Quitting smoking is the hardest resolution to keep

— It’s that time of year when many of us take a cold, hard look at our lives — and, more important, our vices — to set a goal we believe will make us healthier or happier in the year ahead.

There are 1 billion smokers worldwide, and one resolution in the top 10 each year is the intention to kick the habit for good.

But this goal is the most difficult of all resolutions to keep, with three in five people in the United Kingdom who resolved to quit taking the habit up again by the end of January, according to new data released by the Royal Society of Public Health in the UK.

Of more than 2,000 people surveyed about their resolutions at the end of 2016 by research consultancy Populus, 175 (8%) had chosen to quit smoking, but only 41% of those 175 kept it going until January 31. Just 13% remained smoke-free at the end of the year.

“One of the main challenges of smoking is that it’s a chemical addiction,” said Duncan Stephenson, director of external affairs at the Royal Society of Public Health. Quitting “takes huge amounts of willpower.”

Stephenson was unsurprised by the findings. They’re an important reminder that people should not to give up after the first hurdle or slip-up. They can use support services or quitting aids, such as nicotine replacement therapy or e-cigarettes, to improve their chances of success, he said.

“Rather than setting unrealistic goals and making huge changes to lifestyle, we suggest people make small changes using a step-wise approach,” he said. “During the new year, lots of people want to reinvent themselves … but people shouldn’t set themselves up to fail.”

Stephenson likened quitting smoking to the challenge of going on a diet in which people set unrealistic targets by making dramatic — and often short-lived — changes.

“Christmas is one of the most calorific periods of the year, and then you put yourself in a straitjacket when you go on a crash diet,” he said. “In most cases, 95% of diets fail.”

In the organization’s survey, dieting was second from last in terms of resolution success, with 65% of people lasting one month and just 16% making it to the end of the year.

“The most difficult resolutions to keep were the consumptive, addictive behaviors, such as smoking and dieting,” said John Norcross, distinguished professor of psychology at the University of Scranton and author of the behavior change book “Changeology.” Norcross has been exploring resolutions and the factors impacting people’s ability to change for more almost 30 years.

“The easiest ones are the realistic, attainable resolutions that can be accomplished permanently in the first three or four weeks,” he said.

Be realistic

The most successful resolutions in 2016 were among people who had chosen to improve relationships with friends and family, followed by shaping a healthier work-life balance.

More than 80% of people who resolved to improve relationships reported doing so by the end of January, with 58% having stuck with it to the end of the year. A better work-life balance came in second, with 75% keeping this resolution for one month and 43% still feeling they were doing this at the end of the year.

“It’s not so much the topic, it’s how realistic the goal is,” Norcross said, adding that for the most successful resolution, “it doesn’t say ‘fix,’ it says ‘improve’ … so they will have a much higher success rate.”

The fact that people self-reported their success inevitably brings some bias to the findings, in addition to the fact that people had to recall things from earlier in the year, said Norcross.

But also worth noting is the broadness of the data.

“We don’t know how people characterize their success rates. … We don’t have a sense of magnitude for improvement,” said Norcross, giving the example of playing sports and not knowing whether people played once a week or every few months.

For its next survey, Stephenson said, the Royal Society of Public Health will be asking participants for more detail and will inquire further about what threw people off their resolutions.

Global similarities

These findings are likely to be reflected in other countries, including the United States, Stephenson said, underscoring “some of the challenges individuals face in both changing behavior and maintaining” their resolutions.

A 2017 Marist Institute of Public Opinion resolution poll of more than 400 people in the United States found smoking to be the seventh most popular resolution, chosen by 6% of those polled. The most common resolution was wanting to be a better person (16%), followed by wanting to lose weight.

In earlier studies by Norcross in 2002, the most popular resolutions still related to stopping smoking, weight loss and increasing exercise.

Tips for success

To prepare your mind to succeed in maintaining your resolution, Norcross uses the analogy of learning a new sport or skill. A person doing that is likely to slip up and make mistakes — but they should then learn from those slip-ups.

“Let’s say you wanted to learn tennis,” he said. “People say they would have to take lessons, it would take some time, and they are likely to make mistakes, and that’s right.” The same is true when quitting smoking or committing to eating healthier foods.

Successful people know that a slip is not a fall, he said, and relapses are common — and expected. “It’s like someone missing a shot in tennis and not playing again. It’s really quite silly when you think about it,” he said.

But people should be encouraged by the survey numbers, Norcross said, adding that averaging across all resolutions, about 40% of people remain successful at six months. Once there, they are more likely to last the year.

Both Norcross and Stephenson stress that willpower is not enough, not matter how much you may hear otherwise.

“In our studies, people who primarily relied on willpower failed at three times the rate of everyone else,” Norcross said, adding that many steps are needed to make a resolution last. “It starts with getting prepared, rewarding yourself, developing a flourishing environment that supports you and creating the behavior.”

Stephenson agrees, adding that people should “not be discouraged if they relapse,” he said. “It is difficult to maintain behavior change, but if you make small changes, it can have a huge effect.”

Autism study shows benefits when parents get involved

— For millions of families around the world, autism poses daily challenges. Some parents find it difficult or even impossible to communicate with their own children or understand how they perceive the world around them. This mental condition can also affect their child’s ability to interact socially or show emotion, and often create a desire for repetitive behaviors.

But a new study published Tuesday in the Lancet has showed that parents of children with autism may be able to work with them from a young age to help reduce the severity of their symptoms and improve their ability to communicate.

The findings were the outcome of the Pre-school Autism Communication Trial, which was designed to “work with parents to help improve parent-child communication at home,” according to Jonathan Green, professor of child and adolescent psychiatry at the University of Manchester, who co-led the trial.

“(Autism) is a devastating diagnosis to most families,” he added. “Then there is a big question mark above what happens next.”

The benefit of parental intervention

Autism is thought to affect one in 68 children in the United States and one in 100 children in the UK, with half estimated to have intellectual disabilities and about 10% never learning to speak, according to the researchers. It is a spectrum disorder, with children experiencing a range of symptoms and severity. The causes are not fully understood, and there is currently no pharmaceutical treatment or cure.

Previous studies and therapies have involved having children work directly with therapists to improve their communication skills and reduce symptoms, such as repetition. By contrast, the new trial “is a parent-mediated intervention,” said Green, who believes this enables a 24/7 therapeutic space for children with autism in their own homes.

During the trial, children with severe, core symptoms of autism were divided into two groups: one in which children and parents received standard treatment and one in which parents worked with therapists to better understand how they can communicate with their children effectively, as well as pick up on their child’s cues for interaction.

The immediate outcome of this trial was reported in a previous study in 2010, soon after it ended. It found that parents showed improvement in their ability to interact with their children, improvement in children communicating back with their parents and reduced severity of symptoms among children whose parents received this training.

“When we change the parental interactive behavior … that leads to child initiation with the parent, and that change in child initiation with the parent is related to the child changing symptoms,” Green said.

The new study analyzed the long-term impact on children and their parents more than six years later. Although the parents’ synchrony — how much they were attuned to and responsive with their child’s communication — had fallen to equal that of the control group, the researchers saw sustained improvement in children’s communication with their parents as well as a greater reduction in the severity of symptoms among children whose parents had received training.

“That difference had persisted,” said Andrew Pickles, professor of biostatistics and psychological methods at Kings College London, who co-led the research. “Getting in early when there is more chance of general change.”

The researchers described three severity levels associated with autism: mild, moderate and severe. Severe means the child is unaware of people around them, may move their arms vigorously and ignores their parents when they call their name. In contrast, moderate symptoms would involve a child seeming younger than their age and making requests in a loud voice, while mild symptoms may be undetectable.

More than six years after the trial, 46% of the children whose parents had received training were considered to have severe symptoms, but 63% of children whose parents had received standard care were considered to have severe symptoms.

The team stresses that it’s a potential treatment, not a cure.

“(This) clearly doesn’t cure autism,” Green said, but he pointed out that it does have a “sustained decrease in severity.”

Some symptoms did not differ between the two groups, including measures of child anxiety, challenging behaviors and language scores.

Learning to communicate

The original trial involved 152 children with autism, between 2 and 4 years old, and their parents. During the followup, 121 children remained, 59 of whom received the Pre-school Autism Communication Trial intervention.

As part of the therapy, parents had two sessions with a therapist each month for six months, combined with homework to interact with their child for 30 minutes per day. For the next six months, the sessions were reduced to monthly, but the homework remained.

During the therapy sessions, parents watched videos of themselves interacting with their child to learn how they could improve and learn to spot when, and how, their child is interacting with them. The aim was “to help adults self-learn and become self-aware,” Green said.

The video feedback was also used to show parents what actions get better responses from their child, “to make the parent more confident in how they respond back,” said Catherine Aldred, a consultant speech and language therapist with Stockport NHS Trust and the University of Manchester in the UK, who led this part of the trial. The aim was also to “draw the child into becoming an active communicator,” she said.

Having seen such promising results, the team now hopes to take this approach into schools in hope of running parallel sessions, alongside the training of parents, to get “parents and schools talking to each other better,” Green said. This would also “get the child functioning in their everyday world.”

They also hope to further investigate why this intervention had the effect it did. “We want to look at the mechanism for this sustained effect,” Green said. “We could estimate that if it worked with a severe group, it might also work with a mild group.”

But the researchers highlighted that the intervention was done soon after diagnosis, between the ages of 2 and 5 years, and that their intervention may not be effective in older children. “Early after diagnosis, when families are ready, that’s the time to start,” said Green.

“I can see why these researchers are excited,” said Dorothy Bishop, professor of developmental neuropsychology at the University of Oxford, who was not involved in the trial. “The initial results in their previous report were a bit ambiguous, but these results at follow-up are pretty consistent in showing the benefit of this early intervention for autism across a range of measures. … For parents of children with autism, even a modest reduction would be worthwhile.”

“It is a remarkably positive story, because the intervention itself was neither intensive nor invasive,” said Uta Frith, emeritus professor of cognitive development at University College London, who also highlights that more work needs to be done. “There were improvements on a range of measures, but the effects were not dramatic, and they were very variable across the group. We are still a long way from individualized programs that might produce lasting behavioral improvements in all autistic children.”

Teenager controls HIV infection without drugs

— A French teenager infected at birth with HIV has shown the ability to control levels of the infection in her body — without being on antiretroviral treatment.

The finding provides new hope that a “functional” cure for HIV — where the virus is brought down to low levels but not eradicated in the body — may one day be possible.

The 18-year-old female, whose mother was HIV positive, was given antiretroviral treatment soon after birth but stopped at age six and has since maintained undetectable levels of the virus in her blood — known as remission — for 12 years.

“This is the first [time] long-term remission has been shown in children, or adolescents,” said Asier Saez Cirion from the Institut Pasteur in France, who presented the findings at the 8th IAS conference on HIV pathogenesis, treatment and prevention, in Vancouver this week.

Treatment at birth

The researchers believe there may be something unique in her biology that, combined with early treatment, enabled her to control the infection. But for now, the reason remains a mystery.

She was initially treated with antiretroviral drugs as a prophylactic to prevent infection, and then given a combination of four antiretroviral drugs when the virus was found to persist. She was monitored as part of a group of child HIV patients, but failed to go in for observations between the age of five and six, during which time her family chose to stop her treatment.

On returning for check-ups one year later, medical teams found undetectable levels of HIV in her blood despite her break from treatment.

More than 12 years later, the virus remains undetectable.

Learning from adults

“We have already found it was possible in adults,” said Saez-Ciron. This work follows on from his previous research, in which 14 adults with HIV in France — known as the “Visconti patients” — were treated for HIV soon after infection but stopped taking their drugs three years later and showed no resurgence in the amount of virus found in their blood. The group are considered to be post-treatment controllers of the virus.

Today, 12 remain in control of their infection and without drugs and they have an average of 10 years in remission.

What these adults have in common with the French teenager is the early initiation of antiretroviral treatment, thought to aid remission by preventing the formation of HIV reservoirs inside the body.

“Again, treatment was initiated very close to the period of infection,” said Saez-Ciron.

However, in practice, most adults infected with HIV aren’t diagnosed until the virus has taken hold — making early treatment a challenge. But children at risk of infection from their mothers can be identified — and treated — during pregnancy, or at birth.

But pediatric experts warn this kind of remission is not common.

A rare exception?

“This case is very rare,” said Deborah Persaud, a virologist at Johns Hopkins Children’s Center in Baltimore, who worked on the case of the “Mississippi baby,” an infant once believed to have been functionally cured of HIV as a result of immediate treatment with antiretrovirals. No virus was detected for more than two years, before it again showed up in tests.

Persaud is excited that remission has been achieved for this length of time in the teenager, but warns it is unlikely to be replicated easily. “Many kids have gone off treatment — and treated that early — and we haven’t seen this outcome,” she said. “Parents should not take their child of their antiretroviral regimen to see if they’re like this child.”

The team at the Pasteur Institute agrees.

“The fact that you initiate treatment very early doesn’t imply you will achieve remission of infection,” said Saez-Ciron.

The search for a reason

His team are now exploring the biology behind this ability to control infection in hope of identifying key factors — or markers — in the body that could predict the possibility of remission, and ideally a functional cure, in others. It’s hoped this form of “cure” would result in virus levels being so low, they no longer do enough damage to the immune system to cause adverse health consequences.

“Most people are not going to be able to control after treatment interruption, but some can,” said Saez-Ciron. “What we are trying to do now is understand why some can and most do not.” That could help develop strategies to aid this type of remission in others.

Nobel laureate Francoise Barre-Sinoussi, who co-discovered HIV in 1983, and works at the Institut Pasteur, said: “We are learning from this patient, that’s why it’s so exciting.

“We are learning clearly which kind of response the strategy for the future should use. This is critical if we want to make progress in the field of remission in the future.”

Saez-Ciron also presented the results at the 2015 Towards an HIV Cure symposium, held at the beginning of the conference, in which HIV cure researchers gathered from around the world to hear the latest news in the field.

The announcement of the case of the French teenager was met with restrained excitement, but also a desire for more examples of this kind of functional cure.

“Being free of viral rebound is impressive,” said Anthony Fauci, head of the U.S. National Institute of Allergy and Infectious Diseases (NIAID), who spoke at the conference.”But it’s only one case … as time goes by you [need to] accumulate more evidence.”

Step away from the burger: Why a ‘Western’ diet is bad for your health

— The developing world is seeing rapid urbanization, with more than half of the world’s population now living in cities and this figure expected to reach 70% by 2050.

But with this progression comes an urban lifestyle — often meaning less physical activity and the consumption of a “Western” diet.

“[There’s a] nutrition transition occurring around the world,” says David Tilman, professor of Ecology at the University of Minnesota. In a recent study, Tilman explored global trends in diet choices and the link between these diets and health.

“People around the world, as incomes go up, choose more calories and meat in their diet,” says Tilman. The result? Potentially disastrous consequences on health and an increased risk of disease.

“We have a whole new group of people who are malnourished because they eat foods that are no good for them, that have no nutritional benefit,” says Tilman. The trend contradicts the more traditional causes of malnutrition.

Also on the rise is access to, and consumption of, processed foods.

“Processed foods have low nutritional value,” says Tilman, who describes processed food as having empty calories. “Diets low in fruit and vegetables have a strong negative health impact,” he says.

And a diet high in processed foods — and generally a modern “Western” diet — is even worse.

What is a Western diet?

“The biggest features [of a Western diet] are overconsumption of over-refined sugars, highly refined and saturated fats, animal protein and a reduced intake of plant-based fibers,” says Ian Myles, from the U.S. National Institute of Allergy and Infectious Diseases. This translates to a diet high in fat, red meat, salt and sugars, and low in fiber.

“Too many calories in general,” says Myles — a trend aided by the move towards a culture of fast food.

But what impact can this diet have on your health?

Increasing your risk of infection

According to Myles, highly processed and refined foods, common to Western meals, are disliked by the body. “It throws your immune system off kilter,” he says.

The biggest culprits in Myles’ eyes are foods containing fructose and palmitic acid — ingredients found commonly in candy bars — which can kick-start an immune reaction.

“[Palmitic acid] can be confused by the body with bacteria like E.Coli,” says Myles. The body then starts an immune attack against the supposed bacteria, which results in a low level of inflammation.

Distracting the immune system in this way means immune cells won’t be as ready to attack when facing a real infection. “It throws off the way your body responds…and by the time you recognize it, it will have gotten worse,” says Myles.

However, the effect is reversible.

A change in diet to remove exposure to these food components can restore immune activity back to its normal state, according to Myles. “That low-grade inflammation will change,” he says.

Changing your gut bacteria

Your gut microbes play a crucial role in the health and wellbeing of not only your gut, but your whole body.

“Every person carries about 1kg of microbes inside them,” says Jeremy Nicholson, head of the department of surgery and cancer at Imperial College London. According to Nicholson, the body’s gut microbes are heavily connected with the control of the immune system, which in turn controls inflammation.

Eating processed foods can cause the good bacteria in your gut to be pushed out — leaving you more exposed to the bad ones. “The good bacteria don’t survive as well,” says Myles.

Obesity and diabetes

The global increase in diets high in fat and calories is seeing rates of obesity and diabetes rise rapidly across the world. “There is soaring obesity,” says Nicholson.

In 2014, more than 600 million adults were obese globally, and almost 2 billion adults were overweight, according to the World Health Organization.

“Obesity predisposes you to disease,” says Nicholson. Inflammation within the body is also high in obese individuals, increasing their risk of developing diseases such as heart disease, stroke, cancer and joint conditions such as arthritis. “All of these are inflammatory conditions,” says Nicholson.

Increased obesity levels are also thought to contribute to a rise in cases of joint conditions and replacements, due to the extra pressure and wear placed on the joints. “Obese people need hip and knee replacement much earlier in their lives,” says Nicholson.

Linked to obesity, another disease with rates now soaring globally is diabetes, affecting 374 million people in 2014. The development of Type II diabetes is linked with diet and numbers are rising in every country, according to the IDF diabetes atlas.

Cancer risk

Recent studies have linked Western diets with increased risks of colon and prostate cancer. Men eating mostly a Western diet were found to have 2.5 times the risk of dying from prostate cancer whilst the risks associated with colon cancer again linked back to inflammation and a change in the activities of gut bacteria.

“In obese individuals you get different microbial compositions to produce something that can impact cancer,” says Nicholson, who led the recent research exploring risks of colon cancer. In his study, he compared the impact of diet in a group of South Africans and African Americans and found the African Americans to have 50 times more risk of developing colon cancer. “The implications is that … this is related to their Western diet,” he says. By working with African Americans, the team reduced the impact of genetic variation which also plays a role in disease development.

Increased inflammation levels can also damage cells in the region affected — such as the colon — causing higher turnover of cells. The more cells replicate, the more chances there are for mutations in the genes they contain — which increases the risk of cancer.

“Cancer arrives more readily in cells with relatively high turnover,” explains Nicholson.

But Nicholson warns that cancer is not a simple disease: “Hundreds of genes are involved,” he says. “Your microbes are part of the process but not entirely the cause.”

Choices

Clearly, diet plays a large role in the health of a population and when it comes to improving personal health, experts stress the need for people to take more note of what they are eating.

“This is going to have to be voluntary choices people make,” says Tilman.

What will you choose?