TIME Research

The New Science of How to Quit Smoking

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Two studies shed light on promising new ways to make kicking the habit easier, using both biology and behavior

Studies show that most smokers want to quit. So why are some people more successful at cutting out nicotine than others? The latest studies looking at the brains and behavior of smokers may provide some explanations.

Some people may be hardwired to have an easier time giving up their cigarettes, suggests one new trial described in the journal Neuropsychopharmacology. It turns out that some smokers start out with a particularly rich network of brain neurons in an area called the insula, which regulates cravings and urges and communicates cues: like seeing a cigarette or smelling tobacco smoke, then wanting to light up. Joseph McClernon, an associate professor of psychiatry and behavioral sciences at Duke University School of Medicine, ran MRI scans of 85 smokers who puffed more than 10 cigarettes a day. The smokers were then randomly assigned to continue smoking their brand or to smoke low-nicotine cigarettes, along with nicotine replacement therapy, for 30 days. All of the people in the study were then told to stop smoking and given nicotine replacement for 10 weeks.

MORE The Best Way to Quit Smoking Isn’t E-Cigs

Those who relapsed during that time tended to have lower activity in the insula, particularly in the connections between the insula and other motor areas that translate cravings into action, while those who successfully kicked the habit showed more robust activity in this brain region. The pattern remained strong despite how many cigarettes the smokers smoked.

“We’ve known for a while that some people seem to be able to quit and other people can’t,” says McClernon. “This gives us a better sense of what neural mechanisms might underlie those differences.”

The results suggest that it might be possible to identify people who may have a harder time quitting—a quick MRI scan of their brains would reveal how much activity they have in their insula—and provide them with more support in their attempts to quit. “Some smokers might benefit from more intensive, longer duration or even different types of interventions to stop smoking,” says McClernon. “They might need a higher, different level of care to help them make it through.”

But how much this system can be manipulated to help smokers quit isn’t clear yet. Previous studies show how potentially complicated the insula’s connections may be—smoking patients who have strokes and damage to the insula suddenly lose their desire to smoke and quit almost cold turkey. McClernon believes that the richer connections may not only promote interactions between cravings and behavior, but also enhance the connections that can inhibit or suppress those urges as well. Having a more intense communication in the insula may help strengthen the ability to quiet urges and inhibit the desire to smoke, despite cues and the urge to light up.

MORE Taking Medication May Make It Easier to Quit Smoking

But even if you’re not blessed with a brain that’s wired to make quitting easy, you still have options. In another study, published in the New England Journal of Medicine, scientists studied one of the oldest and most reliable ways to motivate people: money. In that trial, Dr. Scott Halpern from the University of Pennsylvania and his colleagues assigned 2,538 employees of CVS Caremark to one of five different smoking cessation programs. All received free access to nicotine replacement and behavioral therapy, and some were also assigned to an individual reward program in which they could earn up to $800 if they remained abstinent at six months. Another group was assigned another individual deposit program which was similar, except they had to pay $150 to participate, which they got back if they remained abstinent. Others were assigned to group versions of the reward and deposit programs so that what they received depended on how many in their group quit successfully.

Not shockingly, more people who were assigned to the reward program (90%) agreed to participate than people who were assigned to the deposit strategy (14%), likely because most people weren’t wiling to put their own money on the line. But when Halpern looked more closely at those who did enroll, the smokers in the deposit programs were twice as likely to be abstinent at six months than those in the reward group and five times as likely to be smoke-free than those who received only free counseling and nicotine replacement.

MORE Paying People Could Help Them Quit Smoking

That’s not entirely surprising, says Halpern, since having some of their own money at risk provided more motivation for the smokers to quit. When it comes to incentivizing smoking cessation, “adding a bit of stick is better than having just a pure carrot,” he says.

Finding the perfect balance of stick and carrot, however, may be more challenging. Halpern believes that from the perspective of an employer, insurer or government, offering even higher rewards than the $800 in the study and lowering the deposit slightly might still provide benefits to all parties. Smokers cost an average of $4,000 to $6,000 more each year in health services than non-smokers, he says, so offering even as much as $5,000 can still result in cost savings for employers, many of whom are now dangling financial incentives in front of their smoking employees to motivate them to quit.

How the financial carrot is proffered is also important, says Halpern. Now, most employers or insurers reward quitting in more hidden ways, with bonuses in direct deposit accounts or with lower premiums. While helpful, these aren’t as tangible to people, and humans respond better to instant gratification. “They’re rewarding people in ways that are essentially blind to the way human psychology works,” he says. “The fact that the benefits occur in the future make them a whole lot less influential than if people were handed money more quickly. Our work suggests that in addition to thinking about the size of the incentive, it’s fundamentally important to think about how to deliver that money.”

Another factor that can make financial incentives more powerful is to make the experience more enjoyable, either by introducing some competition in a group setting or encouraging smokers along the way. In the study, smokers in the group programs were not any more successful than those in the individual regimes, but that may be because the employees didn’t know each other. Grouping colleagues in the same office might have more of an effect, says Halpern. Either way, he says, incorporating such incentives to help more people quit smoking is “really a win-win.”

Read next: The Best Way to Quit Smoking Isn’t E-Cigs

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TIME Mental Health/Psychology

Depression Can Double Risk for Stroke—Even When It’s Treated

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People with prolonged depression had 114% higher risk of stroke than those without symptoms

As if depression isn’t hard enough on the mind, the condition can also wreak havoc all over the body, increasing risk of health problems that at first don’t seem remotely connected to feeling low. Depressed people are at increased risk for type 2 diabetes and cardiovascular death, and according to a new study published Wednesday in the Journal of the American Heart Association, they’re also at greatly increased risk for stroke. Adults over age 50 who report persistent symptoms of depression have double the risk for stroke, the study finds—and that increase lingers even after they report feeling better.

The researchers analyzed data from more than 16,000 middle-aged adults ages 50 and older. Every two years from 1998-2010, the people in the study were asked about their history of stroke, stroke risk factors and symptoms of depression.

People who reported high symptoms of depression—three or more symptoms from an eight-item depression scale—for four consecutive years had about 114% higher risk of stroke compared to those who did not have symptoms of depression at either interview.

It remains unclear exactly how prolonged depressive symptoms lead to an increased stroke risk, but the elevated risk appears to stick around for a long time, even after depression goes away. People whose depressive symptoms had subsided at the second interview still had a 66% higher risk of stroke than those without symptoms.

“We do not know if, had we been able to examine individuals who had been symptom free for a longer time, stroke risk would have declined more,” said study author Paola Gilsanz, a postdoctoral fellow at Harvard T.H. Chan School of Public Health, in an email. “To assess that, we really need a larger study.”

Just as stroke risk was slow to subside, it was slow to take hold, too. People who had just begun developing depressive symptoms weren’t at higher stroke risk than those without symptoms. “We were surprised to see that changes in depressive symptoms seem to take more than two years to influence risk of stroke,” Gilsanz said.

It’s difficult to say from this study whether treatment has mitigating effects, since the authors didn’t specifically look at why people’s symptoms went away. But even though the data suggest that getting rid of symptoms of depression might not immediately erase the increased risk for stroke, they emphasize the importance of early treatment.

“If our findings are replicated, they suggest depressive symptoms merit prompt attention soon after they begin, before they have time to substantially impact stroke risk,” Gilsanz says. “We also recommend that people with depression also focus on keeping their overall stroke risk profile as healthy as possible, as we all should.”

TIME ebola

Health Worker Tests Positive For Ebola in Italy

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The patient was a healthcare worker volunteering in Sierra Leone

A healthcare worker in Italy has been diagnosed with Ebola, the first time a person has received an Ebola diagnosis in the country. The patient is currently undergoing treatment for the disease.

The worker was volunteering in an Ebola treatment center in Sierra Leone, and on May 7, the volunteer flew from Freetown, Sierra Leone to Rome, stopping in Casablanca, Morocco. The patient had no symptoms at that time. It wasn’t until May 10, when the patient was already in Italy, that they began to experience symptoms of the virus. The World Health Organization (WHO) reports that the patient isolated themselves in their home before they were transported on the May 11 to the Hospital of Sassari, Sardinia. On May 12th, samples from the patient confirmed that they did indeed have Ebola.

The patient was then transferred from the Hospital of Sassari to he National Institute for Infectious Diseases (INMI) Lazzaro Spallanzani of Rome in a special aircraft.

Since the patient did not start experiencing symptoms until 72 hours after returning to Italy, WHO says it is not necessary to conduct contact tracing of individuals who were on the same plane. Ebola can only be transmitted via the bodily fluids of a symptomatic person.

More than 26,720 cases of Ebola have been reported in Sierra Leone, Liberia and Guinea since the start of the outbreak, and more than 11,000 people have died.

TIME Mental Health/Psychology

You Asked: Are My Devices Messing With My Brain?

You Asked: Are All My Devices Messing With My Brain?
Illustration by Peter Oumanski for TIME

Yes—and you're probably suffering from phantom text syndrome, too.

First it was radio. Then it was television. Now doomsayers are offering scary predictions about the consequences of smartphones and all the other digital devices to which we’ve all grown so attached. So why should you pay any attention to the warnings this time?

Apart from portability, the big difference between something like a traditional TV and your tablet is the social component, says Dr. David Strayer, a professor of cognition and neural science at the University of Utah. “Through Twitter or Facebook or email, someone in your social network is contacting you in some way all the time,” Strayer says.

“We’re inherently social organisms,” adds Dr. Paul Atchley, a cognitive psychologist at Kansas University. There’s almost nothing more compelling than social information, he says, which activates part of your brain’s reward system. Your noodle is also hardwired to respond to novel sights or sounds. (For most of human history, a sudden noise might have signaled the presence of a predator.) “So something like a buzz or beep or flashing light is tapping into that threat detection system,” he explains.

Combine that sudden beep with the implicit promise of new social info, and you have a near-perfect, un-ignorable stimulus that will pull your focus away from whatever task your brain is working on. And while you may think you can quickly check a text or email and pick up that task where you left off, you really can’t.

“Every time you switch your focus from one thing to another, there’s something called a switch-cost,” says Dr. Earl Miller, a professor of neuroscience at Massachusetts Institute of Technology. “Your brain stumbles a bit, and it requires time to get back to where it was before it was distracted.”

While this isn’t a big deal if you’re doing something simple and rote—making an omelet, say, or folding clothes—it can be a very big deal if your brain is trying to sort out a complex problem, Miller says.

One recent study found it can take your brain 15 to 25 minutes to get back to where it was after stopping to check an email. And Miller’s own research shows you don’t get better at this sort of multitasking with practice. In fact, people who judged themselves to be expert digital multitaskers tended to be pretty bad at it, he says.

“You’re not able to think as deeply on something when you’re being distracted every few minutes,” Miller adds. “And thinking deeply is where real insights come from.”

There seems to be an easy solution to this: When you’re working on something complicated, switch off your phone or email.

That could work for some people. But there’s evidence that as your brain becomes accustomed to checking a device every few minutes, it will struggle to stay on task even at those times when it’s not interrupted by digital alerts. “There’s something called ‘phantom text syndrome,’ ” Atchley says. “You think you hear a text or alert, but there isn’t one.”

While phantom texts can afflict adults, Atchley says this phenomenon is pretty much universal among people under the age of 20—many of whom wouldn’t recognize a world that doesn’t include smartphones. Even if you don’t hear phantom alerts, you may still find yourself reflexively wanting to check your device every few minutes for updates, which disrupts your concentration regardless of whether you ignore that impulse.

Your ability to focus aside, a 2014 study appearing in the journal PLOS One found that people who spend a lot of time “media multitasking”—or juggling lots of different websites, apps, programs or other digital stimuli—tend to have less grey matter in a part of their brain involved with thought and emotion control. These same structural changes are associated with obsessive-compulsive disorder, depression, and anxiety disorders, says that study’s first author, Kepkee Loh, who conducted his research at University College London.

Atchley says more research suggests lots of device use bombards your brain’s prefrontal cortex, which plays a big role in willpower and decision-making. “The prefrontal cortex prevents us from doing stupid things, whether it’s eating junk food or texting while driving,” he explains.

He says this part of the human brain isn’t “fully wired” until your early 20s—another issue that has him worried about how a lot of device use may be affecting children and adolescents.

So what’s the antidote? Spending time in nature may counteract the focus-draining effects of too much tech time, shows research Atchley and Strayer published in 2012. Meditation may also offer focus-strengthening benefits.

Strayer says putting your phone on silent and setting your email only to deliver new messages every 30 minutes are also ways to use your devices strategically and “not be a slave to them,” he adds.

Of course, there are plenty of benefits associated with the latest and greatest technologies. Ease and convenience of staying in touch with friends is a big one. But many open questions remain when it comes to the true cost of our digital distractions.

“Imagine Einstein trying to think about mathematics at a time when part of his brain was wondering what was going on with Twitter,” Atchley says. “People make incredible breakthroughs when they’re concentrating very hard on a specific task, and I wonder if our devices are taking away our ability to do that.”

TIME public health

This Natural Bug Repellent Works Better Than Deet

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If mosquitoes love to slurp your blood—and yes, some people are more prone to a bite than others—you’ll likely stop at nothing to keep them away, harsh chemicals and all. A Consumer Reports survey of 2,011 U.S. adults found that almost 75% are more concerned with the many diseases transported by mosquitoes and ticks, like Lyme disease, West Nile Virus and chikungunya, than with potentially dangerous chemicals in their bug spray. But a new investigation by the product-testing group Consumer Reports finds that you have more natural options that are even more effective.

In Consumer Reports’ entire history of testing bug sprays, harsh chemicals like N, N-diethyl-meta-toluamide, commonly known as deet, have always come out on top. But for the first time, safer, gentler products were more effective.

The winning products used picaridin and oil of lemon eucalyptus as the active ingredients. Both are chemically synthesized ingredients but more similar to natural compounds than deet; they also come with fewer side effects. Best in show were Sawyer Fisherman’s Formula, which held mosquitoes and ticks at bay for eight hours, and Repel Lemon Eucalyptus, which protected against ticks for eight hours and mosquitoes for seven hours.

MORE: You Asked: Why Do Mosquitos Always Bite Me?

To test the effectiveness of the sprays, researchers enlisted the help of some brave testers—the “swat team,” they called them—who were spritzed with different repellents, left to sit for 30 minutes, and then told to reach into a cage with 200 mosquitoes hungry for blood (but free of diseases). Researchers watched the feast and recorded the number of bites; two or more bites in a five-minute session meant the repellent failed. They tested for ticks, too—and even braver testers had repellent applied to parts of their arms and disease-free deer ticks released on their arms to crawl. If two ticks crossed into the sprayed areas, the repellent failed.

Products starring plant oils like citronella, lemongrass and rosemary didn’t work. Candles and wristbands didn’t work, either.

“Look first for products with 20 percent picaridin or 30 percent oil of lemon eucalyptus,” the report said. “We think they’re safer than those with deet.” If deet is your only option, aim for a concentration of about 15 percent, which even outperformed the product with 25 percent. In concentrations more than 30 percent, deet might be dangerous, the authors conclude.

Read the entire Consumer Reports investigation here.

TIME Obesity

‘Thrifty’ Metabolisms May Make It Harder to Lose Weight

File photo dated Thursday October 16, 2014. of a young girl using a set of weighing scales as slimmers should forget what they have been told about avoiding rapid weight loss in favour of slow but sure dieting, according to new research.
Chris Radburn—PA Wire/Press Association Images File photo dated Thursday October 16, 2014. of a young girl using a set of weighing scales as slimmers should forget what they have been told about avoiding rapid weight loss in favour of slow but sure dieting, according to new research.

The study marks the first time lab results have confirmed the widely held belief

Losing those love handles may be easier for some people than for others, says a new study that confirmed the theory that physiology plays a role in a person’s ability to lose weight.

According to a press release, researchers at the Phoenix Epidemiology and Clinical Research Branch studied the metabolisms of 12 obese men and women undergoing a six-week 50% calorie-reduction experiment. After measuring participants’ energy expenditure after a day of fasting and then re-examining them during the caloric-reduction period, researchers found that the slower the metabolism works during a diet, the less weight the person loses.

Coining the terms “thrifty” vs. “spendthrift” metabolisms, the experiment marks first time lab results have confirmed a widely held belief that a speedy metabolism plays a role in weight loss.

“While behavioral factors such as adherence to diet affect weight loss to an extent, our study suggests we should consider a larger picture that includes individual physiology — and that weight loss is one situation where being thrifty doesn’t pay,” said lead author Dr. Susanne Votruba, Ph.D.

Researchers have yet to figure out if the differences in metabolic speeds are innate traits or develop over time. Also, the study was only focused on weight loss, and the team does not know if the body’s response to caloric reduction can be used to prevent weight gain.

Over one-third of Americans are obese, and it leads to some of the most common forms of preventable deaths in the country.

TIME Research

More Than a Quarter of American Adults Have Untreated Tooth Decay

American oral health could use a brush-up

New data on tooth decay and cavities among American adults reveal the sad state of our pearly whites. More than 25% of American adults ages 20 to 64 have untreated tooth decay, and 91% have one tooth — or more — that has been treated for tooth decay or needs to be.

The latest findings published Wednesday from the U.S. Centers for Disease Control and Prevention’s National Center for Health Statistics show that while tooth decay and complete tooth loss have dropped among Americans since the 1960s, disparities still remain, and there’s room for improvement in our oral health.

MORE: The Sugar Industry Shaped Government Advice on Cavities, Report Finds

The data span 2011–2012 and reveal that Hispanic and black adults had more untreated cavities compared with white and Asian adults ages 20 to 64. Black adults had the highest rate at 42%.

About 1 in 5 adults age 65 and older had untreated tooth decay; American adults ages 20 to 39 were twice as likely to have all their teeth, compared with adults ages 40 to 64.

Though the current report only looks at adults, cavities are common among young people too. Even though cavities are preventable, tooth decay is four times more common than asthma in teens ages 14 to 17. It’s the most common chronic disease among kids and adolescents ages 6 to 19.

TIME Infectious Disease

Bird-Flu Outbreak Spreads to Nebraska

It is the 16th state with cases since December

An avian-flu outbreak has been confirmed on a commercial poultry farm in Nebraska, the Department of Agriculture said Tuesday, marking the 16th state to report cases in a flock.

The egg-laying farm in Dixon County is home to some 1.7 million chickens, the federal agency said in a statement, and in addition to quarantine measures, the affected chickens will be euthanized. The Centers for Disease Control and Prevention considers the risk to humans to be “low” but the infection and spread of the virus can be economically devastating to farms.

More than 32 million birds have been affected by the virus since the U.S. Department of Agriculture confirmed several cases in December.

Read next: The New Bird Flu Outbreak: Should You Worry?

TIME Research

Why Autism Is Different in the Brains of Girls Than in Boys

The reasons why girls are less often diagnosed may be both biological and social

Autism, already a mysterious disorder, is even more puzzling when it comes to gender differences. For every girl diagnosed with autism, four boys are diagnosed, a disparity researchers don’t yet fully understand.

In a new study published in the journal Molecular Autism, researchers from the UC Davis MIND Institute tried to figure out a reason why. They looked at 112 boys and 27 girls with autism between ages 3 and 5 years old, as well as a control sample of 53 boys and 29 girls without autism. Using a process called diffusion-tensor imaging, the researchers looked at the corpus callosum — the largest neural fiber bundle in the brain — in the young kids. Prior research has shown differences in that area of the brain among people with autism.

They found that the organization of these fibers was different in boys compared with girls, especially in the frontal lobes, which play a role in executive functions. “The sample size is still limited, but this work adds to growing body of work suggesting boys and girls with autism have different underlying neuroanatomical differences,” said study author Christine Wu Nordahl, an assistant professor in the UC Davis Department of Psychiatry and Behavioral Sciences, in an email.

In other preliminary research presented at the International Meeting for Autism Research, or IMFAR, in Salt Lake City, the study authors showed that when girls and boys with autism are compared with typically developing boys and girls, the behavioral differences between girls with autism and the female controls are greater than the differences among the boys. Nordahl says this suggests that girls can be more severely affected than boys.

A study earlier this year by a separate group found notable differences in symptoms between autistic boys and girls, which could be one of the reasons autism in girls sometimes goes unnoticed or is diagnosed late. Girls generally display less obvious behavioral symptoms at a young age compared with boys, the researchers found.

One of the reasons females with autism are less understood than males is that most research studies do not have equal numbers of boys and girls, says Nordahl. “This is not surprising, given that there are so many more males with autism than females,” she says. “We need to do a better job of trying to recruit females with autism into our studies so that we can fully explore differences between males and females with autism.”

Nordahl says understanding gender differences in autism affects how kids are diagnosed, as well as how they are treated. Understanding what biological differences may be at work can ultimately lead to a better understanding of autism and the best interventions for treatment.

TIME Research

How Self-Promotion Can Backfire

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There are social consequences to tooting your own horn too often

Tuesday in social faux pas news comes a paper showing that when we try to make people like us, we often come across as braggy and annoying.

We often practice a little self-promotion when we’re trying to be impressive. Turns out, it doesn’t always come across the way we want it to. New research published in the journal Psychological Science shows that people frequently overestimate how much their self-promotion works in their favor and underestimate how much it achieves the opposite effect.

“These results are particularly important in the Internet age, when opportunities for self-promotion have proliferated via social networking. The effects may be exacerbated by the additional distance between people sharing information and their recipient, which can both reduce the empathy of the self-promoter and decrease the sharing of pleasure by the recipient,” said study author Irene Scopelliti, a lecturer in marketing at City University London in a statement.

To better understand the phenomena, researchers conducted a few experiments. In the first they asked people to describe in detail a time they bragged about themselves, what emotions they felt, and how they think the person listening to them felt. Then, another group of people were asked to describe a time when they listened to someone brag about themselves, as well as what emotions they felt and how they think the other person felt. The results showed that the people who did the bragging tended to think the people who were listening to them felt happier and more proud of them than they actually did. They were also likely to underestimate how annoying the listener thought they were.

A third part of the study, where the researches asked people to make a positive impression of themselves, showed that, indeed, people tended to brag about themselves to do it. That, too, backfired.

So next time you have something to brag about, consider your audience. Your true friends and family may still want to lend an ear, but that person you’re trying to impress may just find your self-promotion irritating rather than remarkable.

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