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Russi EW. [E-Cigarettes – Friend or Foe?]. Praxis (Bern 1994) 2015; 104:739-743. [PMID: 26135724 DOI: 10.1024/1661-8157/a002056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Not nicotine, but an abundant amount of toxic chemicals produced by the combustion of tobacco are the cause of well-known health problems. E-cigarette vapor contains no or only minimal quantities of potentially harmful substances. Hence it can be assumed that vaping in adults is much less harmful than smoking of cigarettes. Furthermore, no data exist that e-cigarettes will encourage youngsters to become cigarette smokers. E-cigarette vaping has the potential to reduce the daily number of cigarettes smoked or facilitates cessation of smoking in heavily nicotine-dependent smokers, who keep on smoking despite a structured smoking cessation program. Health professionals should be aware of this type of nicotine substitution, since the controversial discussion is often emotional and not evidence-based.
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Abstract
BACKGROUND Migraineurs variably attribute the cause of their headache to tobacco exposure, whereas tobacco is often stated to cause headache-related disability worldwide. Given tobacco's physiological and emotional addictiveness and migraine's substantial economic impact, improved functionality can be difficult for those with migraine exposed to tobacco products. Environmental tobacco exposure in indoor spaces and workplaces is associated with exacerbation of headache. Avoidance of headache triggers is included in most comprehensive migraine treatment programs, yet tobacco awareness, avoidance, or coping is rarely emphasized as part of that regimen. OBJECTIVE The aims of this study were to examine the various types of tobacco products to which headache sufferers are exposed and the known basic mechanisms by which tobacco (nicotine) exposure promotes headache pain, and to review the extensive literature on tobacco related to headache with a detailed descriptive narrative providing the basis for conclusions regarding association of noncluster headache-related tobacco exposure. Tobacco-related recommendations are offered. METHODS MEDLINE, EMBASE, and Google Scholar databases were searched without yearly restriction through the date of submission (May 2015), using the MeSH terms "tobacco," "tobacco products," "smoking," "tobacco use," "headache," and "headache disorders." The selection of articles was not limited to English studies or to humans. Articles were excluded when "headache" and "tobacco" were not both mentioned with data provided. Case series were included. Bibliographies of all articles were screened for additional relevant articles. RESULTS Although migraineurs worldwide report tobacco smoke among triggers, it is rarely among the highest in frequency, and biases abound with predominantly noncontrolled retrospective data. Prospective population-based diary data are extremely limited, and no controlled trials exist to confirm a cause and effect for headache of any type. Although some studies are nonsupportive and even conflicting, headache, pain, and tobacco exposure currently remain associated. CONCLUSION Conflicting data support the validity of patient-reported environmental tobacco exposure as a headache trigger. Prospective controlled studies are needed, but unlikely to be performed, to determine the extent that tobacco influences the headache process, in addition to other under-recognized factors. Meanwhile, because of numerous other negative health effects, decreased tobacco exposure should be recommended to headache patients of all ages in hopes of decreasing disability and improving functionality.
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Affiliation(s)
- Frederick R Taylor
- Department of Neurology, University of Minnesota School of Medicine, Minneapolis, MN, USA
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103
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Schuurmans MM. [Electronic Cigarettes: Lifestyle Gadget or Smoking Cessation Aid?]. Praxis (Bern 1994) 2015; 104:733-737. [PMID: 26135723 DOI: 10.1024/1661-8157/a002057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Electronic cigarettes (e-cigarettes) are vaporisers of liquids often containing nicotine. In the inhaled aerosol carcinogens, ultrafine and metal particles are detected usually in concentrations below those measured in tobacco smoke. Therefore, these products are expected to be less harmful. This has not yet been proven. The long-term safety of e-cigarettes is unknown. Short duration use leads to airway irritation and increased diastolic blood pressure. So far only two randomised controlled trials have investigated efficacy and safety of e-cigarettes for smoking cessation: No clear advantage was shown in comparison to smoking cessation medication. Due to insufficient evidence, e-cigarettes cannot be recommended for smoking cessation. Problematic are the lack of regulation and standardisation of e-cigarette products, which makes general conclusions impossible.
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Kaplan A. Rebuttal: Can electronic cigarettes assist patients with smoking cessation? Yes. Can Fam Physician 2015; 61:e255-e257. [PMID: 26071163 PMCID: PMC4463904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Alan Kaplan
- Family physician practising in Richmond Hill, Ont, a staff physician at Brampton Civic Hospital, and Chair of both the Family Physician Airways Group of Canada and the Respiratory Medicine Program Committee of the College of Family Physicians of Canada.
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Levitz S. Can electronic cigarettes assist patients with smoking cessation? No. Can Fam Physician 2015; 61:500-505. [PMID: 26071150 PMCID: PMC4463887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Suzanne Levitz
- Family physician at Mount Sinai Hospital in Montreal, Que, and a member of the Respiratory Medicine Program Committee of the College of Family Physicians of Canada.
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109
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Smoking cessation during pregnancy. Prescrire Int 2015; 24:157-9. [PMID: 26436173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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110
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Patrounova V. Alternative Forms of Tobacco and E-Cigarettes: Harmful or Harm Reduction? Dent Today 2015; 34:108. [PMID: 26470581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Abstract
<strong>Keywords:</strong> Smoking; Tobacco Products; Tongue, Hairy.
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Affiliation(s)
- Helder Farinha
- Unidade de Saúde Familiar Auren. Agrupamento de Centros de Saúde Médio Tejo. Ourém. Portugal
| | - Vera Martins
- Unidade de Saúde Familiar Auren. Agrupamento de Centros de Saúde Médio Tejo. Ourém. Portugal
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Glasser AM, Cobb CO, Teplitskaya L, Ganz O, Katz L, Rose SW, Feirman S, Villanti AC. Electronic nicotine delivery devices, and their impact on health and patterns of tobacco use: a systematic review protocol. BMJ Open 2015; 5:e007688. [PMID: 25926149 PMCID: PMC4420972 DOI: 10.1136/bmjopen-2015-007688] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION E-cigarettes or electronic nicotine delivery systems (ENDS) have recently attracted considerable attention. Among some individuals there is strong debate and a polarisation of views about the public health benefits versus harms of ENDS. With little regulation, the ENDS market is evolving, and new products are introduced and marketed constantly. Rapid developments in manufacturing, marketing and consumer domains related to ENDS will warrant frequent re-evaluation, based on the state of the evolving science. The purpose of this article is to describe a protocol for an ongoing comprehensive review of the published scientific literature on ENDS. METHODS AND ANALYSIS We will undertake a systematic review of published empirical research literature on ENDS using the National Library of Medicine's PubMed electronic database to search for relevant articles. Data from included studies will be extracted into a standardised form, tables with study details and key outcomes for each article will be created, and studies will be synthesised qualitatively. ETHICS AND DISSEMINATION This review synthesises published literature and presents no primary data. Therefore, no ethical approval is required for this study. Subsequent papers will provide greater detail on results, within select categories, that represent gaps in the literature base.
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Affiliation(s)
- Allison M Glasser
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC, USA
| | - Caroline O Cobb
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Ollie Ganz
- Evaluation Science and Research, Legacy, Washington, DC, USA
| | - Lauren Katz
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC, USA
| | - Shyanika W Rose
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC, USA
| | - Shari Feirman
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC, USA
| | - Andrea C Villanti
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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115
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Tan ASL, Bigman CA, Mello S, Sanders-Jackson A. Is exposure to e-cigarette communication associated with perceived harms of e-cigarette secondhand vapour? Results from a national survey of US adults. BMJ Open 2015; 5:e007134. [PMID: 25814497 PMCID: PMC4386241 DOI: 10.1136/bmjopen-2014-007134] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES E-cigarettes are frequently advertised and portrayed in the media as less harmful compared with regular cigarettes. Earlier surveys reported public perceptions of harms to people using e-cigarettes; however, public perceptions of harms from exposure to secondhand vapour (SHV) have not been studied. We examined associations between self-reported exposure to e-cigarette advertising, media coverage, and interpersonal discussion and perceived harms of SHV. DESIGN Observational study. SETTING National online sample of US adults aged ≥18 years. PARTICIPANTS 1449 US adults (mean age 49.5 years), 51.3% female, 76.6% non-Hispanic Caucasian, 7.5% African-American, 10.0% Hispanic and 5.9% other races. OUTCOMES Perceived harm measures included (1) harmfulness of SHV to one's health, (2) concern about health impact of breathing SHV and (3) comparative harm of SHV versus secondhand smoke (SHS). Predictors were (1) self-reported frequency of exposure to e-cigarette advertising, media coverage and interpersonal discussion (close friends or family) and (2) perceived valence of exposure from each source. Covariates were demographic characteristics, cigarette smoking status and e-cigarette use, and were weighted to the general US adult population. RESULTS More frequent interpersonal discussion was associated with lower perceived harmfulness of SHV to one's health and lower perceived comparative harm of SHV versus SHS. Frequency of e-cigarette ad and other media exposure were not significant predictors. Perceived negative valence of ad exposure and interpersonal discussion (vs no exposure) was associated with higher perceived harm across all three outcomes, while negative valence of media coverage was associated with higher concern about health impact of breathing SHV. Perceived positive valence (vs no exposure) of interpersonal discussion was associated with lower perceived harm across all three outcomes about health impact of breathing SHV. CONCLUSIONS Exposure to information about e-cigarettes through advertising, media coverage and interpersonal discussion could play a role in shaping public perceptions of the harmfulness of SHV.
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Affiliation(s)
- Andy S L Tan
- Population Sciences Division, Dana-Farber Cancer Institute, Center for Community Based Research, Boston, USA Department of Social and Behavioral Sciences, Harvard T H Chan School of Public Health, Boston, USA
| | - Cabral A Bigman
- Department of Communication, University of Illinois at Urbana-Champaign, Urbana, USA
| | - Susan Mello
- Department of Communication Studies, Northeastern University, Boston, USA
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117
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Lerner CA, Sundar IK, Yao H, Gerloff J, Ossip DJ, McIntosh S, Robinson R, Rahman I. Vapors produced by electronic cigarettes and e-juices with flavorings induce toxicity, oxidative stress, and inflammatory response in lung epithelial cells and in mouse lung. PLoS One 2015; 10:e0116732. [PMID: 25658421 PMCID: PMC4319729 DOI: 10.1371/journal.pone.0116732] [Citation(s) in RCA: 443] [Impact Index Per Article: 49.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 12/12/2014] [Indexed: 01/26/2023] Open
Abstract
Oxidative stress and inflammatory response are the key events in the pathogenesis of chronic airway diseases. The consumption of electronic cigarettes (e-cigs) with a variety of e-liquids/e-juices is alarmingly increasing without the unrealized potential harmful health effects. We hypothesized that electronic nicotine delivery systems (ENDS)/e-cigs pose health concerns due to oxidative toxicity and inflammatory response in lung cells exposed to their aerosols. The aerosols produced by vaporizing ENDS e-liquids exhibit oxidant reactivity suggesting oxidants or reactive oxygen species (OX/ROS) may be inhaled directly into the lung during a “vaping” session. These OX/ROS are generated through activation of the heating element which is affected by heating element status (new versus used), and occurs during the process of e-liquid vaporization. Unvaporized e-liquids were oxidative in a manner dependent on flavor additives, while flavors containing sweet or fruit flavors were stronger oxidizers than tobacco flavors. In light of OX/ROS generated in ENDS e-liquids and aerosols, the effects of ENDS aerosols on tissues and cells of the lung were measured. Exposure of human airway epithelial cells (H292) in an air-liquid interface to ENDS aerosols from a popular device resulted in increased secretion of inflammatory cytokines, such as IL-6 and IL-8. Furthermore, human lung fibroblasts exhibited stress and morphological change in response to treatment with ENDS/e-liquids. These cells also secrete increased IL-8 in response to a cinnamon flavored e-liquid and are susceptible to loss of cell viability by ENDS e-liquids. Finally, exposure of wild type C57BL/6J mice to aerosols produced from a popular e-cig increase pro-inflammatory cytokines and diminished lung glutathione levels which are critical in maintaining cellular redox balance. Thus, exposure to e-cig aerosols/juices incurs measurable oxidative and inflammatory responses in lung cells and tissues that could lead to unrealized health consequences.
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Affiliation(s)
- Chad A. Lerner
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Isaac K. Sundar
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Hongwei Yao
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Janice Gerloff
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Deborah J. Ossip
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Scott McIntosh
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Risa Robinson
- Mechanical Engineering Department, Rochester Institute of Technology, Rochester, NY, United States of America
| | - Irfan Rahman
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, United States of America
- * E-mail:
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118
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Zellweger JP. [Against e-cigarette]. Rev Med Suisse 2015; 11:242-243. [PMID: 25845158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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119
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Le Maître B. [ In favor of e-cigarette]. Rev Med Suisse 2015; 11:240-241. [PMID: 25845157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Rigotti NA, Wu M. Advising patients about electronic cigarettes. Eur Heart J 2015; 36:135-136. [PMID: 25741552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
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Kohler M. Electronic cigarettes: the pulmonologist's point of view. Eur Heart J 2015; 36:137. [PMID: 25741553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
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123
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Brandon TH, Goniewicz ML, Hanna NH, Hatsukami DK, Herbst RS, Hobin JA, Ostroff JS, Shields PG, Toll BA, Tyne CA, Viswanath K, Warren GW. Electronic nicotine delivery systems: a policy statement from the American Association for Cancer Research and the American Society of Clinical Oncology. Clin Cancer Res 2015; 21:514-25. [PMID: 25573384 DOI: 10.1158/1078-0432.ccr-14-2544] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Combustible tobacco use remains the number one preventable cause of disease, disability, and death in the United States. Electronic nicotine delivery systems (ENDS), which include e-cigarettes, are devices capable of delivering nicotine in an aerosolized form. ENDS use by both adults and youth has increased rapidly, and some have advocated these products could serve as harm-reduction devices and smoking cessation aids. ENDS may be beneficial if they reduce smoking rates or prevent or reduce the known adverse health effects of smoking. However, ENDS may also be harmful, particularly to youth, if they increase the likelihood that nonsmokers or formers smokers will use combustible tobacco products or if they discourage smokers from quitting. The American Association for Cancer Research (AACR) and the American Society of Clinical Oncology (ASCO) recognize the potential ENDS have to alter patterns of tobacco use and affect the public's health; however, definitive data are lacking. AACR and ASCO recommend additional research on these devices, including assessing the health impacts of ENDS, understanding patterns of ENDS use, and determining what role ENDS have in cessation. Key policy recommendations include supporting federal, state, and local regulation of ENDS; requiring manufacturers to register with the FDA and report all product ingredients, requiring childproof caps on ENDS liquids, and including warning labels on products and their advertisements; prohibiting youth-oriented marketing and sales; prohibiting child-friendly ENDS flavors; and prohibiting ENDS use in places where cigarette smoking is prohibited.
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Affiliation(s)
| | | | - Nasser H Hanna
- Indiana University Health Simon Cancer Center, Indianapolis, IN
| | | | - Roy S Herbst
- Yale Comprehensive Cancer Center, New Haven, Connecticut.
| | - Jennifer A Hobin
- The American Association for Cancer Research, Philadelphia, Pennsylvania
| | | | | | | | | | | | - Graham W Warren
- Medical University of South Carolina, Charleston, South Carolina
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Abstract
OBJECTIVE To test whether exposure and receptivity to e-cigarette marketing are associated with recent e-cigarette use among young adults through increased beliefs that e-cigarettes are less harmful than cigarettes. METHODS Data were collected from 307 multiethnic 4- and 2-year college students; approximately equal proportions of current, never, and former cigarette smokers [mean age = 23.5 (SD = 5.5); 65% female]. RESULTS Higher receptivity to e-cigarette marketing was associated with perceptions that e-cigarettes are less harmful than cigarettes, which in turn, were associated with higher recent e-cigarette use. CONCLUSIONS The findings provide preliminary support to the proposition that marketing of e-cigarettes as safer alternatives to cigarettes or cessation aids is associated with increased e-cigarette use among young adults. The findings have implications for development of e-cigarette regulations.
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Affiliation(s)
| | - Pebbles Fagan
- University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Lisa Kehl
- University of Hawaii Cancer Center, Honolulu, HI, USA
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Berg CJ, Stratton E, Schauer GL, Lewis M, Wang Y, Windle M, Kegler M. Perceived harm, addictiveness, and social acceptability of tobacco products and marijuana among young adults: marijuana, hookah, and electronic cigarettes win. Subst Use Misuse 2015; 50:79-89. [PMID: 25268294 PMCID: PMC4302728 DOI: 10.3109/10826084.2014.958857] [Citation(s) in RCA: 251] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND There has been an increase in non-daily smoking, alternative tobacco product and marijuana use among young adults in recent years. OBJECTIVES This study examined perceptions of health risks, addictiveness, and social acceptability of cigarettes, cigar products, smokeless tobacco, hookah, electronic cigarettes, and marijuana among young adults and correlates of such perceptions. METHODS In Spring 2013, 10,000 students at two universities in the Southeastern United States were recruited to complete an online survey (2,002 respondents), assessing personal, parental, and peer use of each product; and perceptions of health risks, addictiveness, and social acceptability of each of these products. RESULTS Marijuana was the most commonly used product in the past month (19.2%), with hookah being the second most commonly used (16.4%). The least commonly used were smokeless tobacco products (2.6%) and electronic cigarettes (4.5%). There were high rates of concurrent product use, particularly among electronic cigarette users. The most positively perceived was marijuana, with hookah and electronic cigarettes being second. While tobacco use and related social factors, related positively, influenced perceptions of marijuana, marijuana use and related social factors were not associated with perceptions of any tobacco product. Conclusions/Importance: Marketing efforts to promote electronic cigarettes and hookah to be safe and socially acceptable seem to be effective, while policy changes seem to be altering perceptions of marijuana and related social norms. Research is needed to document the health risks and addictive nature of emerging tobacco products and marijuana and evaluate efforts to communicate such risks to youth.
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Affiliation(s)
- Carla J. Berg
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Erin Stratton
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Gillian L. Schauer
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Michael Lewis
- Department of Marketing, Emory University Goizueta Business School, Atlanta, Georgia, USA
| | - Yanwen Wang
- Department of Marketing, Emory University Goizueta Business School, Atlanta, Georgia, USA
| | - Michael Windle
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Michelle Kegler
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
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Abstract
Electronic cigarettes (e-cigarettes) have substantially increased in popularity. Clear evidence about the safety of e-cigarettes is lacking, and laboratory experiments and case reports suggest these products may be associated with potential adverse health consequences. The effectiveness of e-cigarettes for smoking cessation is modest and appears to be comparable to the nicotine patch combined with minimal behavioral support. Although a role for e-cigarettes in the treatment of tobacco dependence may emerge in the future, the potential risk of e-cigarettes outweighs their known benefit as a recommended tobacco treatment strategy by clinicians. Patients should be counseled on the known efficacy and potential risks of e-cigarettes.
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Affiliation(s)
- Jon O Ebbert
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN.
| | - Amenah A Agunwamba
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN
| | - Lila J Rutten
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN; Department of Health Sciences Research, Mayo Clinic, Rochester, MN
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127
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O'Dowd M, Brito A. E-Cigarettes: a public health challenge. MD Advis 2015; 8:16-18. [PMID: 27603104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Mary O'Dowd
- MPH, Comissioner of the New Jersey Department of Health
| | - Arturo Brito
- MD, MPH, Deputy Commissioner of the New Jersey Deapartment of Health
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128
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Electronic cigarettes: poisoning in children. Prescrire Int 2015; 24:21. [PMID: 25729833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Affiliation(s)
| | - Jonathan M Samet
- Department of Preventive Medicine, University of Southern California, Los Angeles
| | - Rob McConnell
- Department of Preventive Medicine, University of Southern California, Los Angeles
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130
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Abstract
OBJECTIVE To provide a systematic review of the existing literature on health consequences of vaporing of electronic cigarettes (ECs). METHODS Search in: PubMed, EMBASE and CINAHL. INCLUSION CRITERIA Original publications describing a health-related topic, published before 14 August 2014. PRISMA recommendations were followed. We identified 1101 studies; 271 relevant after screening; 94 eligible. RESULTS We included 76 studies investigating content of fluid/vapor of ECs, reports on adverse events and human and animal experimental studies. Serious methodological problems were identified. In 34% of the articles the authors had a conflict of interest. Studies found fine/ultrafine particles, harmful metals, carcinogenic tobacco-specific nitrosamines, volatile organic compounds, carcinogenic carbonyls (some in high but most in low/trace concentrations), cytotoxicity and changed gene expression. Of special concern are compounds not found in conventional cigarettes, e.g. propylene glycol. Experimental studies found increased airway resistance after short-term exposure. Reports on short-term adverse events were often flawed by selection bias. CONCLUSIONS Due to many methodological problems, severe conflicts of interest, the relatively few and often small studies, the inconsistencies and contradictions in results, and the lack of long-term follow-up no firm conclusions can be drawn on the safety of ECs. However, they can hardly be considered harmless.
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Affiliation(s)
- Charlotta Pisinger
- Research Centre for Prevention and Health, Glostrup Hospital, DK-2600 Glostrup, Denmark.
| | - Martin Døssing
- Medicinsk Afdeling, Frederikssund Hospital, DK-3600 Frederikssund, Denmark
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131
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O'Dowd A. First TV advertisement for e-cigarettes prompts complaints. BMJ 2014; 349:g7100. [PMID: 25422157 DOI: 10.1136/bmj.g7100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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132
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Rochat T, Nicod LP. [E-cigarette stirs controversies]. Rev Med Suisse 2014; 10:2179-2180. [PMID: 25603563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Pötschke-Langer Martina, Starostzik Christine. [E-cigarettes under scrutiny. "We don't want yet another new addictive substance"]. MMW Fortschr Med 2014; 156 Spec no 2:6-7. [PMID: 25551991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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135
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Abstract
One of the ten great public health achievements in the 20th century was turning the tide on one of the greatest public health disasters of that century: the tobacco use and related disease epidemic. The premature death and disease caused by tobacco can be considered largely as a side-effect of tobacco use behavior and the disease of addiction. The spread of that disease was fostered by an industry that researched the behavioral and biological basis of tobacco use and addiction and applied its findings and knowledge to develop products and marketing approaches to increase the likelihood that people, especially young people, would try tobacco products and develop persistent use and addiction. Researchers outside of the tobacco industry also investigated the behavioral biology of tobacco use and their research has been critical in turning the tide of the tobacco and disease epidemic. The behavioral factors are considered vital to understand and address by United States Food and Drug Administration and Surgeon General, as well as the World Health Organization in their tobacco control efforts. This commentary discusses key behavioral factors in the rise and fall of the epidemic, as well as some of those increasingly discussed as potential contributors to the endgame.
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Affiliation(s)
- Jack E Henningfield
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, USA.
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136
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Hajek P, Etter JF, Benowitz N, Eissenberg T, McRobbie H. Electronic cigarettes: review of use, content, safety, effects on smokers and potential for harm and benefit. Addiction 2014; 109:1801-10. [PMID: 25078252 PMCID: PMC4487785 DOI: 10.1111/add.12659] [Citation(s) in RCA: 384] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 05/13/2014] [Accepted: 06/12/2014] [Indexed: 11/29/2022]
Abstract
AIMS We reviewed available research on the use, content and safety of electronic cigarettes (EC), and on their effects on users, to assess their potential for harm or benefit and to extract evidence that can guide future policy. METHODS Studies were identified by systematic database searches and screening references to February 2014. RESULTS EC aerosol can contain some of the toxicants present in tobacco smoke, but at levels which are much lower. Long-term health effects of EC use are unknown but compared with cigarettes, EC are likely to be much less, if at all, harmful to users or bystanders. EC are increasingly popular among smokers, but to date there is no evidence of regular use by never-smokers or by non-smoking children. EC enable some users to reduce or quit smoking. CONCLUSIONS Allowing EC to compete with cigarettes in the market-place might decrease smoking-related morbidity and mortality. Regulating EC as strictly as cigarettes, or even more strictly as some regulators propose, is not warranted on current evidence. Health professionals may consider advising smokers unable or unwilling to quit through other routes to switch to EC as a safer alternative to smoking and a possible pathway to complete cessation of nicotine use.
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Affiliation(s)
- Peter Hajek
- UK Centre for Tobacco and Alcohol Studies, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
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137
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Ballbè M, Martínez-Sánchez JM, Sureda X, Fu M, Pérez-Ortuño R, Pascual JA, Saltó E, Fernández E. Cigarettes vs. e-cigarettes: Passive exposure at home measured by means of airborne marker and biomarkers. Environ Res 2014; 135:76-80. [PMID: 25262078 DOI: 10.1016/j.envres.2014.09.005] [Citation(s) in RCA: 128] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 08/29/2014] [Accepted: 09/03/2014] [Indexed: 05/06/2023]
Abstract
BACKGROUND There is scarce evidence about passive exposure to the vapour released or exhaled from electronic cigarettes (e-cigarettes) under real conditions. The aim of this study is to characterise passive exposure to nicotine from e-cigarettes' vapour and conventional cigarettes' smoke at home among non-smokers under real-use conditions. METHODS We conducted an observational study with 54 non-smoker volunteers from different homes: 25 living at home with conventional smokers, 5 living with nicotine e-cigarette users, and 24 from control homes (not using conventional cigarettes neither e-cigarettes). We measured airborne nicotine at home and biomarkers (cotinine in saliva and urine). We calculated geometric mean (GM) and geometric standard deviations (GSD). We also performed ANOVA and Student's t tests for the log-transformed data. We used Bonferroni-corrected t-tests to control the family error rate for multiple comparisons at 5%. RESULTS The GMs of airborne nicotine were 0.74 μg/m(3) (GSD=4.05) in the smokers' homes, 0.13 μg/m(3) (GSD=2.4) in the e-cigarettes users' homes, and 0.02 μg/m(3) (GSD=3.51) in the control homes. The GMs of salivary cotinine were 0.38 ng/ml (GSD=2.34) in the smokers' homes, 0.19 ng/ml (GSD=2.17) in the e-cigarettes users' homes, and 0.07 ng/ml (GSD=1.79) in the control homes. Salivary cotinine concentrations of the non-smokers exposed to e-cigarette's vapour at home (all exposed ≥ 2 h/day) were statistically significant different that those found in non-smokers exposed to second-hand smoke ≥ 2 h/day and in non-smokers from control homes. CONCLUSIONS The airborne markers were statistically higher in conventional cigarette homes than in e-cigarettes homes (5.7 times higher). However, concentrations of both biomarkers among non-smokers exposed to conventional cigarettes and e-cigarettes' vapour were statistically similar (only 2 and 1.4 times higher, respectively). The levels of airborne nicotine and cotinine concentrations in the homes with e-cigarette users were higher than control homes (differences statistically significant). Our results show that non-smokers passively exposed to e-cigarettes absorb nicotine.
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Affiliation(s)
- Montse Ballbè
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d׳Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; Catalan Network of Smoke-free Hospitals, L׳Hospitalet de Llobregat, Barcelona, Spain; Cancer Prevention and Control Group, Institut d׳Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona - IDIBAPS, Barcelona, Spain; Department of Clinical Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Jose M Martínez-Sánchez
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d׳Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Prevention and Control Group, Institut d׳Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Biostatistics Unit, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain.
| | - Xisca Sureda
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d׳Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Prevention and Control Group, Institut d׳Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Marcela Fu
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d׳Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Prevention and Control Group, Institut d׳Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Raúl Pérez-Ortuño
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - José A Pascual
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Department of Experimental and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Esteve Saltó
- Health Plan Directorate, Ministry of Health, Generalitat de Catalunya, Spain; Department of Public Health, Universitat de Barcelona, Barcelona, Spain
| | - Esteve Fernández
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d׳Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; Catalan Network of Smoke-free Hospitals, L׳Hospitalet de Llobregat, Barcelona, Spain; Cancer Prevention and Control Group, Institut d׳Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, Universitat de Barcelona, Barcelona, Spain
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138
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Abstract
Smoking causes around 100,000 deaths each year in the UK, and is the leading cause of preventable disease and early mortality. Smoking cessation remains difficult and existing licensed treatments have limited success. Nicotine addiction is thought to be one of the primary reasons that smokers find it so hard to give up, and earlier this year DTB reviewed the effects of nicotine on health. Electronic cigarettes (e-cigarettes) are nicotine delivery devices that aim to mimic the process of smoking but avoid exposing the user to some of the harmful components of traditional cigarettes. However, the increase in the use of e-cigarettes and their potential use as an aid to smoking cessation has been subject to much debate. In this article we consider the regulatory and safety issues associated with the use of e-cigarettes, and their efficacy in smoking cessation and reduction.
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139
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Pieri L, Chellini E, Gorini G. [Smoking fewer cigarettes per day may determine a significant risk reduction in developing smoking attributable diseases? Is there a risk reduction for e-cigarette users?]. Epidemiol Prev 2014; 38:390-393. [PMID: 25651772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Among Italian smokers--about 10 millions in 2013--about 600,000 began using electronic cigarettes (e-cigs) in last years. About 10% of e-cig users quitted smoking tobacco, whereas the 90% was dual users. Among them, about three out of four decreased the number of cigarettes smoked per day (cig/day), but did not quit. How many fewer cigarettes a smoker has to smoke to obtain significant health benefits? Is there a threshold? In order to observe a significant 27% reduction in the risk of developing lung cancer, a smoker must reduce the number of cig/day by at least 50%, while for the other smoking-related diseases (acute myocardial infarction - AMI, stroke, chronic obstructive pulmonary diseases), halving the number of cig/day did not drive to a significant risk reduction. Even smoking 5 cig/day increases the risk of AMI, whereas it significantly lowers the risk of lung cancer. Obviously, quitting smoking is the best choice to highly reduce risks for all smoking-related diseases. Therefore, in order to achieve significant risk reductions, e-cig users should quit smoking as first choice, or, if they feel it is impossible to them, reduce the consumption of traditional cigarettes to less than 5 cig/day.
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Affiliation(s)
- Luca Pieri
- Scuola di specializzazione in igiene e medicina preventiva, Università di Firenze.
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140
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Misra M, Leverette RD, Cooper BT, Bennett MB, Brown SE. Comparative in vitro toxicity profile of electronic and tobacco cigarettes, smokeless tobacco and nicotine replacement therapy products: e-liquids, extracts and collected aerosols. Int J Environ Res Public Health 2014; 11:11325-47. [PMID: 25361047 PMCID: PMC4245615 DOI: 10.3390/ijerph111111325] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 10/16/2014] [Accepted: 10/24/2014] [Indexed: 02/04/2023]
Abstract
The use of electronic cigarettes (e-cigs) continues to increase worldwide in parallel with accumulating information on their potential toxicity and safety. In this study, an in vitro battery of established assays was used to examine the cytotoxicity, mutagenicity, genotoxicity and inflammatory responses of certain commercial e-cigs and compared to tobacco burning cigarettes, smokeless tobacco (SLT) products and a nicotine replacement therapy (NRT) product. The toxicity evaluation was performed on e-liquids and pad-collected aerosols of e-cigs, pad-collected smoke condensates of tobacco cigarettes and extracts of SLT and NRT products. In all assays, exposures with e-cig liquids and collected aerosols, at the doses tested, showed no significant activity when compared to tobacco burning cigarettes. Results for the e-cigs, with and without nicotine in two evaluated flavor variants, were very similar in all assays, indicating that the presence of nicotine and flavors, at the levels tested, did not induce any cytotoxic, genotoxic or inflammatory effects. The present findings indicate that neither the e-cig liquids and collected aerosols, nor the extracts of the SLT and NRT products produce any meaningful toxic effects in four widely-applied in vitro test systems, in which the conventional cigarette smoke preparations, at comparable exposures, are markedly cytotoxic and genotoxic.
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Affiliation(s)
- Manoj Misra
- Lorillard Tobacco Company, A.W. Spears Research Center, 420 North English Street, Greensboro, North Carolina 27405, USA.
| | - Robert D Leverette
- Lorillard Tobacco Company, A.W. Spears Research Center, 420 North English Street, Greensboro, North Carolina 27405, USA.
| | - Bethany T Cooper
- Lorillard Tobacco Company, A.W. Spears Research Center, 420 North English Street, Greensboro, North Carolina 27405, USA.
| | - Melanee B Bennett
- Lorillard Tobacco Company, A.W. Spears Research Center, 420 North English Street, Greensboro, North Carolina 27405, USA.
| | - Steven E Brown
- Lorillard Tobacco Company, A.W. Spears Research Center, 420 North English Street, Greensboro, North Carolina 27405, USA.
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141
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Pepper JK, Ribisl KM, Emery SL, Brewer NT. Reasons for starting and stopping electronic cigarette use. Int J Environ Res Public Health 2014; 11:10345-61. [PMID: 25286168 PMCID: PMC4210982 DOI: 10.3390/ijerph111010345] [Citation(s) in RCA: 171] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 09/28/2014] [Accepted: 09/28/2014] [Indexed: 11/16/2022]
Abstract
The aim of our study was to explore reasons for starting and then stopping electronic cigarette (e-cigarette) use. Among a national sample of 3878 U.S. adults who reported ever trying e-cigarettes, the most common reasons for trying were curiosity (53%); because a friend or family member used, gave, or offered e-cigarettes (34%); and quitting or reducing smoking (30%). Nearly two-thirds (65%) of people who started using e-cigarettes later stopped using them. Discontinuation was more common among those whose main reason for trying was not goal-oriented (e.g., curiosity) than goal-oriented (e.g., quitting smoking) (81% vs. 45%, p < 0.001). The most common reasons for stopping e-cigarette use were that respondents were just experimenting (49%), using e-cigarettes did not feel like smoking cigarettes (15%), and users did not like the taste (14%). Our results suggest there are two categories of e-cigarette users: those who try for goal-oriented reasons and typically continue using and those who try for non-goal-oriented reasons and then typically stop using. Research should distinguish e-cigarette experimenters from motivated users whose decisions to discontinue relate to the utility or experience of use. Depending on whether e-cigarettes prove to be effective smoking cessation tools or whether they deter cessation, public health programs may need distinct strategies to reach and influence different types of users.
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Affiliation(s)
- Jessica K Pepper
- Lineberger Comprehensive Cancer Center, University of North Carolina, Campus Box 7295, Chapel Hill, NC 27599, USA.
| | - Kurt M Ribisl
- Lineberger Comprehensive Cancer Center, University of North Carolina, Campus Box 7295, Chapel Hill, NC 27599, USA.
| | - Sherry L Emery
- Institute for Health Research and Policy, University of Illinois at Chicago, 528 Westside Research Office Bldg., 1747 West Roosevelt Road, Chicago, IL 60608, USA.
| | - Noel T Brewer
- Lineberger Comprehensive Cancer Center, University of North Carolina, Campus Box 7295, Chapel Hill, NC 27599, USA.
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142
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Abstract
The recent popularity of electronic (e)-cigarettes and their rapid uptake by youth has ignited the debate about their role as a harm-reduction strategy. Harm reduction in the context of tobacco control contends that in societies that have achieved considerable success in curbing smoking, leaving the remaining hard-to-quit smokers with an abstinence-only option is unfair, especially when less-harmful choices are available. On one side of the debate are those who call for caution in endorsing such products until critical pieces of evidence about their safety and potential become available, whereas the other side argues that waiting until all questions about e-cigarettes are answered is dogma driven. In this piece, I try to discuss the unresolvable contention between harm-reduction goals of offering safer options to smokers, and those of e-cigarette makers of being commercially viable and profitable.
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Affiliation(s)
- Wasim Maziak
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida; and Syrian Center for Tobacco Studies, Aleppo, Syria.
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143
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144
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Affiliation(s)
- John R Ashton
- UK Faculty of Public Health, 4 St Andrews Place, London NW1 4LB
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145
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Abstract
Electronic cigarettes (e-cig) are proliferating in the world's lucrative nicotine delivery market at an alarmingly fast pace. E-cig are aggressively marketed as an alternative to conventional tobacco cigarettes, although very little is known about the health consequences of e-cig use. Chemical analysis of e-cig vapor/liquid has shown that many toxicants and carcinogens present in cigarette smoke are also found, albeit generally in lower concentrations, in a wide range of e-cig products. Notwithstanding the presence of toxicants and carcinogens in e-cig products, the biological effects of exposure to these contaminants have not been determined in e-cig users. The ongoing research and future investigations on e-cig initiation, use, perceptions, dependence, and toxicity are expected to provide empirical evidence that can be used to inform the general public, scientific community, and regulatory authorities of the health risks/benefits associated with e-cig use. This information will help stimulate scientists in the field of tobacco research, as well as assist the regulatory agencies in making scientifically based decisions on the development and evaluation of regulations on tobacco products to protect the public's health. Finding the scientific underpinnings for the health risks/benefits of e-cig use can impact millions of people who are increasingly turning to e-cig as a replacement for or complement to conventional tobacco cigarettes.
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Affiliation(s)
- Ahmad Besaratinia
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, M/C 9603, Los Angeles, CA 90033, USA.
| | - Stella Tommasi
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, M/C 9603, Los Angeles, CA 90033, USA
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146
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147
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Bhatnagar A, Whitsel LP, Ribisl KM, Bullen C, Chaloupka F, Piano MR, Robertson RM, McAuley T, Goff D, Benowitz N. Electronic cigarettes: a policy statement from the American Heart Association. Circulation 2014; 130:1418-36. [PMID: 25156991 DOI: 10.1161/cir.0000000000000107] [Citation(s) in RCA: 290] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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148
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Gualano MR, Passi S, Bert F, La Torre G, Scaioli G, Siliquini R. Electronic cigarettes: assessing the efficacy and the adverse effects through a systematic review of published studies. J Public Health (Oxf) 2014; 37:488-97. [PMID: 25108741 DOI: 10.1093/pubmed/fdu055] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To investigate the efficacy and the adverse effects (AEs) of the electronic cigarette, we performed a systematic review of published studies. METHODS We selected experimental and observational studies examining the efficacy (as reduction of desire to smoke and/or number of cigarettes smoked and/or quitting or as reduction of nicotine withdrawal symptoms) and the safety of EC (AEs self-reported or clinical/laboratory). The following search engines were used: PubMed, ISI Web of Knowledge and Cochrane Controlled Trials Register. RESULTS Finally, six experimental studies and six cohort studies were included. In the prospective 12-month, randomized controlled trial, smoking reduction was documented in 22.3 and 10.3% at Weeks 12 and 52, respectively (P < 0.001 versus baseline). Moreover, two cohort studies reported a reduction in the number of cigarette/day (from 50 to 80%) after the introduction of the EC. 'Mouth and throat irritation', 'nausea', 'headache' and 'dry cough' were the most frequently AEs reported. CONCLUSIONS The use of the EC can reduce the number of cigarettes smoked and withdrawal symptoms, but the AEs reported are mainly related to a short period of use. Long-term studies are needed to evaluate the effects of the EC usage after a chronic exposure.
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Affiliation(s)
- Maria Rosaria Gualano
- Department of Public Health Sciences, School of Medicine, University of Torino, via Santena 5/bis, Turin 10126, Italy
| | - Stefano Passi
- Department of Public Health Sciences, School of Medicine, University of Torino, via Santena 5/bis, Turin 10126, Italy
| | - Fabrizio Bert
- Department of Public Health Sciences, School of Medicine, University of Torino, via Santena 5/bis, Turin 10126, Italy
| | - Giuseppe La Torre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, Rome 00185, Italy
| | - Giacomo Scaioli
- Department of Public Health Sciences, School of Medicine, University of Torino, via Santena 5/bis, Turin 10126, Italy
| | - Roberta Siliquini
- Department of Public Health Sciences, School of Medicine, University of Torino, via Santena 5/bis, Turin 10126, Italy
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149
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Polosa R, Morjaria JB, Caponnetto P, Campagna D, Russo C, Alamo A, Amaradio M, Fisichella A. Effectiveness and tolerability of electronic cigarette in real-life: a 24-month prospective observational study. Intern Emerg Med 2014; 9:537-46. [PMID: 23873169 DOI: 10.1007/s11739-013-0977-z] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 07/04/2013] [Indexed: 10/26/2022]
Abstract
Electronic cigarettes (e-Cigarette) are battery-operated devices designed to vaporise nicotine that may aid smokers to quit or reduce their cigarette consumption. Research on e-Cigarettes is urgently needed to ensure that the decisions of regulators, healthcare providers and consumers are evidence based. Here we assessed long-term effectiveness and tolerability of e-Cigarette used in a 'naturalistic' setting. This prospective observational study evaluated smoking reduction/abstinence in smokers not intending to quit using an e-Cigarette ('Categoria'; Arbi Group, Italy). After an intervention phase of 6 months, during which e-Cigarette use was provided on a regular basis, cigarettes per day (cig/day) and exhaled carbon monoxide (eCO) levels were followed up in an observation phase at 18 and 24 months. Efficacy measures included: (a) ≥50% reduction in the number of cig/day from baseline, defined as self-reported reduction in the number of cig/day (≥50%) compared to baseline; (b) ≥80% reduction in the number of cig/day from baseline, defined as self-reported reduction in the number of cig/day (≥80%) compared to baseline; (c) abstinence from smoking, defined as complete self-reported abstinence from tobacco smoking (together with an eCO concentration of ≤10 ppm). Smoking reduction and abstinence rates were computed, and adverse events reviewed. Of the 40 subjects, 17 were lost to follow-up at 24 months. A >50% reduction in the number of cig/day at 24 months was shown in 11/40 (27.5%) participants with a median of 24 cig/day use at baseline decreasing significantly to 4 cig/day (p = 0.003). Smoking abstinence was reported in 5/40 (12.5%) participants while combined >50% reduction and smoking abstinence was observed in 16/40 (40%) participants at 24 months. Five subjects stopped e-Cigarette use (and stayed quit), three relapsed back to tobacco smoking and four upgraded to more performing products by 24 months. Only some mouth irritation, throat irritation, and dry cough were reported. Withdrawal symptoms were uncommon. Long-term e-Cigarette use can substantially decrease cigarette consumption in smokers not willing to quit and is well tolerated. ( http://ClinicalTrials.govnumberNCT01195597 ).
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Affiliation(s)
- Riccardo Polosa
- Centro per la Prevenzione e Cura del Tabagismo (CPCT), Azienda Ospedaliero-Universitaria "Policlinico-V. Emanuele", Università di Catania, Catania, Italy,
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150
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Hanson K. Electronic cigarettes and alternative nicotine products. NCSL Legisbrief 2014; 22:1-2. [PMID: 25514811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
(1) Electronic cigarettes currently are not regulated by the FDA. (2) Ingredients and design of electronic cigarettes and vaporizers vary. (3) States are taking action to regulate electronic cigarettes in various ways.
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