Comprehensive Tobacco Control Policy Regimes and Population Health: Assessing Causal Loops

Tobacco products remain among the most controversial consumer products of all time: cigarettes are the only legal product that, when used as intended, are lethal. The global and individual burden attributable to the primary use of tobacco, or secondary or tertiary exposure to cigarette smoke, whether measured by morbidity, mortality, or economic costs, is substantial. With the combined efforts of scientific research, public health and policy advocates, the image and use of tobacco products has undergone profound change. However, while much has been achieved regarding the attitudinal, behavioral, and policy changes needed to diminish the individual, social, and economic costs of tobacco use, much remains to be yet accomplished if these adverse tobacco use impacts are to be further curtailed. There is considerable evidence that tobacco use is becoming highly concentrated in lower socio-economic groups and that the rate of decline in smoking is slowing. Further, as the tobacco epidemic emerges in the developing world, there is considerable interest line applying the lessons learned in industrialized countries to developing countries, thereby truncating the tobacco epidemic and forgoing some of the enormous costs in countries least able to absorb such costs.;The unifying theme of the present work is an integration of the public health and political science perspectives on tobacco control so as to establish a more comprehensive framework of the underlying factors and elements interrelating tobacco use and tobacco control policy. A substantial challenge in developing such a framework is the complexity of the relationship between the two primary outcomes of interest. The relationships, including interdependencies and feedback mechanisms, are much more accurately characterized by a causal loop. This work presents an overview of the tobacco epidemic, a review of two very different literatures with different perspectives on the tobacco epidemic (public health literature and political and policy science), an empirical policy history analysis integrating the political and policy science viewpoint with the public health perspective on the evolution of the tobacco epidemic, and two quantitative analyses alternately supporting the interdependence and complex temporal relationship between tobacco control policy adoption and population health outcomes as well as the importance of societally-derived factors. An integrated conceptual model based on the causal loops of tobacco control policy and tobacco-related population health is then presented that incorporates the realms of population, governmental, judicial, public health, tobacco industry and other subsystems, and scientific communities. However, while this framework does assimilate the key elements and forces elucidated during the course of this work and integrates the political and policy science with the public health perspective, in truth this framework likely elicits more questions than it answers. The research questions and agendas and metrics proposed highlight both the strengths and deficiencies of the two perspectives

Highlighting the Mechanistic Relationship Between Perinatal Depression and Preeclampsia: A Scoping Review

Background: Although there is scientific literature supporting an association between depression and preeclampsia (PE), little is known about the underlying mechanistic pathways that may explain these observed associations. Thus, this study aimed to outline the relationship between depression and PE, and to highlight the underlying cardiovascular and metabolic risk factors that are common to both. Methods: A scoping review of the literature was conducted in Medline, Scopus, and Web of Science. Results: From 706 articles initially identified, 23 articles met the inclusion criteria and were included in this review. Although some studies reported a positive association between PE and postpartum depressive symptoms, challenges comparing different methodologies, measurement instruments and when measurements were administered, and patient populations do not permit a decisive conclusion. In addition, very few studies addressed potential underlying mechanisms that may be contributing to observed associations; thus, a secondary search was conducted to identify cardiovascular and metabolic risk factors that are common to both depression and PE. Conclusion: The cardiovascular and metabolic risk factors (i.e., increased inflammation and oxidative stress and decreased vascular and endothelial function) common to both depression and PE suggest that these factors may contribute as underlying mechanisms in both conditions. These similarities underscore the importance to better understand these mechanisms so preventative and therapeutic strategies could be developed to improve maternal health

Beneficial pleiotropic antidepressive effects of cardiovascular disease risk factor interventions in the metabolic syndrome

© 2018 The Authors. Background--Although the increased prevalence and severity of clinical depression and elevated cardiovascular disease risk represent 2 vexing public health issues, the growing awareness of their combined presentation compounds the challenge. The obese Zucker rat, a model of the metabolic syndrome, spontaneously develops significant depressive symptoms in parallel with the progression of the metabolic syndrome and, thus, represents a compelling model for study. The primary objective was to assess the impact on both cardiovascular outcomes, specifically vascular structure and function, and depressive symptoms in obese Zucker rats after aggressive treatment for cardiovascular disease risk factors with long-term exercise or targeted pharmacological interventions. Methods and Results--We chronically treated obese Zucker rats with clinically relevant interventions against cardiovascular disease risk factors to determine impacts on vascular outcomes and depressive symptom severity. While most of the interventions (chronic exercise, anti-hypertensive, the interventions (long-term exercise, antihypertensive, antidyslipidemia, and antidiabetic) were differentially effective at improving vascular outcomes, only those that also resulted in a significant improvement to oxidant stress, inflammation, arachidonic acid metabolism (prostacyclin versus thromboxane A2), and their associated sequelae were effective at also blunting depressive symptom severity. Using multivariable analyses, discrimination between the effectiveness of treatment groups to maintain behavioral outcomes appeared to be dependent on breaking the cycle of inflammation and oxidant stress, with the associated outcomes of improving endothelial metabolism and both cerebral and peripheral vascular structure and function. Conclusions--This initial study provides a compelling framework from which to further interrogate the links between cardiovascular disease risk factors and depressive symptoms and suggests mechanistic links and potentially effective avenues for intervention

Changes in Cardiovascular Health in the United States, 2003–2011

Background Cardiovascular disease is the leading cause of death in the United States, making improving cardiovascular health a key population health goal. As part of efforts to achieve this, the American Heart Association has developed the first comprehensive cardiovascular health index (CVHI). Our objective was to investigate the changes in CVHI in US states from 2003 to 2011. Methods and Results CVHI was examined using Behavioral Risk Factor Surveillance System data between 2003 and 2011 (odd‐numbered years). Total CVHI decreased from 3.73±0.01 in 2003 to 3.65±0.01 in 2009. The majority of states (88%) experienced a decline in CVHI and an increase in the prevalence of “poor” CVHI between 2003 and 2009. Among CVHI components, the highest prevalence of “ideal” was observed for blood glucose followed by smoking, whereas the lowest prevalence of “ideal” was observed for physical activity and diet. Between 2003 and 2009, prevalence of “ideal” smoking and diet status increased, while “ideal” prevalence of blood pressure, cholesterol, blood glucose, body mass index, and physical activity status decreased. We observed statistically significant differences between 2009 and 2011, outside the scope of the 2003–2009 trend, which we hypothesize are partially attributable to differences in sample demographic characteristics related to changes in Behavioral Risk Factor Surveillance System methodology. Conclusions Overall, CVHI decreased, most likely due to decreases in “ideal” blood pressure, body mass index, and cholesterol status, which may stem from low prevalence of “ideal” physical activity and diet status. These findings can be used to inform state‐specific strategies and targets to improve cardiovascular health

Application of a novel index for understanding vascular health following pharmacological intervention in a pre-clinical model of metabolic disease

While a thorough understanding of microvascular function in health and how it becomes compromised with progression of disease risk is critical for developing effective therapeutic interventions, our ability to accurately assess the beneficial impact of pharmacological interventions to improve outcomes is vital. Here we introduce a novel Vascular Health Index (VHI) that allows for simultaneous assessment of changes to vascular reactivity/endothelial function, vascular wall mechanics and microvessel density within cerebral and skeletal muscle vascular networks with progression of metabolic disease in obese Zucker rats (OZR); under control conditions and following pharmacological interventions of clinical relevance. Outcomes are compared to “healthy” conditions in lean Zucker rats. We detail the calculation of vascular health index, full assessments of validity, and describe progressive changes to vascular health index over the development of metabolic disease in obese Zucker rats. Further, we detail the improvement to cerebral and skeletal muscle vascular health index following chronic treatment of obese Zucker rats with anti-hypertensive (15%–52% for skeletal muscle vascular health index; 12%–48% for cerebral vascular health index; p < 0.05 for both), anti-dyslipidemic (13%–48% for skeletal muscle vascular health index; p < 0.05), anti-diabetic (12%–32% for cerebral vascular health index; p < 0.05) and anti-oxidant/inflammation (41%–64% for skeletal muscle vascular health index; 29%–42% for cerebral vascular health index; p < 0.05 for both) drugs. The results present the effectiveness of mechanistically diverse interventions to improve cerebral or skeletal muscle vascular health index in obese Zucker rats and provide insight into the superiority of some pharmacological agents despite similar effectiveness in terms of impact on intended targets. In addition, we demonstrate the utility of including a wider, more integrative approach to the study of microvasculopathy under settings of elevated disease risk and following pharmacological intervention. A major benefit of integrating vascular health index is an increased understanding of the development, timing and efficacy of interventions through greater insight into integrated microvascular function in combination with individual, higher resolution metrics

Exercise Improves Vascular Dilator Reactivity in Chronically Stressed Rats with Pre-existing Metabolic Syndrome

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Perivascular Adipose Tissue Diminishes Nitric Oxide Bioavailability in Metabolic Syndrome

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Exercise as a Treatment for Peripheral Vascular Dysfunction Caused by Metabolic Syndrome and Depression

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