhD, a researcher that was definitely someone I should be impressing. Upon entering this individuals office on an extreme
ly hot New York day, the fan was turned to the meeting area and the smell of cannabis filled the room as the flow of air reached me (I had been administered the drug to a participant earlier that afternoon). Probably not the best first impression I have ever made!

I did, of course, take every opportunity to explore New York. I was lucky enough to get tickets to watch the New York Yankees beat the Boston Red Sox at the Yankee Stadium, which was also one of the last games played by baseball-legend Derek Jeter. I made several trips to the American Natural History Museum (my favourite type of museum, and this one cannot be done in a day), and while there saw a live spider show, a 3D film about Great White Sharks and a full T-Rex skeleton. The glorious weather allowed for several leisurely strolls around Central Park. And, of course, the American food definitely needs a mention. If anyone reading this takes a trip over the Atlantic, I would definitely recommend visiting Big Daddy’s Diner for what could be the best milkshake on the planet. And don’t be shy about trying a hotdog from one of the carts that can be found on nearly every street corner. The reason there are so many of them is that they’re delicious! I would also recommend a trip to the Russian Tea Rooms for caviar afternoon tea, an evening at the New York Metropolitan Opera (if that’s your cup of tea), and a trip to Coney Island.

t_rex Although it was daunting going abroad for that length of time to begin with, I don’t think I would be having those feelings again and I would definitely jump at any opportunity to work in a different environment in the future. I am very grateful that I am a PhD student in a large working group like TARG, as without this I probably would not have come across opportunities such as this one. This experience has taught me the importance of inter-disciplinary research, and the need for several fields contributing evidence to a much larger research question. Since this trip, I have been successful in a fellowship application allowing me 9 months in a different department at the University of Bristol, an application that I probably would not have made if it wasn’t for my experience at the Columbia University. I am an epidemiologist and do not have any plans to change that; however I do plan to conduct more interdisciplinary research in the future. I would like to that Gill (and everyone in her lab group) for welcoming me and making this trip possible. I look forward to hopefully working with you again in the future…

E-cigarettes and teenagers: cause for concern?

Posted on May 20, 2015April 20, 2015 by meryemgrabski

By Marcus Munafo @MarcusMunafo

This blog originally appeared on the Mental Elf site on 20th April 2015

Electronic cigarettes (e-cigarettes) are a range of products that deliver vapour which typically contains nicotine (although zero-nicotine solutions are available). The name is misleading because some products are mechanical rather than electronic, and because they are not cigarettes. While first-generation products were designed to be visually similar to cigarettes, second- and third-generation products are visually distinctive and come in a variety of shapes and sizes. Critically, these products do not contain tobacco, and are therefore intended to deliver nicotine without the harmful constituents of tobacco smoke.

There has been rapid growth in the popularity and use of e-cigarettes in recent years, accompanied by growth in their marketing. At present they are relatively unregulated in many countries, although countries are introducing various restrictions on their availability and marketing. For example, a ban on sales to under-18s will be introduced in England and Wales in 2015.

These products have stimulated considerable (and often highly polarized) debate in the public health community. On the one hand, if they can support smokers in moving away from smoking they have enormous potential to reduce the harms associated with smoking. On the other hand, the quality and efficacy of these products remains largely unknown and is likely to be highly variable, and data on the long-term consequences of their use (e.g., the inhalation of propylene glycol vapour and flavourings) is lacking. There is also a concern that these products may re-normalise smoking, or act as a gateway into smoking.

E-cigarettes and teenagers: a gateway

Methods

This study reports the results of a survey conducted by Trading Standards in the North-West of England on 14 to 17 year-old students. The survey focuses on tobacco-related behaviours, and a question on access to e-cigarettes was introduced in 2013. This enabled identification of factors associated with e-cigarette use among people under 18 years old.

The study used data from the 5^th Trading Standards North West Alcohol and Tobacco Survey among 14 to 17 year-olds in North-West England, conducted in 2013. The questionnaire was made available to secondary schools across the region through local authority Trading Standards departments, and delivered by teachers during normal school lessons. Compliance was not recorded, and the sample was not intended to be representative but to provide a sample from a range of communities.

The survey consisted of closed, self-completed questions covering sociodemographic variables, alcohol consumption and tobacco use. There were also questions on methods of access to alcohol and tobacco, as well as involvements in violence when drunk. E-cigarette access was assessed by the question “Have you ever tried or purchased e-cigarettes?”.

The study used data from the North West Alcohol and Tobacco Survey, which asked 14 to 17 year-olds lots of questions about their substance use behaviour.

Results

A total of 114 schools participated, and the total dataset included 18,233 participants, of which some were removed for missing data or spoiled questionnaires (e.g., unrealistic answers), so that the final sample for analysis was 16,193. Some of the main findings of the survey included:

In total, 19.2% of respondents reported having accessed e-cigarettes, with this being higher in males than females, and increasing with age and socioeconomic deprivation.

Level of e-cigarette access was higher among those who had smoked, ranging from 4.9% of never smokers, through 50.7% of ex-smokers, 67.2% of light smokers and 75.8% of heavy smokers.

E-cigarette use was associated with alcohol use, with those who drank alcohol more likely to have accessed e-cigarettes than non-drinkers, as well as with smoking by parents/guardians.

Nearly 1 in 5 of the young people surveyed

Conclusion

The authors conclude that their results raise concerns around the access to e-cigarettes by children, particularly among those who have never smoked cigarettes. They argue that their findings suggest that the children who access e-cigarettes are also those most vulnerable to other forms of substance use and risk-taking behavior, and conclude with a call for the “urgent need for controls on e-cigarette sales to children”. The study has some important strengths, most notably its relatively large size, and ability to determine which respondents were living in rich and poor areas.

Understanding the determinants of e-cigarette use, and patterns of use across different sections of society, is important to inform the ongoing debate around their potential benefits and harms. However, it is also not clear what this study tells us that was not already known. The results are consistent with previous, larger surveys, which show that young people (mostly smokers) are trying e-cigarettes. Critically, these previous surveys have shown that while some young non-smokers are experimenting with electronic cigarettes, progression to regular use among this group is rare. Product labels already indicate that electronic cigarettes are not for sale to under-18s, and in 2014 the UK government indicated that legislation will be brought forward to prohibit the sale of electronic cigarettes to under-18s in England and Wales (although at present no such commitment has been made in Scotland).

This study does not add anything significant to our knowledge about e-cigarettes.

Limitations

There are a number of important limitations to this study:

As the authors acknowledge, this was not meant to be a representative survey, and the results can therefore not be generalized to the rest of the north-west of England, let alone the wider UK.

As a cross-sectional survey it was not able to follow up individual respondents, for example to determine whether never smokers using e-cigarettes progress to smoking. This problem is common to most e-cigarette surveys to date.

The question asked does not tell us whether the participants actually used the e-cigarette they accessed, or what liquid was purchased with the e-cigarette (e.g., the concentration of nicotine). Zero-nicotine solutions are available, and there is evidence that these solutions are widely used by young people.

The results are presented confusingly, with numerous percentages (and percentages of percentages) reported. For example, 4.9% of never smokers reported having accessed e-cigarettes, but this is less than 3% of the overall sample (fewer than 500 out of 16,193 respondents). This is potentially an important number to know, but is not reported directly in the article.

Summary

This study does not add much to what is already known. Young people experiment with substances like tobacco and alcohol, and as e-cigarettes have become widely available they have begun to experiment with these too. However, to describe electronic cigarette use as “a new drug use option” and part of “at-risk teenagers’ substance using repertoires” is probably unnecessarily alarmist, given that:

There is evidence that regular use of e-cigarettes among never smokers is negligible
There is little evidence of e-cigarette use acting as a gateway to tobacco use
The likelihood that e-cigarette use will be associated with very low levels of harm

It's alarmist to suggest

Links

Primary reference

Huges K, Bellis MA, Hardcastle KA, McHale P, Bennett A, Ireland R, Pike K. Associations between e-cigarette access and smoking and drinking behaviours in teenagers. BMC Public Health 2015; 15: 244. doi: 10.1186/s12889-015-1618-4

Other references

Young Persons Alcohol and Tobacco Survey 2013. Lancashire County Council’s Trading Standards.

Screening of A Royal Hangover: TARG goes to the movies

Posted on April 15, 2015April 15, 2015 by meryemgrabski

By David Troy @DavidTroy79

I recently hosted a documentary screening of ‘A Royal Hangover’ on behalf of the Tobacco and Alcohol Research Group at the University of Bristol. The film documents anecdotes from all facets of the drinking culture in the UK, from politicians to police, medical specialists to charities, the church and scientists, and addicts and celebrities, with high profile personalities such as Russell Brand and controversial figures such as sacked Government Drugs Advisor Professor David Nutt. The director Arthur Cauty kindly agreed to take part in a question and answer session after the film to discuss his experience making the film and debate the issues raised in the film.

The film begins with Arthur talking about his own relationship with alcohol (or his lack of one). He preferred to shoot silly films, play music or wrestle than go out drinking with his friends. The film deals with the history of alcohol starting off in the 16^th and 17^th century when it was safer to drink beer than water. Even babies were given what was called “small beer for small people”. In the early 18^th century, gin became the drink of choice and reached epidemic levels, famously depicted in William Hogarth’s ‘Gin Lane’. Gin was unregulated and sold not just in public houses but in general stores and on the street. Moving on to the 20^th century, Lloyd George recognised the danger of alcohol to the war effort in World War 1, and was quoted as saying that “we are fighting Germany, Austria and drink; and as far as I can see, the greatest of these deadly foes is drink”. Around this time, restrictions on the sale of alcohol were introduced by government. During World War 2, beer was seen as important to morale and a steady supply of it was seen as important to the war effort. Since then, we have seen a steady increase in consumption levels through the ‘hooligan/lager lout’ phenomenon of the 1980’s and the binge drinking of the 1990’s and the early 2000’s. Consumption levels have been falling slightly since the mid 2000’s but there are still 10 million people drinking above the government’s recommended level.

During the film, Arthur investigates how different societies treat alcohol. French and American drinkers describe a more reserved and responsible attitude to alcohol. This is somewhat contradicted by 2010 data in a recent report by the World Health Organisation which reports that French people over the age of 15 on average consume 12.2 litres of pure alcohol a year compared to Britons at 11.6 and Americans at 9.2 litres respectively. The drinking culture of France and the United States is certainly different to that of the UK. The French consume more wine, less beer, and tend to drink alcohol whilst eating food. The US (outside of ‘Spring Break’ culture) is more disapproving of public intoxication. However, neither society should be held up as a gold standard when it comes to alcohol use.

The film talks about the enormous cost of alcohol to England; approximately £21 billion annually in healthcare (£3.5 billion), crime (£11 billion) and lost productivity (£7.3 billion) costs. These are the best data available, but costs of this nature are difficult to calculate. Arthur talked to professionals on the front line – he interviewed a GP who said that a huge proportion of her time is devoted to patients with alcohol problems and their families. She has to treat the “social and psychological wreck” that comes when one family member has an alcohol addiction. A crime commissioner from Devon and Cornwall police states that 50% of violence is alcohol-related in his area.

The film attempts to understand the reasons why alcohol use is at current levels, and offers some possible solutions. Alcohol is twice as affordable now as in the 1980’s and is more freely available than ever. This needs to be curtailed. Evidence suggests that alcoholic beverages were 61% more affordable per person in 2012 than in 1980, and the current number of licensed premises in England and Wales is at the highest level recorded in over 100 years. Licensed premises with off sales only alcohol licences have also reached a record high, more than doubling in number compared with 50 years ago. The evidence shows that price increases and restrictions on availability are successful in reducing alcohol consumption. More alcohol education in schools was highlighted as being necessary. The evidence suggests that alcohol education in schools can have some positive impact on knowledge and attitudes. Overall, though, school-based interventions have been found to have small or no effects on risky alcohol behaviours in the short-term, and there is no consistent evidence of longer-term impact. Alcohol education in schools should be part of the picture but other areas may prove more fruitful. The film suggests that parental and peer attitudes towards alcohol affect drinking norms, and these attitudes need to change. In multiple surveys, it has been found that the behaviour of friends and family is the most common influential factor in determining how likely and how often a young person will drink alcohol. Alcohol marketing was cited as a problem and it needs to regulated more stringently. Alcohol marketing increases the likelihood that adolescents will start to use alcohol and increases the amount used by established drinkers, according to a report commissioned by the EU. The exposure of children to alcohol marketing is of current concern. A recent survey showed that primary school aged children as young as 10 years old are more familiar with beer brands, than leading brands of biscuits, crisps and ice-cream.

David Nutt discussed research he conducted with colleagues, which assessed the relative harms of 20 drugs, including both harms to the individual and to others. They found that alcohol was the most harmful drug overall. Professor Nutt also covered the circumstances surrounding his sacking as government’s chief drug advisor; he claimed that ecstasy and LSD were less dangerous than alcohol, which led to his dismissal. This highlights the inherent tension between politics and science. Evidence can diverge from government policy and popular opinion, and scientists can lose their positions when reporting evidence that is politically unpopular. In my view, the reluctance of governments to implement evidence-based alcohol policies is frustrating; minimum unit pricing (MUP) being the latest example. Despite good evidence supporting how MUP can reduce alcohol-related harms, lobbying by the alcohol industry has halted its progress.

The film deals with the human cost of alcohol misuse, with personal stories of addiction permeating the film. Carrie Armstrong (who writes a blog discussing her battle with alcohol addiction), as well as Persia Lawson and Joey Rayner (who write a lifestyle blog ‘Addictive Daughter’), discussed the havoc alcohol caused in their lives, and explained how young men and women come to them for help with their own alcohol dependencies. Russell Brand talked about his own alcohol addiction during the film. He contends that his drug and alcohol use was medicinal and thinks that alcohol and drug addicts “have a spiritual craving, a yearning and we don’t the language, we don’t have the code to express that in our society”. Arthur interviewed Chip Somers of Focus 12, who talked about the low levels of funding to treat alcohol addiction. Only a small minority (approximately seven per cent) of the 1.6 million alcohol dependants in the UK can get access to treatment compared to two-thirds of addicts of other drugs.

Arthur recorded over 100 hours of footage of drinkers on nights out during the course of filming. He described it as follows: “As the sun goes down, society fades away and what emerges from the shadows is a monster of low inhibition, aggression and casual chaos”. He sums it up as us “going to war on ourselves. On one side is the police, the emergency services, the council and various groups of volunteers and on the other side you’ve got everybody else”. He was assaulted three times and witnessed multiple scenes of violence close up. His bravery is admirable – there were many scenes I found difficult to watch. The scenes of senseless violence were horrible to look at, as were the images of individuals who were so intoxicated as to be helpless and in need of medical attention.

The Q&A after the screening was quite illuminating. Arthur spoke about the reception the film has been receiving at home and abroad. The reception has been great in the United States, where the film has had successful showings at film festivals. The interest in the UK has been a little disappointing, however, which Arthur puts down to the reluctance of society at large to acknowledge our dysfunctional relationship with alcohol. Nevertheless, there has been positive feedback from viewers of the film. Many people have contacted Arthur to tell him how the film has opened their eyes to their own relationship with alcohol and prompted them to make a change. The audience was keen to engage in the conversation. One person, who has a family member with an alcohol addiction, said how important it is to raise awareness of these issues. Another person called for policy measures to be implemented such as MUP to curb use across the population.

Arthur came across as someone who is acutely aware of the damage alcohol is causing in the UK, and is doing what he can to raise the public’s consciousness about it. He has presented a unique look at booze Britain, in equal parts shocking, hilarious, sympathetic and thought provoking – a film we can all relate to. It was a very enjoyable and informative evening and I hope the audience took something away from it. I believe the arts and sciences need to work together to improve how knowledge is communicated. It was my hope that by showing this documentary, information on alcohol harms in society would be more accessible to a general audience. Change begins with the acknowledgement of new information that alters the view of ourselves and our behavior. It has been estimated that over 7 million people in the UK are unaware of the damage their personal alcohol use is doing. I believe the blame lies on both sides. Alcohol researchers need to communicate the harms of alcohol in more engaging and accessible ways and members of the general public need to seek out such information. All too often scientists get the reputation as being cold, boring, and amoral. Collaborating with filmmakers and other proponents of the arts on events such as the one I hosted can assist in changing that stereotype.

Research Responsibly: Things to Consider when Science and Politics Meet

Posted on January 13, 2015 by meryemgrabski

By Meryem Grabski

It might not come as a surprise that doing a PhD is not always fun. One thing that gets me through those difficult, yet inevitable, times is the idea that the research I am doing could potentially make a difference for the better. I am sure this is true for many people involved in research fields that touch upon big societal questions such as health, climate change, economics, or education.

Surprisingly though, I realized a little while ago that I have given little thought to how relevant findings make their way to those who implement societal changes, such as policy makers. Usually scientists are trained to communicate their findings to other scientists, not politicians (or the general public, the people that empower the policy makers in the first place, but I will leave this important issue to one side for now). So what should scientific advice to policy makers look like? Is a brief summary of the research outcomes adequate or should a preference for the implementation of the findings be stated?

I started thinking about this after a discussion in our weekly lab meeting about an article published by Tamsin Edwards, a climate scientist. She describes how her refusal to give specific recommendations for political courses of action has sometimes been met with criticism – from environmentalists and members of the public, as well as fellow climate scientists. She gets accused of having a hidden political agenda, not fulfilling her role as an expert sufficiently, and failing to act and therefore delaying important and pending decisions. Even if some of these points are valid, a counter-argument could equally be made that openly stating political preferences could impact scientific impartiality and lead to the abuse of science to serve political agendas.

This complex issue is described in a model by Pielke, which characterizes four ways in which scientists can position themselves towards policy making. These roles, described in more details in Pilke’s book The Honest Broker: Making Sense of Politics and Policy are briefly summarized below, as well as their potential benefits and pitfalls.

The “pure scientists” do research for the sake of research only and have no further interest in the application of the findings. In reality, this type of “ivory tower” scientist is very rare today, especially in fields where findings might have a potential impact on society.

Pros: Maximal impartiality; because pure scientists are not interested in engaging in political decision-making, they are least likely to be biased towards one specific outcome.

Cons: Since pure scientists are not motivated to make scientific findings accessible, they are not facilitating the implementation of their findings, therefore making them useless for society. Even the publication of findings in scientific journals is often trapped behind expensive paywalls and therefore not accessible by interested members of the public.

The “issue advocates” can be placed on the other end of the continuum of involvement with politics. They believe that participating in the political decision making process is an important part of their role as a scientist. The issue advocate is dedicated to a specific political agenda or outcome, and therefore more likely to narrow the view of the advice seeker to one specific course of action, in line with their own views.

Pros: As the political opinion of the issue advocates is laid out openly, they might be less suspected of having a “hidden political agenda” (even though, in the case of “stealth advocacy”, the opposite could be the case as explained below). Acting as an expert with a specific goal in mind, an issue advocate might be more efficient in aiding policy makers with the fast implementation of findings.

Cons: Issue advocates might be more likely to be biased towards specific research outcomes (as they strongly favour one political outcome they are likely to be in a dilemma when their research findings do not support this outcome). Pielke describes the danger of “stealth issue advocacy”, which refers to a scientist hiding a political agenda while claiming to focus on the science. This usually results in scientific “facts” being manipulated for political debate. This behaviour can harm the credibility of scientific claims in general.

The “science arbiters” believe that science should not be directly involved in political decision making, but are willing to act as experts to inform policy making. Science arbiters focus on narrow, scientifically testable questions in order to stay removed from political debate.

Pros: More useful to society than “pure scientists”, as they are willing to act as scientific experts if specific questions are asked.

Cons: Science arbiters could be accused of being too passive, as they are only reacting to requests, but not actively engaging in sharing their knowledge.

The “honest broker of policy alternatives” is, as compared to the science arbiter, actively seeking to integrate scientific findings in policy decision making by providing policy makers with clarification on specific questions and presenting several alternatives of political action. The honest broker is, in contrast to the issue advocate, not interested in a specific political outcome but in simply engaging with policy decision makers in order to integrate scientific knowledge into the decision making process. Tamsin Edward’s stance towards policy making could be described as “honest brokering”.

Pros: The honest broker is a great facilitator of scientific expertise to society.

Cons: The role of the honest broker seems difficult to maintain for one person alone as they are very actively engaged in politics but at the same time have to remain completely impartial to one specific political outcome and furthermore should examine the issue from several aspects. Pielke suggests that committees and bodies of several experts could act as an honest broker together.

Pielke further elaborates on which role might be most suitable, taking into account the degree of consensus on political values and the degree of uncertainty in scientific knowledge. Admittedly the different roles described are idealized and in reality might not quite fit into this abstract framework.

I personally found two important points to take away from this discussion: Firstly, it is crucial to understand that there are different options regarding how to discuss scientific findings with policy makers. Secondly, there is no perfect one-size-fits-all approach concerning which option to choose, as each option has advantages and disadvantages. I believe that reflecting on the issue and discussing it, privately, like we did in our lab group or, like Edwards, in an open debate, are a good start to finding a personal stance towards policy making. This might seem laborious and time consuming but, in my opinion, should be integral to all scientists, who pride themselves with doing science that matters.

The missing heritability problem

Posted on November 18, 2014October 20, 2014 by Marcus Munafo

By Marcus Munafo

Missing heritability has been described as genetic “dark matter”In my last post I described the transition from candidate gene studies to genome-wide association studies, and argued that the corresponding change in the methods used, focusing on the whole genome rather than on a handful of genes of presumed biological relevance, has transformed our understanding of the genetic basis of complex traits. In this post I discuss the reasons why, despite this success, we still have not accounted for all the genetic influences we expect to find.

As I discussed previously, genome-wide association studies (GWAS) have been extremely successful in identifying genetic variants associated with a range of disease outcomes – countless replicable associations have emerged over the last few years. Nevertheless, despite this success, the proportion of variability in specific traits accounted for so far is much less than what twin, family and adoption studies would lead us to expect. The individual variants identified are associated with a very small proportion of variance in the trait of interest (typically 0.1% of less), so that together they still only account for a modest proportion. Twin, family and adoption studies would lead us to expect that 50% or more of the variance in many complex traits is attributable to genetic influences, but so far we have found only a small fraction of that total. This has become known as the “missing heritability” problem. Where are the other genes? Should we be seeking common genetic variants of smaller and smaller effect, in larger and larger studies? Or is there a role for rare variants (i.e., those which occur with a low frequency in a particular population, typically a minor allele frequency less than 5%), which may have a larger effect?

It is clear that some missing heritability will be accounted for by variants that have not yet been identified via GWAS. Most GWAS genotyping chips don’t capture rare variants very well, but evolutionary theory predicts that those mutations that strongly influence complex phenotypes will tend to occur at low frequencies. Under the evolutionary neutral model, variants with these large effects are predicted to be rare. However, under the same model, while rare variants of large effect constitute the majority of causal variants, they still only contribute a small proportion of phenotypicvariance in a population, because they are rare. On the other hand, common variants of small effect contribute a greater overall proportion of variance. There are new methods which use a less stringent threshold for including variants identified via GWAS – instead of only including those that reach “genomewide significance” (i.e., a P-value < 10^-8 – see my earlier post), those which reach a much more modest level of statistical evidence (e.g., P < 0.5) are included. This much more inclusive approach has shown that when considered together, common genetic variants do in fact seem to account for a substantial proportion of expected heritability.

In other words, complex traits, such as most disease outcomes but also those behavioural traits of interest to psychologists, are highly polygenic – that is, they are influenced by a very large number of common genetic variants of very small effect. This, in turn, explains why we have yet to reliably identify specific genetic variants associated with many psychological and behavioural traits – while the latest GWAS of traits such as height and weight (the GIANT Consortium) includes data on over 250,000 individuals, there exists no such collection of data on most psychological and behavioural traits. This situation is changing though – a recent GWAS of educational attainment combined data on over 125,000 individuals, and three genetic loci were identified with genomewide significance, although these were associated with very small effects (as we would expect). Excitingly, these findings have recently been replicated. Another large GWAS, this time of schizophrenia, identified 108 loci associated with the disease, putting this psychiatric condition on a par with traits such as height and weight in terms of our understanding of the underlying genetics.

The success of the GWAS method is remarkable – the recent schizophrenia GWAS, for example, has provided a number of intriguing new biological targets for further study. It should only be a matter of time (and sample size) before we begin to identify variants associated with personality, cognitive ability and so on. Once we do, we will understand more about the biological basis for these traits, and finally begin to account for the missing heritability.

References:

Munafò, M.R., & Flint J. (2014). Schizophrenia: genesis of a complex disease. Nature, 511, 412-3.

Rietveld, C.A., et al. (2013). GWAS of 126,559 individuals identifies genetic variants associated with educational attainment. Science, 340, 1467-71.

@MarcusMunafo

@BristolTARG

This blog first appeared on The Inquisitive Mind site on 18th October 2014.

Welcome to the Real World

Posted on August 7, 2014August 8, 2014 by oliviamaynard

Dave Troy

Taking laboratory studies into the ‘real world’ is every scientist’s nightmare. We love the lab – it’s where we feel safe, where we can control our world, our variables, our environment, and our interventions. However, lab studies can only tell us so much; eventually we need to know whether the findings from our lab studies apply in the real world. This is what the Tobacco and Alcohol Research Group (TARG) has endeavored to do. Findings in our lab suggest that individuals drink beer slower from a straight-sided glass compared to a curved glass. As a first step towards testing this effect in the real world, we carried out a small feasibility study to investigate whether a large-scale study might be possible. We needed to find out what outcome measure we could use to measure alcohol consumption, whether pubs and customers would be willing to take part, and what the logistical challenges of running a study of this nature might be. With this in mind, we contacted the owner of Dawkin’s Ales. He was open to the prospect of stocking three of his pubs (The Portcullis, Clifton Village; The Victoria, Clifton; and the Green Man, Kingsdown) with differently shaped pint glasses over a couple of weekends, using monetary takings as a proxy measure of the amount of alcohol consumed. He was extremely supportive of the endeavor and we would like to thank him for all his help. He seemed to be genuinely interested in the outcome of the study and in science in general. The feasibility study was a success: we showed that this type of drinking rate study can be carried out in a pub environment. However, there were some teething problems. Variables such as the size of a dishwasher caused unforeseen complications. Only when you get into the real world, do you realise how unstandardised it is.

What we learned on our adventures in the real world is that communication is key. Cultivating good relationships with pub landlords and staff was vital to the success of the feasibility study. Naturalistic studies are unpredictable – nothing goes to plan. Good communication and rapport with stakeholders is vital and can assist in acquiring high quality data. Pub staff are also a great source of industry knowledge. We were educated on the extent of research by the drinks industry into the effect of different glass shapes on drinking behavior, which is extensive in their opinion. They were also full of ideas regarding what other experiments could be carried out. One of the landlords mentioned that people “drink with their eyes”, which piqued an interest in me about how our other senses may play a role in our drinking behaviour. Another comment was that people tend to drink more quickly when they are standing up. This hadn’t occurred to me before, but I was told that it has grabbed the attention of policy makers, who want to discourage ‘vertical drinking’ by demanding pub license holders supply more seating. Another topic that came up again and again is the use of “nucleated” beer glasses. These have marking at the bottom of beer glasses to promote the formation of bubbles, maintaining the head for longer. The importance attached to it by pub staff and customers suggests it might be an important factor in people’s drinking. All of these are ideas that we may take forward in our lab studies. Pub staff also made valuable suggestions on how to improve future pub studies. One landlady said that we should do it over a whole week to get a better picture of the cadence of an average drinking week.

On a personal level, I learned more as an experimenter helping with this study than in all my previous lab studies. Perhaps surprisingly, the attention to detail and organisation required is above the requirements of a lab study. The logistics involved are greater and an ability to think on your feet is essential. The real world is a challenging place to do research but the advantages are clear. The data collected reflects more natural behavior of participants and therefore your findings have greater relevance. Activity that would have otherwise have gone unnoticed can be observed. Qualitative data collected can inform future research. Another advantage is that you can interact with professionals who have their ear to the ground, which can lead to ideas for new studies. There are also some challenges. There is a greater probability that an external variable, not controlled for in your study, has influenced your findings. Natural environments lack the control of lab studies. It may be difficult to replicate a study when there are so many variables at play. Nevertheless, lab and naturalistic studies complement each other and there is a need for both in science. Advances in technology, such as tablet computers and smartphones, have made acquiring vast amounts of data in the ‘real world’ much easier. Researchers in TARG will continue to engage with the public in natural settings in the future and hopefully capture data that will inform people’s lifestyles and public health policy.

Closing the gap in academia: why a girl needs a high impact paper to get level with the boys

Posted on June 6, 2014June 6, 2014 by katebutton

Katherine S. Button @ButtonKate

As if I don’t suffer enough with procrastination, I was recently sent an online Principal Investigator predictor tool, and encouraged to try it. This uses gender and publications to rank an individual against PIs and non-PIs, to calculate the likelihood that the individual will become a PI. This is based on a recent article which suggested that factors like number of first-author publications, and the Impact Factors of the corresponding journal, strongly predict the likelihood of becoming a PI. The fact that these things predict success isn’t surprising, although it’s perhaps a shame that success is so closely tied to such imperfect measures. Nevertheless, the tool helps you to reflect on whether you should focus effort on having more first-author publications, rather than those where your contribution might be lost in the crowd.

Initial scoffs about navel-gazing aside, I entered the PMIDs of my publications and was bemused (and chuffed!) to be told I had a 99% chance of becoming PI. Ever the cautious scientist, however, I was concerned my probability might be inflated by the several letters to editors that were the aftermath of a high-profile paper published in Nature Reviews Neuroscience. Thus the sensitivity analyses began…

First I removed all letters and commentaries, restricting my publications to original research articles only, resulting in P(PI) = 81%. Not bad, but I was still concerned that the results were skewed by my one high-profile outlier. So I re-ran the prediction using only those publications which were completely independent of the NRN paper, resulting in P(PI) = 73%. Less good. Then, out of feminist curiosity, I ran the same prediction but this time stating that I was male, resulting in P(PI | Male) = 82%. So, changing my sex from female to male had the same effect as a first author publication in Nature Reviews Neuroscience. Damn.

Dismayed, but not surprised, I then re-ran the other analyses for my male alter-ego. The effects were less dramatic for the original research articles, P(PI | male) = 88%, corresponding to a 7% advantage for being male, and had no effect when I used all my publications, P(PI | male) = 99%. This suggests that the probability of making it as a PI decreases with decreasing research outputs at a disproportionately higher rate for women than men.

Science has never been so competitive, and it’s difficult to successfully make the transition to independent scientist unless you’re a high-flier. An argument often levelled at women is that they are too risk averse to make it in such a competitive environment. But it seems to me that, rather than being risk averse, pursuing an independent career may simply be more risky for women who, given the same objective level of ability as a man, are less likely to succeed to PI.

This fits with my pet theory that sex biases in academia are most influential at the mid-range of ability. The brilliant high-fliers will probably succeed regardless of their sex. It’s at the mid-range where men may have an advantage compared with women of the same quality, who are disproportionality penalised.

I think role models are important in encouraging women to stay in STEM subjects. We need to see that other women have succeeded but also that the cost of success is reasonable; not everyone wants to devote every waking minute to science, and those that do (male or female) will no doubt already be well on their way to international stardom. For the rest of us, we want to have a scientifically valuable and worthwhile career and a reasonable family and social life. If this balance comes at the cost of being a talented but “average” scientist, then so be it, but why should such a choice disproportionality penalise women?

After a glib Tweet suggesting I might consider a sex change if my publications drop off, I was pointed in the direction of a Nature article Does Gender Matter written by Ben Barres, a man who has experienced working in science as both genders. The article is excellent, tackling the “women are innately less good than men” argument with a critical look at the evidence. Sticking with the anecdotal for now, however:

“Shortly after [Ben Barres], changed sex, a faculty member was heard to say “Ben Barres gave a great seminar today, but then his work is much better than his sister’s.”

Unfortunately this resonates all too well with discussions I’ve had with colleagues about the high rate of attrition of women in science who have suggested that men at the post-doctoral level are simply stronger candidates. These implicit beliefs about the superior competency of men over women, which are unfounded in terms of objective evidence, are no doubt at the heart of why proportionally fewer women succeed in science. Outstanding female scientists may suffer less from such biases, because the fact that they are outstanding makes them noteworthy. But the majority of scientists (both male and female) are worthy and talented but not outstanding, and here women may suffer disproportionately compared to their male counterparts.

As a psychologist studying how implicit cognitions bias behaviour, I’m in favour of positive discrimination to re-dress the balance. We have clear evidence that implicit sex discrimination pervades all aspects of the scientific process (on the part of both men and women). One often hears the counter-argument no female scientist wants to be appointed as a token gesture to address gender imbalance in a science department, or that all appointments should be on merit alone. But not all scientists can be world leaders, and the vast majority of PIs are talented but (by definition) average.

So, where gender bias is extreme (as I suspect it is in many science departments), let’s have judicious use of positive discrimination in the short-term. What’s the worst that can happen? You might appoint a talented but “average” woman, but she’s likely to be no less talented than an average male counterpart, and at least there’ll be more role models for us women who value our work-life balance.

Across the Pond – Life as an International Postgraduate Student

Posted on April 5, 2014April 5, 2014 by michael

Deciding to pursue your studies in a foreign country is both an exciting and scary prospect. During the spring of 2012 I made the decision to leave my family and friends behind in Canada and make my way across the ocean to the great unknown that was Bristol to pursue a PhD in Experimental Psychology. Despite never having visited the city, and not having anyone I knew waiting for me on the other side, I took the leap and boarded a plane to the next few years of my life. I haven’t looked back since.

park street — My first picture on Park Street

International students have become commonplace at universities worldwide among undergraduates and postgraduates alike . If you are one of many students considering studying abroad, you will be in good company no matter which university you choose to attend. International students tend to be active members of the student population and are especially eager to immerse themselves in all aspects of student life. Having left their old lives behind, international students coming to a new city and university are looking to make new friends and have new experiences. By attending events and visiting the Bristol International Student Centre (BISC) I quickly met many other postgraduates from around the world who I had the chance to discover the city with, and formed lasting friendships. Whether they are in your programme of study or not, or even doing a Masters or PhD, there are often many more similarities than differences between you, and you will be able to quickly establish your new circle of friends in your home away from home.

One thing that may take some time is adjusting to a new academic system, which may differ from what you are used to in your home country. While this is may be more relevant to taught postgraduates rather than research students, you may have to come to terms with it anyway for your own degree requirements or if you decide to teach or mark essays (more on that later). For instance, while a PhD in experimental psychology back home entails demanding modules and coursework while conducting research, the same degree is focused almost exclusively on research output in the UK. Also, many of my postgraduate friends who were studying for a taught Masters degree felt that there was a lot crammed into one year, as the same degree in many of their countries often last two years with the same amount of content. I certainly did not envy their exams and coursework! At Bristol’s School of Experimental Psychology, PhD students who have not previously completed a Masters, like myself, are asked to attend the taught Masters lectures and have to complete a certain amount of coursework. I quite enjoyed attending these lectures and it was a nice refresher during the early months, as my PhD work was slowly starting to pick up. Like most postgraduate departments, you can expect to have colleagues from all walks of life, each with different backgrounds and usually studying quite different topics even within the same school. This only adds to your experience, as you learn from each other almost as often as you might your supervisors or your lecturers; having the luxury of all of the school’s PhD students working in the same building is invaluable. You are usually only a door away from the answer to most of your questions, and more often than not someone in your own office can answer it for you! I know that the university where I did my undergraduate degree did not have quite the same set-up, so I didn’t take the convenience of the PhD students’ office building (only across the street from our main department) for granted. While these types of things may not be at the top of your priority list when looking at foreign universities, they can have a serious impact on your quality of life as a student. Take every opportunity you can to gain insight from current students, as no one is in a better position to give you an idea of what you’ll be getting yourself into for the next few years of your life. I was lucky enough to contact a colleague with whom I share a supervisor who was not only kind enough to answer my questions but also showed me around and helped me get set up once I arrived in Bristol. While I can only speak to my experience in my own school, PhD students tend to be very kind and helpful; you only need to ask for it!

Of course, an important thing to consider when looking to study abroad is cost. Let’s face it, being an international student isn’t cheap. That being said, if you are coming from somewhere like the United States, you may be surprised to know that tuition isn’t much more than what you might pay at home. However, coming from Canada (where tuition fees are quite low) meant I would be taking on a significant increase in the cost of my schooling. While tallying the cost of tuition, rent and living expenses may be daunting, there are some important things to bear in mind. The first is funding. Even if you are deciding to study abroad, your country may very likely still have funding opportunities available to you. What you need to do is find them and apply as soon as possible. Something to bear in mind is that funding, if awarded, only begins several months after your application has been submitted, reviewed, and finally approved. And most likely they will not pay you retroactively for all the time that application was under review and this process can take up to almost one year in some cases. This means in an ideal situation you should try to apply for funding almost a full year before you expect to begin your studies. If this is not feasible, keep this in mind and start working on it almost as soon as you arrive. Acquiring funding will really help you breathe easier and not have to worry as much about keeping finances airtight. Of course, if you can’t get funding you will need to be a bit more proactive and find ways to earn money while you are studying. While being a postgraduate is already quite demanding in itself, with enough organisation and time-management you can balance it all and be successful. It just might take a bit more work. An excellent way to make some money while you are studying is to take on a research demonstrator or teaching assistant position. As a demonstrator in psychology, I attend the lab sessions for year 1 or year 2 statistics lectures and assist the students with completing the data collection, analysis and write up for their lab reports. I am also responsible for marking a group of lab reports and providing the students with feedback for future reports. This makes for a very attractive addition to your CV and is a great way to get some first-hand experience of what you might expect from a future faculty position. If you are even contemplating a career in academia in the future this is a great way to get a head start, and I would definitely recommend it. If demonstrating isn’t your thing, consider essay marking. This still gives you a small taste of the academic world and is often less time-demanding. Both these jobs are usually available in your department and also tend to pay pretty well. Another great place to look for jobs is in your university’s student union. There tend to be a lot of jobs with hours and pay rates that are really attractive to students, and as a postgraduate you are an attractive candidate who can hopefully market yourself well in an interview. I was lucky enough to nab a job involving sports with flexible hours and I really enjoy it. Finally, another great job opportunity is working as a senior resident or warden at a university hall. Rent or accommodation costs will represent one of your most significant expenses, and working as a senior resident can see your rent cut by as much as half. Depending on the hall, you may have different commitments or working hours but they tend to be quite reasonable and the savings are really worth it. These are only a couple of ways to make money or cut costs while you are studying and there are many more out there if you look for them. Although this should be a no-brainer, I will mention it here: take advantage of cheap or FREE activities, services and especially FOOD whenever the opportunity arises. These can be quite numerous, especially at the beginning of the academic year, so be sure not to miss out! While being an international student is far from cheap, remember that you are getting an invaluable experience at a new university in a new country. This is especially true if you are attending a prestigious university or working on a topic that you are very passionate about, because then you will never doubt your investment. And that is what your education is: an investment. Even if you decide to return home after your degree, you now have experiences that are likely to be radically different from the other people who may be applying for the same job as you. You have acquired more than just a degree while away from home and it’s important to remember that when you go to that job interview or write that next letter of intent.

hand_placing_coin_in_piggyban_450 — International degree – A worthwhile investment

It is quite hard to summarise my experience as an international postgraduate student but so far the experience has been nothing less than positive. I do not take my situation for granted: I am studying a topic I am very interested and passionate about at a world-class university with excellent supervisors and the best colleagues I could ask for. If you decide to study abroad for the right reasons, namely to pursue a degree that interests you in a place that inspires you and not your dream shopping destination, you will not be disappointed. If you have questions about anything I covered in this blog post or anything that I didn’t, feel free to contact me and I’ll be happy to answer any questions you might have. In closing, if you are thinking about studying abroad, do not be afraid to make the leap. Your friends and family will still be there when you visit and will support you on this journey that will change your life forever. Open up to new experiences, new people, and learning new things about yourself and you will not regret your decision.

Michael Dalili is a 2nd year PhD student in TARG.

From ‘Canadia’ to Bristol and Back Again – My Adventures with TARG

Posted on January 31, 2014April 4, 2014 by oliviamaynard

By Meghan Chenoweth

I didn’t realize it at the time, but my connection with TARG, where I performed a one-month research exchange in the fall of 2013, started when I was a neophyte Pharmacology PhD student. In 2011, I had co-written a chapter with my supervisor Rachel Tyndale in the book “Genetic Influences on Addiction – An Intermediate Phenotype Approach”, for which Marcus Munafò served as an editor. Fast-forward a year later, and I am sitting in my living room in Toronto on a Saturday afternoon reading an email from Rachel asking if I would want to do a stint of training in the UK with Marcus. Opportunities included: working with data from a large cohort (1000s!) of adolescents, learning new analytical approaches, gaining perspectives on tackling research questions from a novel angle, and living in a new city for a month. My first response was: “When can I start?”

Marcus and I met at SRNT in early 2013 to discuss the opportunity in person, and over the next several months, plans were set in motion. With excitement and anticipation, I arrived in Bristol on a Saturday morning in October 2013 and checked into my accommodations on campus. My initial awe at what would be my home for the next month quickly turned to panic as I realized I forgot to pack a travel adapter. In quick succession, my laptop and cell phone died. I set out into the sunshine, jet-lagged and completely unfamiliar with my new surroundings, determined to find a travel adapter. I happened upon a local shop operated by an electrician and his wife, and after providing me with a travel adapter, they thanked me for bringing the sunshine with me from ‘Canadia’. They then proceeded to draw several maps of Bristol, recommending things to do and sights to see. This was only the beginning of an incredibly long list of kind people I either met or had the pleasure of working with in Bristol.

As I reflect on my time working and socializing with members of TARG, I realize I could probably fill an entire blog. I think it may be more palatable to summarize my more scholastic experiences in four short “lessons” I have learned. These, I think, are applicable to many fields and disciplines, not just research.

Bristolian Christmas steps — Bristolian Christmas Steps

Lesson #1: It is important to focus not only on the end result, but also the process used to get there

One of the many great things about working in a talented epidemiology research group like TARG is gaining a true appreciation for the elegance of the analytic approaches used in epidemiologic studies. This is particularly true for longitudinal studies like ALSPAC, where repeated observation at the individual level occurs over many years. I am fortunate to have previously gained some exposure to longitudinal data analysis techniques through working with Jennifer O’Loughlin at the University of Montreal on the NDIT cohort. Fully immersing myself in TARG for a month was an excellent way to not only learn, but also to utilize these approaches in a hands-on manner. I enjoyed writing an ALSPAC research proposal, and having regular meetings with Marcus and Jon Heron. This, together with regular email contact with Rachel, helped guide our ideas and approach to set the collaboration in motion.

I feel that this experience broadened my view of how good research is conducted, in terms of study design and analytic approaches, and I find myself reading papers more critically now. There can be a natural tendency to focus on the outcome and interpretation of the outcome, rather than the process used to generate it. Without a sound process, however, the results are likely meaningless. This lesson was solidified for me by David Nutt during his plenary lecture at the Bristol Neuroscience Festival. In describing how the definition of ‘drug’ changes across disciplines, David Nutt humorously pointed out that pharmacologists define a drug as a substance, that when given to a rat, results in a scientific paper. After I had finished laughing and could hear myself think again, I realized it was a fine teachable moment for me as a budding researcher: never lose sight of the process.

Lesson #2: New perspectives on your own work can arise from sharing ideas with individuals from a variety of disciplines

I learned rather quickly that TARG members are experts in social networking, after Jen Ware sent me my itinerary for the month. We later joked that I would be well hydrated, with daily coffee mornings and weekly pub nights with the School of Experimental Psychology. These were welcoming forums to chat with people from a variety of training levels and areas of expertise within psychology. In a formal conference setting, I have often felt intimidated to approach faculty members, even if I had rehearsed a specific question I wanted to ask (which never comes out quite how you intend). The informal psychology coffee mornings and pub nights, which junior graduate students through to senior faculty members attend, were settings very much conducive to conversation and the sharing of ideas.

Lesson #3: Planning and performing work in a novel environment is refreshing and restorative

Toward the end of my last week with TARG, I was completely surprised to feel so refreshed and ready to continue my projects back home. Working with TARG stimulated new ways of thinking about science and approaches I could use with my existing projects, which gave me a new energy with which to tackle them. I showed up to work early every morning during my first week back in Toronto, which I like to attribute to my newfound zest as opposed to jet lag…

Lesson #4: New collaborations continue long after they begin

This has to be the best part about establishing a new collaboration. I am happy to report that I am continuing to work on an analysis using ALSPAC data. I am too scared to count the number of times I have emailed Jon Heron asking for help, but he is always incredibly responsive. It continues to be a great learning exercise for me and I can honestly say I now view setbacks in a more positive light, as so much more is learned through active trouble-shooting.

I am indebted to Marcus and his group for warmly welcoming me to TARG and I am looking forward to staying in touch with them in the years to come. I think it goes without saying that I would highly recommend an exchange to any trainee that is presented with an opportunity to research abroad, especially with a group like TARG.

Meghan Chenoweth is currently completing her PhD in Pharmacogenetics at University of Toronto.

Diary of a dependent smoker: The e-cigarette experience

Posted on November 6, 2013November 8, 2013 by oliviamaynard

This blog post reflects the author’s personal experience.

Day 1. Saturday 28^th September 2013, 1.21pm. Inadvertent quit date.

It didn’t cross my mind for a second that this would be my last cigarette. Whilst I’d been away at a (tobacco control) conference, my husband had, out of the blue, decided to invest in an e-cigarette. That was four days ago. He hasn’t had a cigarette since. So, today, I decided to finally invest. I’m a pretty heavy smoker (~25 per day), and have been for about eight years (I appreciate the irony of this, having devoted five years of my life to the study of tobacco dependence). Anyone who has been unfortunate enough to fly long-haul with me will testify just how horrendous I am to be around without tobacco. Ditto my colleagues who’ve experienced my wrath after enlisting me as guinea pig in any experiment involving overnight abstinence. Anyway, I digress. I visited a local store dedicated to the sale of e-cigarettes (‘e-cigs’). Now I’m pretty au fait with the literature on these things. I had lots of questions (mainly relating to vapour composition and actual nicotine delivery), to which I didn’t really receive any satisfactory answers (the general public must not press with such line of questioning – they offered me a job in the store!). But I did learn a lot about the mechanics of these things, and tried out a lot of flavours. Seriously, you have a lot of options! I tried cherry, apple, mango, kiwi, very berry, raspberry, candy floss, blueberry, cherry cola, grape, and barely scratched the surface. There’s also an extensive range of tobacco flavours, dessert flavours (cheesecake anyone?!), rum, beer (?!); the list goes on… I was pretty stunned at the variety. But, in the end, I settled for blueberry and cherry cola. These flavoured nicotine solutions come in several strengths. I was advised, as a 25 cigarette per day smoker, to go for the 18mg mix. So, e-cig ‘starter pack’ in hand [pic], I carried on running my Saturday errands. Three hours later, I suddenly realised I hadn’t had (or wanted) a real cigarette. Now, honestly, it was not my intention to give up smoking. I was just curious (from both a personal and professional perspective) and thought this device might be a useful travel aid. But hey, why not see how long I could run with this? My husband was doing incredibly well so far, so why shouldn’t I try too. So how was I feeling at this point? A little restless. My throat was a little sore. But I wasn’t feeling irritable. I’ve tried giving up before. Nicotine gum, inhalator, bupropion – on all of these, giving up smoking had taken over my ENTIRE LIFE. Cigarettes were always on my mind. Today, that hasn’t been the case. But I have felt like something has been missing. For some reason I’ve been craving the scratch of metal on flint (my trusty clipper, a.k.a. conditioned reinforcer). ‘Smoking’ inside has been a novelty though. I guess I’ve been enjoying the novelty of it all. The cravings kicked in in force after dinner, but a 15 minute ‘vaping’ session helped check them. And yet I didn’t feel totally satisfied… A night in, watching back-to-back episodes of ‘24’, kept me suitably distracted and on track though. Oh, and I downloaded a stop smoking app to keep track of my progress – more on that tomorrow…

Day 2. Sunday 29^th September 2013.

I knew this was going to be hard. The first cigarette of the morning has always been my favourite. For eight years, the first thing I’ve done every morning, without fail, is roll out of bed, head down to the kitchen to roll a cigarette, and sit out in the garden to smoke. That was all I could think about when I woke up. So, this morning, I went out and sat in exactly the same place, and spent 10 minutes vaping. It wasn’t the same, but it helped. I spent almost half of my morning puffing away on that thing (I’m curious to know what my total daily inhalation volume is). I’ve also been really hungry today. We decided to head down to the pub to treat ourselves to a Sunday roast. This was going to be hard – two glasses of wine and a big lunch. We sat out in the garden for half an hour afterwards. That thing was glued to my mouth. But I didn’t crack. When we got home I ended up taking a four hour ‘nap’ (I should add, my sleep has been pretty irregular, and I’ve been having very lucid dreams). I woke up with a dry mouth (again, that’s becoming a pretty regular feature), and a deep sense of incompleteness. More vaping. I’m writing at 11.24pm, and my stop smoking app informs me of the following:

Time since last cigarette: 1 d 10 h 03 mins

Money saved: £7.98

Not smoked: 35.48 cigarettes

Time saved: 0 d 3 h 32 mins

e-cig2

Day 3. Monday 30^th September. Hell hath no fury like a girl without cherry cola flavoured nicotine.

Today has been the hardest day to date. I woke up, after a disturbed night’s sleep, from a particularly violent and lucid dream, with a painfully dry mouth. Reaching for an (empty) glass of water, I noticed the time. ****. I was horribly late for work (read: I have a meeting in 20 minutes and even if I jump straight into the car now I’ll still be late). Thirsty, flustered, and desperate for a cigarette, I flew into a whirlwind, got ready in 25 minutes (a record), and leapt into the car, ready to vape the hell out of that magic stick. However, two deep breaths in, the battery dies on me. Damn. I’m already 40 minutes late at this point. I get to work, park up, and run to the supermarket round the corner. I’ve devoted way too much effort to this cause to give up now. So instead of buying tobacco (the cheaper option by the way), I invested in a disposable e-cigarette. Now this model is very different to the one I’ve been using. It actually looks like a cigarette (see pic). No charging and no refilling needed. So I tear open the packet and start puffing away whilst running into work. It tasted DISGUSTING. I forgot to add, this e-cig was tobacco flavoured, not the fruity concoction I’m starting to grow used to (is cherry cola becoming a new conditioned reinforcer for me?!). I think this was the first time it hit me that my sense of taste had returned in force. Anyway, this hit the spot. Despite the vile taste in my mouth.

e-cig3

A day of data analysis ensues. I have a growing sense of unfulfilment. By 5pm I am in a terrible mood – irritable, hungry, restless. Driving home, my new e-cig, supposedly equivalent to 20 cigarettes, containing an advertised 16mg of nicotine, starts tauntingly flashing at me, before promptly giving up the ghost. At this point I should highlight that I’ve been going through about 2.5ml a day of a solution that contains 18mg nicotine per 10ml bottle. Now, I haven’t been keeping tabs on my circulating nicotine and cotinine levels (I should have been), but a moment of grumpy mental arithmetic en route home tells me something is amiss here. If the advertised nicotine content is correct, then the actual nicotine delivery of these things must wildly fluctuate across models (we know this to be true). So anyway, I get home, disproportionately angry that my husband hasn’t bought baked beans, and spend the next 15 minutes glued to his (cotton candy flavoured) e-cig while mine charges. At the shop (buying beans), I feel a quiet satisfaction in not adding a pouch of tobacco to my basket at the counter. It’s now 7.26pm:

Time since last cigarette: 2 d 6 h 05 mins

Money saved: £12.68

Not smoked: 56.35 cigarettes

Time saved: 0 d 5 h 38 mins

Day 4. Tuesday 1^st October.

Nothing much to report today, other than generally feeling a bit tetchy and low, for no real reason. That’s new I guess. And my throat is still a bit sore. Night.

Day 5. Wednesday 2^nd October.

So today I passed the 100 cigarettes not smoked mark. That feels pretty damn good! This morning also marked the first morning to date that I’ve woken up and haven’t been desperate for a cigarette. I still wanted one, but I didn’t feel like I needed one. And that is a big deal, at least to me. I also managed to resist the urge following a night out with friends, despite a lot of curry and a lot of wine. Jen 1, tobacco 0.

Day 6. Thursday 3^rd October.

I think I’m getting used to this now. I also realised that I’m not so reliant on my e-cigarette anymore. I mean, I’m still using it a lot, and definitely devoting more time to it than I ever did with cigarettes, but it’s not permanently glued to my mouth today. I did have one particularly big craving to smoke today after an argument on the phone – definitely the biggest craving since day one. But that soon passed. I think the increasing brevity of these posts stands testament to the fact that this is getting easier. It’s now 9.25pm:

Time since last cigarette: 5 d 8 h 04 mins

Money saved: £30.02

Not smoked: 133.40 cigarettes

Time saved: 0 d 13 h 20 mins

Day 7. Friday 4^th October.

I encountered my first bar tonight that prohibits e-cigarette use. I asked why this was and was informed that “people get very drunk and we’re worried that people might see other people smoking e-cigarettes and think it’s ok to smoke real cigarettes inside too”. Hmm…

Day 8. Saturday 5^th October.

My throat is KILLING me. I was genuinely in agony when I woke up this morning. My teeth have been hurting a lot too. They’ve been pretty sensitive since I had them bleached a couple of years ago, but the pain has flared up in style recently. Coincidence perhaps? Obviously association does not imply causation, but, the vapour is very sweet tasting – need to check which sweeteners are used in that nicotine solution… By the way, today marks one entire week tobacco free! It’s 12.21pm.

Time since last cigarette: 6 d 23 h 01 mins

Money saved: £39.15

Not smoked: 173.99 cigarettes

Time saved: 0 d 17 h 23 mins

Day 10. Monday 7^th October.

So my teeth feel fine again now. But for the last couple of days I’ve really had a sore throat – so sore that I’ve been putting off using my e-cig until I’m literally desperate for nicotine. And my nose has been running, constantly. I’m not sure if this is just my airways clearing themselves, a side effect of the e-cig, or just a cold. Whichever it is, I decided to try and remedy it by really heavily cutting back on my vaping today, and to patch up the withdrawal with nicotine lozenges. That actually seems to be working pretty well. Let’s see how the throat fares tomorrow… It’s 8.55pm:

Time since last cigarette: 9 d 07 h 34 mins

Money saved: £52.40

Not smoked: 232.89 cigarettes

Time saved: 0 d 23 h 17 mins

Day 12. Wednesday 9^th October

My throat feels fine. However, my e-cig is a long way from fine. In fact, it tastes like burnt metal. I’m no expert on these things, but from what I can tell the heating element has burnt out. I was told this would only need to be replaced every two months, but I guess I’ve been using it a lot, particularly during week one. Anyway, this means I ended up stuck at work without any withdrawal soothing vapour. But I did have a pack of nicotine lozenges on hand as back up, and you know what? I actually did pretty well on those today. And I have a back up mouthpiece at home, so life is good.

Day 13. Thursday 10^th October

Absolutely nothing to report today, other than passing the ‘1 day of my life saved’ milestone (Fun fact: Adults between the ages of 25 and 34 years who quit smoking gain around 10 years of life compared to those who continue to smoke! More info here). Oh, and I’ve just read back through this blog for the first time. It feels pretty good to have come this far! It’s now 11.11pm.

Time since last cigarette: 12 d 09 h 50 mins

Money saved: £69.81

Not smoked: 310.26 cigarettes

Time saved: 1 d 07 h 01 mins

Day 16. Sunday 13^th October.

I feel like I’ve spent a lot of this blog complaining about my teeth. But I have to mention it again, because I’ve started to notice a trend – they only seem to start hurting when I’m using the Cherry Cola flavour solution. No problems with Blueberry. There’s no information as to exactly what ‘flavourings’ consist of in these solutions on the company website. I’m going to dig deeper on this. Also, another observation: I seem to be much more sensitive to the effects of alcohol since quitting smoking. Two glasses of wine really have been knocking me for six. Anecdotal evidence, of course, although my husband has independently also made the same connection. Is there any research into this?! A five minute literature search does indeed suggest that nicotine decreases blood alcohol concentration! Surely this information needs to be publicised more widely for clear safety reasons… It’s 10.19pm:

Time since last cigarette: 15 d 08 h 58 mins

Money saved: £86.48

Not smoked: 384.35 cigarettes

Time saved: 1 d 14 h 26 mins

Day 19. Wednesday 16^th October.

Why do I always leave it to the last minute to pack for holiday?! Super quick update today. It’s 12.29am:

Time since last cigarette: 18 d 11 h 21 mins

Money saved: £103.86

Not smoked: 461.62 cigarettes

Time saved: 1 d 22 h 09 mins

Day 20. Thursday 17^th October.

HOLIDAY! Operation mini-break is go. I’m currently sitting at the airport. For some reason, I am DESPERATE for a cigarette right now – more so than I have been all week. I’m pinning this to one of two reasons: 1) I actually can’t have a cigarette right now (rather than just choosing not to); or 2) Whenever I’m at an airport I’m always in some growing state of nicotine withdrawal, and now my surroundings are basically acting as cues to provoke the deep state of unrest with which they’ve become associated. Possibly both. Plus I’m drinking coffee, which always makes me want to smoke.

Day 34. Thursday 31^st October.

Woah. It’s been a REALLY long time since my last entry. I’ve been meaning to squeeze in an update for ages but a back-to-back holiday, business trip, and unexpected stint in hospital have all gotten in the way (incidentally, not having to drag a drip outside every hour for a smoke has definitely been an unexpected bonus to quitting). So…update. And this is going to be my final entry, as I only planned to keep this diary going until the 1 month mark.

Today marks my 34^th day smoke-free. I am genuinely feeling pretty proud of myself, given that the longest I’ve gone without tobacco in the last eight years is a little under 24 hours. It hasn’t been easy. There have definitely been times when I’ve been desperate for a cigarette. And I have begged friends for a drag whilst out (they refused, for which I was grateful, at least the next morning). However, I have not (yet) slipped at all, which is pretty great considering I never even intended on quitting in the first place.

I also wanted to sum up on my experiences of quitting using an e-cigarette. Firstly, I should make it clear that I almost certainly wouldn’t have been able to quit without these. As I said in one of my first entries, I have tried a LOT of different cessation methods before, and failed royally with each every time. However, I also have some concerns. Before starting this experiment, I felt quite strongly that these products shouldn’t come under MHRA regulation. Why should products which seem to be proving to be so helpful in getting people off cigarettes be regulated more tightly than cigarettes themselves? However, over the course of the last month it has become very clear that some regulation of e-cigarettes is certainly warranted. There is a huge degree of variability between brands and models, for example, in terms of actual nicotine delivery. I have also experienced a number of negative symptoms which have coincided with the use of these products. These have ranged from the relatively minor (e.g., dry mouth, sore throat, and tooth ache, as discussed), to the more serious (e.g., coughing up bloody phlegm, as I rather worryingly experienced last night). All in all, however, I really am in favour of these devices. But for now, I think I’ll be switching to nicotine lozenges. It’s 3pm. My final stats are:

Time since last cigarette: 33 d 02 h 39 mins

Money saved: £186.25

Not smoked: 827.78 cigarettes

Time saved: 3 d 10 h 47 mins

P.s. If you’re interested in learning more about e-cigarettes, you might want to check out this briefing, recently released by Action on Smoking and Health.

This article is posted by Jen Ware