A study conducted in the state of Nebraska, United States revealed that smoking is associated with poor cognitive performance and reduced brain volume among more than 1,000 children aged 9 to 10 years old who were followed up for two years. The study found that the effects of smoking could have a lasting impact.
Among those investigated, 116 children reported using tobacco products and were considered to be the earliest group of tobacco users in the study. This group performed poorly on the tests (mean, b = -2.9; SE, 0.6; P <.001), showing lower crystallized cognitive composite scores (b = -2.4; SE, 0.5; P <.001) and total cognitive composite scores (b = -2.9; SE, 0.5; P = .01). In a follow-up study of two years, smokers had lower cortical volumes in the frontal, parietal, and temporal lobes than non-users.
According to a report by Dr. Hongying Daisy Dai, Chief Researcher at the University of Nebraska Medical Center, electronic cigarettes and smokeless tobacco products should not be considered as a substitute to traditional cigarettes for youth to reduce tobacco-related harm. Authorities should implement comprehensive intervention strategies and tobacco control policies to prevent tobacco initiation.
From October 2016 to October 2018, a study titled Adolescent Brain Cognitive Development (ABCD) included 11,729 children from 21 US-based websites. This study followed up with the participants from August 2018 to January 2021. Participants were asked to complete a survey about tobacco use, including e-cigarettes, cigarettes, cigars, smokeless tobacco, hookah, pipes, and nicotine replacement products.
Dai and colleagues utilized a comprehensive combination of cognitive assessment measures, including the National Institutes of Health Toolbox Cognitive Battery, morphometric analysis, and structural MRI, to evaluate differences between users and non-users. In terms of race and ethnicity, 2.1% of the sample were Asian; 20.3% were Hispanic/Latino; 14.9% were non-Hispanic Black; and 52.1% were non-Hispanic White. Just over a quarter (27.3%) of the sample had parents who were college graduates, and 13.7% had parents with an annual income less than $25,000.
During a two-year follow-up period, the scores of first-time tobacco users in oral recognition (b=-2.1; SE, 0.5; P<.001), picture sequencing memory (b=-3.0; SE, 0.7; P<.001), and crystallized cognitive composite scores (b=-2.7; SE, 0.8; P=.005) remained lower than non-users. In SMRI analysis, former smokers exhibited significantly decreased measurements in the entire brain, including the total cortical surface area in the first wave (b=-5014.8 mm3; SE, 7043.9; P=.002), total cortical volume in the first wave (b=-174,621.0 mm3; SE, 5857.7; P=.003) and follow-up (b=-21,790.8 mm3; SE, 7043.9; P=.002), and total intracranial volume in the first wave (b=-38,442.8 mm3; SE, 12,057.7; P=.009).
In a related editorial, Dr. Laviolette from the University of Western Ontario wrote, "The findings reported by Dai and colleagues raise many important questions for future clinical and preclinical investigations. It is important to determine the extent to which these pathophysiological findings extend beyond the window of brain maturation prior to adolescence. Furthermore, it is crucial to identify the specific molecular mechanisms and biomarkers underlying these persistent tobacco-induced pathophysiological effects.
He added that the description of potential mechanisms could facilitate similar identification of intervention and reversal strategies for "neurological and psychiatric phenotypes caused by nicotine exposure in children, adolescents, and even prenatal exposure." Additionally, advances in genomic and transcriptomic analysis could better understand the potential genetic factors that could make individuals more susceptible to nicotine products during critical periods of brain development, as well as factors that could increase the risk of serious neurological and cognitive outcomes after exposure to nicotine during the developmental window for some individuals.
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