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Salari N, Rahimi S, Darvishi N, Abdolmaleki A, Mohammadi M. The global prevalence of E-cigarettes in youth: A comprehensive systematic review and meta-analysis. PUBLIC HEALTH IN PRACTICE 2024; 7:100506. [PMID: 38817636 PMCID: PMC11137589 DOI: 10.1016/j.puhip.2024.100506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/22/2024] [Accepted: 05/09/2024] [Indexed: 06/01/2024] Open
Abstract
Objectives Smoking, especially cigarettes, is known as one of the most common social and health problems among people. E-cigarettes are another form of tobacco that has been an ordinary daily occurrence.Study Design: systematic review and meta-analysis. Methods Systematic searching of databases was performed in Scopus, Web of Science, PubMed, Science Direct, MagIran, IranDoc, SID and Google search engine based on the PRISMA 2020 guideline. This search was conducted by the end of May 2021. Following full-text assessments, the related data were extracted from the papers. Newcastle-Ottawa scale was also used to evaluate the quality of methodology of the articles. Finally, study analysis was performed using Comprehensive Meta-Analysis software (version 2) based on the random effect model. Results Global prevalence of E-cigarette in younger individuals was 16.8 (95 % CI: 10.6-25.6) and 4.8 (95 % CI: 3-7.6) in the Ever and Current modes of E-cigarette, respectively. We also found that E-cigarettes were used more common in young boys than young girls in both Ever and Current modes. In young boys, the prevalence of E-cigarette were 18.8 (95 % CI: 8.4-36.8) and 4.9 (95 % CI: 3-8) in both modes of Ever and Current, respectively. In young girls, these factors were 9.9 (95 % CI: 5-18.6) and 1.6 (95 % CI: 1-3.1) in both modes of Ever and Current, respectively. Conclusions The global prevalence of e-cigarettes among young people, especially young boys, is increasing. Based on this, the prevention and management of the damage of this social phenomenon requires comprehensive global study, planning and policy.
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Affiliation(s)
- Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sahel Rahimi
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Niloofar Darvishi
- Department of Psychiatric Nursing, Faculty of Nursing School, Tehran Medical Sciences, Islamic Azad University Science and Research Branch, Tehran, Iran
| | - Amir Abdolmaleki
- Department of Operating Room, Nahavand School of Allied Medical Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Masoud Mohammadi
- Research Center for NonCommunicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran
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Shamhuyenhanzva RM, Muposhi A, Hungwe DR. A downstream social norms approach for curtailing e-cigarette waste: Promising social marketing interventions from consumer interactions. WASTE MANAGEMENT & RESEARCH : THE JOURNAL OF THE INTERNATIONAL SOLID WASTES AND PUBLIC CLEANSING ASSOCIATION, ISWA 2023; 41:1238-1245. [PMID: 36922705 DOI: 10.1177/0734242x231160083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Irresponsibly disposed electronic cigarette (e-cigarette) waste poses significant public health and environmental harm. This study explores downstream social marketing interventions that can be used to curtail the growth of e-cigarette waste in South Africa through the lenses of the social norms approach. This study harnesses the power of social marketing to identify downstream interventions that can be used by marketers to curb the problem of e-cigarette waste. An exploratory research design and a qualitative method were employed. Six virtual focus groups were conducted to collect cross-sectional data from South African electronic cigarette users. Reciprocal altruism, social orientation value, moral licensing and ecological beliefs were found to be the main normative influences that characterise e-cigarette waste. The results support the proposition that social marketers should employ a downstream approach to develop interventions to curtail the growth of e-cigarette waste. Such measures are envisaged to complement upstream initiatives. This study offers new insights on how to manage e-cigarette waste in the context of an emerging market.
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Affiliation(s)
- Roy Malon Shamhuyenhanzva
- Department of Marketing, Retail Business and Sport Management, Vaal University of Technology, Vanderbijlpark, South Africa
| | - Asphat Muposhi
- Department of Information and Marketing Sciences, Midlands State University, Gweru, Zimbabwe
| | - Delight Rufaro Hungwe
- Department of Information and Marketing Sciences, Midlands State University, Gweru, Zimbabwe
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3
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Lee JW, Kim S. Comparison of a Tobacco-Specific Carcinogen in Tobacco Cigarette, Electronic Cigarette, and Dual Users. J Korean Med Sci 2023; 38:e140. [PMID: 37191844 DOI: 10.3346/jkms.2023.38.e140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/30/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND 4-(Methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) is known as a lung carcinogen. The objective of this study was to investigate associations of urine NNAL concentrations and smoking status. METHODS This was a cross-sectionally designed study based on data from the 2016-2018 Korean National Health and Nutrition Examination Survey. A total of 2,845 participants were classified into past-smoker, electronic cigarette (e-cigar) only, dual-user, and cigarette only smoker groups. All sampling and weight variables were stratified and analysis was conducted accounting for the complex sampling design. Analysis of covariance was used to compare the geometric mean of urine NNAL concentrations and log-transformed urine NNAL level among smoking status with weighted survey design. Post hoc paired comparisons with Bonferroni adjustment was performed according to smoking status. RESULTS The estimated geometric mean concentrations of urine NNAL were 1.974 ± 0.091, 14.349 ± 5.218, 89.002 ± 11.444, and 117.597 ± 5.459 pg/mL in past-smoker, e-cigar only, dual-user, and cigarette only smoker groups, respectively. After fully adjusting, log-transformed urine NNAL level was significantly different among groups (P < 0.001). Compared with the past-smoker group, e-cigar only, dual-user, and cigarette only smoker groups showed significantly higher log-transformed urine NNAL concentrations in post hoc test (all P < 0.05). CONCLUSION E-cigar only, dual-user, and cigarette only smoker groups showed significantly higher geometric mean concentrations of urine NNAL than the past-smoker group. Conventional cigarette, dual users, and e-cigar users can potentially show harmful health effects from NNAL.
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Affiliation(s)
- Jae-Woo Lee
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea
- Department of Preventive Medicine, Graduate School of the Catholic University of Korea, Seoul, Korea
| | - Sukil Kim
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Giovacchini CX, Crotty Alexander LE, Que LG. Electronic Cigarettes: A Pro-Con Review of the Current Literature. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2843-2851. [PMID: 35872217 DOI: 10.1016/j.jaip.2022.07.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/27/2022] [Accepted: 07/08/2022] [Indexed: 05/11/2023]
Abstract
Electronic cigarettes (e-cigarettes, e-cigs, or electronic nicotine delivery systems) are battery-operated devices typically containing glycerol and/or propylene glycol-based solutions with varying nicotine content, known as e-liquids. Although e-cigarettes were originally developed as a potentially less harmful alternative to traditional combustible tobacco cigarette smokers, several factors have driven their popularity among smokers and nonsmokers alike, including their sleek product designs, innumerable appealing flavors, lack of combustible smoke and odor, and high potential nicotine concentrations. Furthermore, many advocates have promoted the idea that e-cigarettes are safe to use, or at least safer than conventional tobacco, despite limited longitudinal data to support these claims. Here, we examine what is known about the impacts of e-cigarette use on traditional cigarette smoking cessation, lung health, and youth and young adult tobacco product exposure. Upon review of the currently available literature, the negative effects of e-cigarette use seem to outweigh any potential benefit, because the available evidence does not confirm the use of e-cigarettes as an effective strategy for supporting traditional combustible tobacco cigarette smoking cessation, particularly given the emerging adverse effects on lung health and the potential future public health effects of e-cigarette adoption among a burgeoning new generation of tobacco product users.
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Affiliation(s)
- Coral X Giovacchini
- Division of Pulmonary, Allergy, and Critical Care, Duke University Health System, Durham, NC
| | - Laura E Crotty Alexander
- Pulmonary Critical Care Section, VA San Diego Healthcare System, San Diego, Calif; Division of Pulmonary, Critical Care, Sleep, and Physiology, University of California San Diego, San Diego, Calif.
| | - Loretta G Que
- Division of Pulmonary, Allergy, and Critical Care, Duke University Health System, Durham, NC.
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de Lima Dantas JB, Freire TFC, Sanches ACB, Julião ELD, Medrado ARAP, Martins GB. Action of Matricaria recutita (chamomile) in the management of radiochemotherapy oral mucositis: A systematic review. Phytother Res 2022; 36:1115-1125. [PMID: 35129844 DOI: 10.1002/ptr.7378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 12/15/2021] [Accepted: 12/22/2021] [Indexed: 12/27/2022]
Abstract
The objective of this study was to evaluate the effect of topical chamomile in the prevention and/or treatment of oral mucositis (OM) in cancer patients. It was a systematic review, which sought articles of the randomized clinical trial according to the PRISMA parameters, registered in the PROSPERO. The databases used were PubMed, Cochrane Library, and Bireme. Descriptors were selected from DeCs/MeSH and the PICO strategy was applied. The search found 148 publications. After all the steps, six articles were selected. The total sample included 492 patients and all studies used the same OM measurement scale. The results showed that the application of topical chamomile was effective in the prevention and/or treatment of OM in four of the six studies, with a dose ranging from 1% to 2.5% and duration that ranged from single to 4 times a day. Some limitations were observed: the minimum age of the patients was not informed, and there was no specification of the sites involved or the chemotherapies used. The application of topical chamomile in the preventive/therapeutic of chemo-induced OM seems to be recommended. In addition, scientific production should be encouraged, as it aims to determine useful protocols for this phytotherapy for the oncology population.
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Affiliation(s)
- Juliana Borges de Lima Dantas
- Graduate Program in Interactive Processes of Organs and Systems, Health Sciences Institute, Federal University of Bahia, Salvador, Brazil.,Adventist College of Bahia, Department of Dentistry, Cachoeira, Brazil
| | - Tila Fortuna Costa Freire
- Graduate Program in Interactive Processes of Organs and Systems, Health Sciences Institute, Federal University of Bahia, Salvador, Brazil
| | - Ana Carla Barletta Sanches
- Graduate Program in Interactive Processes of Organs and Systems, Health Sciences Institute, Federal University of Bahia, Salvador, Brazil
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Tang MS, Lee HW, Weng MW, Wang HT, Hu Y, Chen LC, Park SH, Chan HW, Xu J, Wu XR, Wang H, Yang R, Galdane K, Jackson K, Chu A, Halzack E. DNA damage, DNA repair and carcinogenicity: Tobacco smoke versus electronic cigarette aerosol. MUTATION RESEARCH. REVIEWS IN MUTATION RESEARCH 2022; 789:108409. [PMID: 35690412 PMCID: PMC9208310 DOI: 10.1016/j.mrrev.2021.108409] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 12/06/2021] [Accepted: 12/13/2021] [Indexed: 01/03/2023]
Abstract
The allure of tobacco smoking is linked to the instant gratification provided by inhaled nicotine. Unfortunately, tobacco curing and burning generates many mutagens including more than 70 carcinogens. There are two types of mutagens and carcinogens in tobacco smoke (TS): direct DNA damaging carcinogens and procarcinogens, which require metabolic activation to become DNA damaging. Recent studies provide three new insights on TS-induced DNA damage. First, two major types of TS DNA damage are induced by direct carcinogen aldehydes, cyclic-1,N2-hydroxy-deoxyguanosine (γ-OH-PdG) and α-methyl-1, N2-γ-OH-PdG, rather than by the procarcinogens, polycyclic aromatic hydrocarbons and aromatic amines. Second, TS reduces DNA repair proteins and activity levels. TS aldehydes also prevent procarcinogen activation. Based on these findings, we propose that aldehydes are major sources of TS induce DNA damage and a driving force for carcinogenesis. E-cigarettes (E-cigs) are designed to deliver nicotine in an aerosol state, without burning tobacco. E-cigarette aerosols (ECAs) contain nicotine, propylene glycol and vegetable glycerin. ECAs induce O6-methyl-deoxyguanosines (O6-medG) and cyclic γ-hydroxy-1,N2--propano-dG (γ-OH-PdG) in mouse lung, heart and bladder tissues and causes a reduction of DNA repair proteins and activity in lungs. Nicotine and nicotine-derived nitrosamine ketone (NNK) induce the same types of DNA adducts and cause DNA repair inhibition in human cells. After long-term exposure, ECAs induce lung adenocarcinoma and bladder urothelial hyperplasia in mice. We propose that E-cig nicotine can be nitrosated in mouse and human cells becoming nitrosamines, thereby causing two carcinogenic effects, induction of DNA damage and inhibition of DNA repair, and that ECA is carcinogenic in mice. Thus, this article reviews the newest literature on DNA adducts and DNA repair inhibition induced by nicotine and ECAs in mice and cultured human cells, and provides insights into ECA carcinogenicity in mice.
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Affiliation(s)
- Moon-Shong Tang
- Department of Environmental Medicine, Pathology and Medicine, United States.
| | - Hyun-Wook Lee
- Department of Environmental Medicine, Pathology and Medicine, United States
| | - Mao-Wen Weng
- Department of Environmental Medicine, Pathology and Medicine, United States
| | - Hsiang-Tsui Wang
- Department of Environmental Medicine, Pathology and Medicine, United States
| | - Yu Hu
- Department of Environmental Medicine, Pathology and Medicine, United States
| | - Lung-Chi Chen
- Department of Environmental Medicine, Pathology and Medicine, United States
| | - Sung-Hyun Park
- Department of Environmental Medicine, Pathology and Medicine, United States
| | - Huei-Wei Chan
- Department of Environmental Medicine, Pathology and Medicine, United States
| | - Jiheng Xu
- Department of Environmental Medicine, Pathology and Medicine, United States
| | - Xue-Ru Wu
- Departmemt of Urology, New York University School of Medicine, New York, NY10016, United States
| | - He Wang
- Department of Pathology and Laboratory Medicine, Robert Wood Johnson MedicalSchool, Rutgers University, Piscataway, NJ 08854, United States
| | - Rui Yang
- Department of Environmental Medicine, Pathology and Medicine, United States
| | - Karen Galdane
- Department of Environmental Medicine, Pathology and Medicine, United States
| | - Kathryn Jackson
- Department of Environmental Medicine, Pathology and Medicine, United States
| | - Annie Chu
- Department of Environmental Medicine, Pathology and Medicine, United States
| | - Elizabeth Halzack
- Department of Environmental Medicine, Pathology and Medicine, United States
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Manning K, Garey L, Viana AG, Smit T, Zvolensky MJ. The moderating role of anxiety sensitivity in terms of fatigue severity and e-cigarette use expectancies. J Health Psychol 2021; 26:2676-2687. [PMID: 32498566 PMCID: PMC7916988 DOI: 10.1177/1359105320926534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Little is understood about individual difference factors related to e-cigarette expectancies about use. This study examined the interactive effects of fatigue severity and anxiety sensitivity in relation to e-cigarette expectancies among 525 e-cigarette users (51.0% female, Mage = 35.25 years, standard deviation = 10.10). Results indicated a significant interaction between fatigue severity and anxiety sensitivity in terms of positive expectancies (β = 0.57, p < 0.001, 95% confidence interval = (0.002, 0.01)), but not for negative expectancies (β = 0.25, p = 0.08, 95% confidence interval = (0, 0.005)) for e-cigarette use. These results support anxiety sensitivity as a moderator in the relation between fatigue severity and positive outcome expectancies for e-cigarette use.
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Affiliation(s)
| | | | | | | | - Michael J Zvolensky
- University of Houston, USA
- The University of Texas MD Anderson Cancer Center, USA
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9
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Williams MA, Reddy G, Quinn MJ, Millikan Bell A. Toxicological assessment of electronic cigarette vaping: an emerging threat to force health, readiness and resilience in the U.S. Army. Drug Chem Toxicol 2021; 45:2049-2085. [PMID: 33906535 DOI: 10.1080/01480545.2021.1905657] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The U.S. Army and U. S. Army Public Health Center are dedicated to protecting the health, and readiness of Department of the Army Service Members, civilians, and contractors. Despite implementation of health programs, policies and tobacco control interventions, the advent of electronic nicotine delivery systems (ENDS), including electronic cigarettes (e-cigs), represent unregulated and poorly defined systems to supplant or substitute use of conventional nicotine products (e.g., cigarettes and pipe tobacco). E-cigs present unique challenges to healthcare officials vested in preventive medicine. The health impact of an e-cig and vaping on an individual's acute or chronic disease susceptibility, performance and wellness, is fraught with uncertainty. Given the relatively recent emergence of e-cigs, high-quality epidemiological studies, and applied biological research studies are severely lacking. In sparsely available epidemiological studies of short-term cardiovascular and respiratory health outcomes, any attempt at addressing the etiology of acute and chronic health conditions from e-cig use faces incredible challenges. Until relatively recently, this was complicated by an absent national regulatory framework and health agency guidance on the manufacture, distribution, selling and use of e-cigs or similar ENDS devices and their chemical constituents. Two key issues underpin public health concern from e-cig use: 1) continued or emergent nicotine addiction and potential use of these devices for vaping controlled substances; and 2) inadvertent sudden-onset or chronic health effects from inhalational exposure to low levels of complex chemical toxicants from e-cig use and vaping the liquid. Herein, the health impacts from e-cig vaping and research supporting such effects are discussed.
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Affiliation(s)
- Marc A Williams
- Toxicology Directorate - Health Effects Program, U.S. Army Public Health Center, Aberdeen Proving Ground, MD, USA
| | - Gunda Reddy
- Toxicology Directorate - Health Effects Program, U.S. Army Public Health Center, Aberdeen Proving Ground, MD, USA
| | - Michael J Quinn
- Toxicology Directorate - Health Effects Program, U.S. Army Public Health Center, Aberdeen Proving Ground, MD, USA
| | - Amy Millikan Bell
- Office of the Director - Medical Advisor, U.S. Army Public Health Center, Aberdeen Proving Ground, USA
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10
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Kaur G, Batra S. Regulation of DNA methylation signatures on NF-κB and STAT3 pathway genes and TET activity in cigarette smoke extract-challenged cells/COPD exacerbation model in vitro. Cell Biol Toxicol 2020; 36:459-480. [PMID: 32342329 DOI: 10.1007/s10565-020-09522-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 03/19/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a global health problem. Currently, there is a lack of knowledge about the pathobiology of this disease and available therapies are ineffective. Cigarette smoking is the leading cause of COPD; however, not all smokers develop COPD. Exacerbations of COPD caused by microbes are common and detrimental. Approximately 20-50% of patient exacerbations are caused by bacterial colonization in the lower airways. It is generally accepted that epigenetic mechanisms, especially DNA methylation, play an important role during progression of COPD. Thus, we hypothesized that DNA methylation patterns vary significantly following smoke exposure and during exacerbations caused by bacterial infections. To test our hypothesis, we used an in vitro study model that mimics COPD exacerbations and performed extensive studies to understand the role of CpG promoter methylation of NF-κB and STAT3-mediated pathway genes. Both NF-κB and STAT3 transcription factors play critical roles in orchestrating inflammatory responses during cigarette smoke exposure. In brief, human lung adenocarcinoma cells with type II alveolar epithelium characteristics (A549) were challenged with cigarette smoke extract (CSE) or DMSO (control) followed by a 3-h challenge with bacterial lipopolysaccharide (LPS; from Pseudomonas aeruginosa) prior to the termination of CSE exposure (COPD exacerbation group). The production of cytokines/chemokines, regulation of transcription factors, and DNA methylation of specific genes were then assessed. We also studied changes in the expression and activity of ten-eleven translocases (TETs), the enzymes responsible for DNA demethylation, and assessed their role in regulating DNA methylation in the CSE-challenged group. RESULTS There was a significant increase in the release of cytokines/chemokines (IL-8, MCP-1, IL-6 and CCL5) in the COPD exacerbation group as compared to the control group. Hypomethylation of NF-κB-mediated pathway genes correlated with their induction in our COPD exacerbation study model. Further, we observed an important role of TET1/2 in regulating the DNA methylation of NF-κB, STAT3, IKK, and NIK genes and cytokine/chemokine production by A549 cells during CSE challenge. CONCLUSIONS Studies to further define the role of TETs in CSE-mediated epigenetic regulation may lead to the development of better and more effective therapeutic intervention strategies for COPD.
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Affiliation(s)
- Gagandeep Kaur
- Laboratory of Pulmonary Immunotoxicology, Department of Environmental Toxicology, Southern University and A&M College, Baton Rouge, LA, 70813, USA
| | - Sanjay Batra
- Laboratory of Pulmonary Immunotoxicology, Department of Environmental Toxicology, Southern University and A&M College, Baton Rouge, LA, 70813, USA.
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Erythropel HC, Jabba SV, DeWinter TM, Mendizabal M, Anastas PT, Jordt SE, Zimmerman JB. Formation of flavorant-propylene Glycol Adducts With Novel Toxicological Properties in Chemically Unstable E-Cigarette Liquids. Nicotine Tob Res 2020; 21:1248-1258. [PMID: 30335174 DOI: 10.1093/ntr/nty192] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 09/13/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION "Vaping" electronic cigarettes (e-cigarettes) is increasingly popular with youth, driven by the wide range of available flavors, often created using flavor aldehydes. The objective of this study was to examine whether flavor aldehydes remain stable in e-cigarette liquids or whether they undergo chemical reactions, forming novel chemical species that may cause harm to the user. METHODS Gas chromatography was used to determine concentrations of flavor aldehydes and reaction products in e-liquids and vapor generated from a commercial e-cigarette. Stability of the detected reaction products in aqueous media was monitored by ultraviolet spectroscopy and nuclear magnetic resonance spectroscopy, and their effects on irritant receptors determined by fluorescent calcium imaging in HEK-293T cells. RESULTS Flavor aldehydes including benzaldehyde, cinnamaldehyde, citral, ethylvanillin, and vanillin rapidly reacted with the e-liquid solvent propylene glycol (PG) after mixing, and upward of 40% of flavor aldehyde content was converted to flavor aldehyde PG acetals, which were also detected in commercial e-liquids. Vaping experiments showed carryover rates of 50%-80% of acetals to e-cigarette vapor. Acetals remained stable in physiological aqueous solution, with half-lives above 36 hours, suggesting they persist when inhaled by the user. Acetals activated aldehyde-sensitive TRPA1 irritant receptors and aldehyde-insensitive TRPV1 irritant receptors. CONCLUSIONS E-liquids are potentially reactive chemical systems in which new compounds can form after mixing of constituents and during storage, as demonstrated here for flavor aldehyde PG acetals, with unexpected toxicological effects. For regulatory purposes, a rigorous process is advised to monitor the potentially changing composition of e-liquids and e-vapors over time, to identify possible health hazards. IMPLICATIONS This study demonstrates that e-cigarette liquids can be chemically unstable, with reactions occurring between flavorant and solvent components immediately after mixing at room temperature. The resulting compounds have toxicological properties that differ from either the flavorants or solvent components. These findings suggest that the reporting of manufacturing ingredients of e-liquids is insufficient for a safety assessment. The establishment of an analytical workflow to detect newly formed compounds in e-liquids and their potential toxicological effects is imperative for regulatory risk analysis.
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Affiliation(s)
- Hanno C Erythropel
- Department of Chemical and Environmental Engineering, Yale University, New Haven, CT.,Yale Tobacco Center of Regulatory Science, Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Sairam V Jabba
- Yale Tobacco Center of Regulatory Science, Department of Psychiatry, Yale School of Medicine, New Haven, CT.,Department of Anesthesiology, Duke University School of Medicine, Durham, NC
| | - Tamara M DeWinter
- Yale Tobacco Center of Regulatory Science, Department of Psychiatry, Yale School of Medicine, New Haven, CT.,Yale School of Forestry and Environmental Studies, Yale University, New Haven, CT
| | - Melissa Mendizabal
- Department of Chemical and Environmental Engineering, Yale University, New Haven, CT
| | - Paul T Anastas
- Department of Chemical and Environmental Engineering, Yale University, New Haven, CT.,Yale School of Forestry and Environmental Studies, Yale University, New Haven, CT.,Department of Chemistry, Yale University, New Haven, CT.,Yale School of Public Health, Yale University, New Haven, CT
| | - Sven E Jordt
- Yale Tobacco Center of Regulatory Science, Department of Psychiatry, Yale School of Medicine, New Haven, CT.,Department of Anesthesiology, Duke University School of Medicine, Durham, NC
| | - Julie B Zimmerman
- Department of Chemical and Environmental Engineering, Yale University, New Haven, CT.,Yale Tobacco Center of Regulatory Science, Department of Psychiatry, Yale School of Medicine, New Haven, CT.,Yale School of Forestry and Environmental Studies, Yale University, New Haven, CT
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12
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Soteriades S, Barbouni A, Rachiotis G, Grevenitou P, Mouchtouri V, Pinaka O, Dadouli K, Hadjichristodoulou C. Prevalence of Electronic Cigarette Use and its Determinants among 13-to-15-Year-Old Students in Greece: Results from the 2013 Global Youth Tobacco Survey (GYTS). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1671. [PMID: 32143414 PMCID: PMC7084902 DOI: 10.3390/ijerph17051671] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 02/26/2020] [Accepted: 03/03/2020] [Indexed: 11/30/2022]
Abstract
Electronic cigarette use has increased over the past decade. Its potential role in smoking cessation, in addiction and as a 'gateway' to tobacco smoking is subject to intense research. This cross-sectional study, carried out in 2013, aims to present the habits of students aged 13-15 in Greece with regard to e-cigarettes and investigate potential risk factors and the relationship between e-cigarettes, tobacco smoking and other nicotine products. It is the first such study to be carried out in Greece. The survey was based on the standardized methodology of the Global Youth Tobacco Survey. All potential associations were investigated using multiple logistic regression. In total 2.8% of the 4096 participating students were current e-cigarette users and 12.3% of them were ever users. E-cigarette use was associated with male gender, being older, current use of combustible tobacco products and e-cigarette use in the family. Ever e-cigarette use, being older, female gender and higher pocket money were associated with an increased susceptibility to tobacco smoking. E-cigarette prevalence in Greece in 2013 was similar to that of other, developed countries. The smoking and vaping habits of adolescents must be monitored in order to assess trends over time and whether any policy alterations are necessary.
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Affiliation(s)
- Soteris Soteriades
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Katsigra Building, 22 Papakyriazi St., 41222 Larissa, Greece (C.H.)
| | - Anastasia Barbouni
- Department of Public Health, University of West Attica, 196 Alexandras Ave., 11521 Athens, Greece
| | - George Rachiotis
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Katsigra Building, 22 Papakyriazi St., 41222 Larissa, Greece (C.H.)
| | - Panoraia Grevenitou
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Katsigra Building, 22 Papakyriazi St., 41222 Larissa, Greece (C.H.)
| | - Varvara Mouchtouri
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Katsigra Building, 22 Papakyriazi St., 41222 Larissa, Greece (C.H.)
| | - Ourania Pinaka
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Katsigra Building, 22 Papakyriazi St., 41222 Larissa, Greece (C.H.)
| | - Katerina Dadouli
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Katsigra Building, 22 Papakyriazi St., 41222 Larissa, Greece (C.H.)
| | - Christos Hadjichristodoulou
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Katsigra Building, 22 Papakyriazi St., 41222 Larissa, Greece (C.H.)
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El-Shahawy O, Park SH, Duncan DT, Lee L, Tamura K, Shearston JA, Weitzman M, Sherman SE. Evaluating State-Level Differences in E-cigarette and Cigarette Use Among Adults in the United States Between 2012 and 2014: Findings From the National Adult Tobacco Survey. Nicotine Tob Res 2020; 21:71-80. [PMID: 29490078 DOI: 10.1093/ntr/nty013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 02/14/2018] [Indexed: 11/15/2022]
Abstract
Objective To examine the association between state-level tobacco control measures and current use estimates of both e-cigarettes and cigarettes, while accounting for socio-demographic correlates. Methods Using the 2012-2013 and 2013-2014 National Adult Tobacco Survey (NATS), we assessed prevalence estimates of US adults' e-cigarette and cigarette current use. Four state groups were created based on the combined state-specific prevalence of both products: low cigarette/e-cigarette (n = 15), high cigarette/e-cigarette (n = 16), high cigarette/low e-cigarette (n = 11), and low cigarette/high e-cigarette) (n = 9). To evaluate the implementation of state-level tobacco control measures, Tobacco Control Index (TCI) was calculated using the State of Tobacco Control annual reports for 2012 and 2013. Multinomial logistic regression models were used to examine differences among the four groups on socio-demographic factors and TCI. Low cigarette/e-cigarette group was used as the referent group. Results Current use estimates of each product varied substantially by state; current e-cigarette use was highest in Oklahoma (10.3%) and lowest in Delaware (2.7%), and current cigarette use was highest in West Virginia (26.1%), and lowest in Vermont (12.6%). Compared to low cigarette/e-cigarette, all other US-state categories had significantly lower TCI scores (high cigarette/e-cigarette: adjusted Relative Risk Ratio [aRRR] = 0.61; 95% confidence interval [CI]: 0.60-0.61, high cigarette/low e-cigarette: aRRR = 0.74; 95% CI: 0.73-0.74, and low cigarette/high e-cigarette: aRRR = 0.72; 95% CI: 0.71-073). Conclusions Enforcing existing tobacco control measures likely interacts with e-cigarette use despite being cigarette-focused. Continuing to monitor e-cigarette use is critical to establish baseline use and evaluate future e-cigarette specific federal and state-level tobacco regulatory actions while accounting for the existing tobacco control environment. Implications This study investigates state-level current use estimates of e-cigarettes and cigarettes among US adults; and their association with four existing tobacco control measures. The overall score of these measures was negatively associated with state-level current use estimates such that states with low current e-cigarette and cigarette use had the highest mean overall score. This study assesses the potential relationship between existing state-level tobacco control measures and e-cigarette use and calls for improving the enforcement of the known-to-work tobacco control measures across all US states, while developing evidence-based regulations and interventions specific to e-cigarettes within the existing US tobacco use environment.
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Affiliation(s)
- Omar El-Shahawy
- Department of Population Health, New York University School of Medicine, New York, NY.,Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates.,College of Global Public Health, New York University, New York, NY.,AHA Tobacco Regulation and Addiction Center, American Heart Association, Dallas, TX
| | - Su Hyun Park
- Department of Population Health, New York University School of Medicine, New York, NY.,College of Global Public Health, New York University, New York, NY
| | - Dustin T Duncan
- Department of Population Health, New York University School of Medicine, New York, NY.,College of Global Public Health, New York University, New York, NY
| | - Lily Lee
- Department of Pediatrics, New York University School of Medicine, New York, NY
| | - Kosuke Tamura
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Jenni A Shearston
- Department of Population Health, New York University School of Medicine, New York, NY.,Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates.,College of Global Public Health, New York University, New York, NY
| | - Michael Weitzman
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates.,College of Global Public Health, New York University, New York, NY.,Department of Pediatrics, New York University School of Medicine, New York, NY
| | - Scott E Sherman
- Department of Population Health, New York University School of Medicine, New York, NY.,Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates.,College of Global Public Health, New York University, New York, NY
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14
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Lee JH, Patra JK, Shin HS. Analytical methods for determination of carbonyl compounds and nicotine in electronic No-Smoking aid refill solutions. Anal Biochem 2020; 588:113470. [PMID: 31605695 DOI: 10.1016/j.ab.2019.113470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/07/2019] [Accepted: 10/08/2019] [Indexed: 10/25/2022]
Abstract
The present investigation aimed to develop analytical methods to determine carbonyl compounds and nicotine and to assess the carbonyl compounds and nicotine concentrations in commercial refill solutions for electronic no-smoking aids (ENSAs). The analytical methods for carbonyl compounds and nicotine in refill solutions for ENSAs were developed and analyzed from 30 popular branded products by gas chromatography and liquid chromatography. They were then validated in terms of linearity of the calibration curve, limit of detection (LOD), limit of quantification (LOQ), accuracy (%), and precision (%). Further, the existence of carbonyl compounds and nicotine in the refill solutions for ENSAs was also evaluated. None of the samples contained nicotine, but carbonyl compounds were sensed in a concentration range from 0.9 to 11.65 μg/mL. Manufacturers of ENSA refill solutions have advertised no-smoking aids as less harmful than tobacco cigarettes and as free from harmful substances. However, carbonyl compounds were detected in all 30 samples. The investigation of ENSA refill solutions needs to be broadened to gain a better accepting of the existence of harmful materials in ENSA refill solutions and prevent unsuspected ill-health effects.
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Affiliation(s)
- Jong-Hoon Lee
- Department of Food Science and Biotechnology, Food and Bio Safety Research Center, Dongguk University-Seoul, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Jayanta Kumar Patra
- Research Institute of Biotechnology & Medical Converged Science, Dongguk University-Seoul, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Han-Seung Shin
- Department of Food Science and Biotechnology, Food and Bio Safety Research Center, Dongguk University-Seoul, Goyang-si, Gyeonggi-do, Republic of Korea.
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15
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Lee Y, Chiang T, Kwon E, Baik S, Chang Y. Trends and sociodemographic factors of e‐cigarette use among adult daily smokers in South Korea. Int J Health Plann Manage 2019; 35:960-969. [DOI: 10.1002/hpm.2932] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 10/10/2019] [Indexed: 11/11/2022] Open
Affiliation(s)
- Yen‐Han Lee
- Department of Applied Health Sciences Indiana University School of Public Health Indiana USA
| | - Timothy Chiang
- College of Medicine Pennsylvania State University Hershey Pennsylvania USA
| | - Elizabeth Kwon
- Department of Applied Health Sciences Indiana University School of Public Health Indiana USA
| | | | - Yen‐Chang Chang
- Center for General Education National Tsing Hua University Hsinchu City Taiwan
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16
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Truman P, Stanfill S, Heydari A, Silver E, Fowles J. Monoamine oxidase inhibitory activity of flavoured e-cigarette liquids. Neurotoxicology 2019; 75:123-128. [PMID: 31536738 DOI: 10.1016/j.neuro.2019.09.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 09/09/2019] [Accepted: 09/13/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND AIMS Monoamine oxidase inhibitors have been hypothesised to be important in tobacco dependence, reinforcing the brain's response to nicotine by delaying the degradation of neurotransmitters by monoamine oxidases. The development of electronic cigarettes has provided an alternative nicotine delivery system, which is widely viewed as less toxic than tobacco smoke. However, significant data gaps remain. This paper reports the results of measurements of monoamine oxidase inhibitory activity in a small sample of commercially available, flavoured e-liquids. METHODS Twelve e-liquids were tested for monoamine oxidase inhibitory activity, using the kynuramine assay and monoamine oxidase enzymes (human, recombinant). Control samples of carrier liquids, propylene glycol and glycerol, and nicotine were also tested. RESULTS Four e-liquids contained high levels of inhibitory activity, four more were moderately inhibitory. The remaining four e-liquids were mildly inhibitory, while the carrier liquids, and nicotine were inactive at relevant concentrations. The active compounds in the e-liquids were subsequently identified as vanillin and ethyl vanillin. Under some conditions of use, the sampled e-liquids with the highest concentrations of monoamine oxidase inhibitory activity have the potential to expose consumers to physiologically significant levels of MAO inhibitory activity. CONCLUSIONS While only a small sample of e-liquids was tested, the findings suggest that some flavours have pharmacological actions, with potential to enhance the response to nicotine or to other drugs. The public health implications of these preliminary findings on addiction and smoking cessation warrant exploration and further research.
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Affiliation(s)
- Penelope Truman
- School of Health Sciences, Massey University Wellington, New Zealand.
| | - Stephen Stanfill
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ali Heydari
- School of Health Sciences, Massey University Wellington, New Zealand
| | | | - Jefferson Fowles
- Environmental Health Investigations Branch, California Department of Public Health, Richmond, CA, USA
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17
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Czoli CD, Fong GT, Goniewicz ML, Hammond D. Biomarkers of Exposure Among "Dual Users" of Tobacco Cigarettes and Electronic Cigarettes in Canada. Nicotine Tob Res 2019; 21:1259-1266. [PMID: 30203076 PMCID: PMC6698946 DOI: 10.1093/ntr/nty174] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 09/05/2018] [Indexed: 01/01/2023]
Abstract
INTRODUCTION "Dual use" refers to the concurrent use of tobacco cigarettes (smoking) and electronic cigarettes (e-cigarettes; vaping). Although dual use is common among e-cigarette users, there is little evidence regarding biomarkers of exposure among dual users and how these change under different conditions of product use. METHODS A nonblinded within-subjects crossover experiment was conducted with adult daily dual users (n = 48) in Ontario, Canada. Participants completed three consecutive 7-day periods in which the use of tobacco cigarettes and e-cigarettes was experimentally manipulated, resulting in four study conditions: Dual use, Tobacco cigarette use, E-cigarette use, and No product use. Repeated measures models were used to examine changes in product use and biomarkers of exposure. RESULTS Compared to dual use, cotinine remained stable when participants exclusively smoked (p = .524), but significantly decreased when they exclusively vaped (p = .027), despite significant increases in e-cigarette consumption (p = .001). Levels of biomarkers of exposure to toxicants, including carbon monoxide (CO), 1-hydroxypyrene (1-HOP), and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), were significantly lower when participants exclusively vaped than when they engaged in dual use (CO = -41%, p < .001; 1-HOP = -31%, p = .025; NNAL = -30%, p = .017). Similar findings were observed among participants abstaining from both products as compared to dual use (CO: -26%, p < .001; 1-HOP = -14% [ns]; NNAL = -35%, p = .016). In contrast, levels of biomarkers of exposure increased when participants exclusively smoked as compared to dual use (CO = +21%, p = .029; 1-HOP = +23%, p = .048; NNAL = +8% [ns]). CONCLUSIONS Although dual use may reduce exposure to tobacco smoke constituents to some extent, abstaining from smoking is the most effective way to reduce such exposure. IMPLICATIONS Public health authorities should clearly communicate the relative risk of e-cigarettes and tobacco cigarettes to the general public, focusing on two salient points: (1) e-cigarettes are not harmless, but they are less harmful than tobacco cigarettes; and (2) using e-cigarettes while smoking may not necessarily reduce health risks; therefore, consumers should stop smoking completely to maximize potential health benefits.
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Affiliation(s)
- Christine D Czoli
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Geoffrey T Fong
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
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18
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Yang B, Spears CA, Popova L. Psychological distress and responses to comparative risk messages about electronic and combusted cigarettes. Addict Behav 2019; 91:141-148. [PMID: 30477820 DOI: 10.1016/j.addbeh.2018.11.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 11/16/2018] [Accepted: 11/16/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND People with mental illness suffer disproportionately high health burdens of smoking. Communicating to these smokers that electronic cigarettes (e-cigarettes) are a less harmful alternative to combusted cigarettes might help them reduce their health risks by encouraging complete switching to e-cigarettes. However, such messages might also cause unintended consequences (e.g., dual use of both combusted and e-cigarettes). Our study examined how smokers with vs. without serious psychological distress (SPD) responded to messages communicating reduced harm of e-cigarettes in relation to cigarettes. METHOD In an online experiment, 1400 U.S. adult smokers with and without SPD viewed 1 of 6 messages about reduced harm of e-cigarettes compared to cigarettes or a control message. Then participants reported e-cigarette- and cigarette-related beliefs, and behavioral intentions. RESULTS Message type (comparative risk messages vs. control) did not interact with SPD status to produce differential impacts on smokers with and without SPD. Regardless of being exposed to a comparative risk message or a control message, smokers with SPD reported greater perceived absolute risk of e-cigarettes and cigarettes, greater support for tobacco control, greater intentions to switch to e-cigarettes completely and seek help with quitting, and were less likely to report e-cigarettes were less harmful than cigarettes compared to smokers without SPD. DISCUSSION Smokers with SPD had greater intentions to switch to e-cigarettes completely and seek help quitting compared to smokers without SPD, which indicates that smokers with SPD may be optimistic about e-cigarettes to help them quit smoking.
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Affiliation(s)
- Bo Yang
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Claire Adams Spears
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, USA; Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Lucy Popova
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, USA; Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA.
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19
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Owens VL, Ha T, Soulakova JN. Widespread use of flavored e-cigarettes and hookah tobacco in the United States. Prev Med Rep 2019; 14:100854. [PMID: 30976489 PMCID: PMC6441788 DOI: 10.1016/j.pmedr.2019.100854] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/17/2019] [Accepted: 03/19/2019] [Indexed: 11/28/2022] Open
Abstract
In 2009, the U.S. Food and Drug Administration banned the sale of flavored cigarettes (excluding menthol) in the U.S. However, the sale of flavored e-cigarettes (FE) and flavored hookah tobacco (FHT) is still legal. In this study (conducted in the US in the period from October 2018 to February 2019), we estimated the prevalence of use of FE and FHT across users' sociodemographic characteristics (e.g., age, sex, race/ethnicity) and identified the key characteristics of tobacco users associated with use of FE and FHT. We analyzed the 2014–2015 Tobacco Use Supplement to the Current Population Survey data for current e-cigarette (n = 3691) and hookah tobacco (n = 658) users. Among e-cigarette users, 65.5% used FE; and among hookah tobacco users, 87.3% used FHT. Among e-cigarette users, the prevalence of use of FE was significantly higher for 18–24 year-old than 45+ year-old adults; women than men; Southern than Northeastern residents; and never smokers of regular cigarettes than current smokers of regular cigarettes (all adjusted p's < 0.05). Among hookah tobacco users, the rates of FHT use were significantly higher for women than men, and never smokers of regular cigarettes than current smokers (all adjusted p's < 0.05). Because availability and accessibility of flavored tobacco products may promote tobacco use, revising regulatory guidelines concerning manufacturing and distribution of FE and FHT may help reduce the popularity of emerging tobacco products. Implications Among users of emerging tobacco products such as e-cigarettes and hookah tobacco, use of flavored products is very common. Among e-cigarette users, 66% consumed flavored e-cigarettes; and among users of hookah tobacco, 87% consumed flavored hookah tobacco. Use of flavored products was especially common among users who were young adults, women, or never and former smokers of regular cigarettes. Availability of emerging tobacco products in many different flavors could be a reason for tobacco use initiation and continued use of tobacco after cessation of regular-cigarette smoking.
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Affiliation(s)
- Victoria L Owens
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, 6900 Lake Nona Blvd., Orlando, FL 32827, United States of America
| | - Trung Ha
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, 6900 Lake Nona Blvd., Orlando, FL 32827, United States of America
| | - Julia N Soulakova
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, 6900 Lake Nona Blvd., Orlando, FL 32827, United States of America
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20
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Marti J, Buckell J, Maclean JC, Sindelar J. To "vape" or smoke? Experimental evidence on adult smokers. ECONOMIC INQUIRY 2019; 57:705-725. [PMID: 30559550 PMCID: PMC6294299 DOI: 10.1111/ecin.12693] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 05/10/2018] [Indexed: 05/19/2023]
Abstract
A growing share of the United States population uses e-cigarettes but the optimal regulation of these controversial products remains an open question. We conduct a discrete choice experiment to investigate how adult tobacco cigarette smokers' demand for e-cigarettes and tobacco cigarettes varies by four attributes: (i) whether e-cigarettes are considered healthier than tobacco cigarettes, (ii) the effectiveness of e-cigarettes as a cessation device, (iii) bans on use in public places, and (iv) price. We find that adult smokers' demand for e-cigarettes is motivated more by health concerns than by the desire to avoid smoking bans or higher prices.
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Affiliation(s)
- Joachim Marti
- Lecturer, Institute of Social and Preventive Medicine (IUMSP), Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Lausanne, Switzerland;
| | - John Buckell
- Post-doctoral Associate, School of Public Health, Yale University,
| | | | - Jody Sindelar
- Professor, School of Public Health, Yale University, NBER, & IZA,
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21
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Goniewicz ML, Smith DM, Edwards KC, Blount BC, Caldwell KL, Feng J, Wang L, Christensen C, Ambrose B, Borek N, van Bemmel D, Konkel K, Erives G, Stanton CA, Lambert E, Kimmel HL, Hatsukami D, Hecht SS, Niaura RS, Travers M, Lawrence C, Hyland AJ. Comparison of Nicotine and Toxicant Exposure in Users of Electronic Cigarettes and Combustible Cigarettes. JAMA Netw Open 2018; 1:e185937. [PMID: 30646298 PMCID: PMC6324349 DOI: 10.1001/jamanetworkopen.2018.5937] [Citation(s) in RCA: 333] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
IMPORTANCE Use of electronic cigarettes (e-cigarettes) is increasing. Measures of exposure to known tobacco-related toxicants among e-cigarette users will inform potential health risks to individual product users. OBJECTIVES To estimate concentrations of tobacco-related toxicants among e-cigarette users and compare these biomarker concentrations with those observed in combustible cigarette users, dual users, and never tobacco users. DESIGN, SETTING, AND PARTICIPANTS A population-based, longitudinal cohort study was conducted in the United States in 2013-2014. Cross-sectional analysis was performed between November 4, 2016, and October 5, 2017, of biomarkers of exposure to tobacco-related toxicants collected by the Population Assessment of Tobacco and Health Study. Participants included adults who provided a urine sample and data on tobacco use (N = 5105). EXPOSURES The primary exposure was tobacco use, including current exclusive e-cigarette users (n = 247), current exclusive cigarette smokers (n = 2411), and users of both products (dual users) (n = 792) compared with never tobacco users (n = 1655). MAIN OUTCOMES AND MEASURES Geometric mean concentrations of 50 individual biomarkers from 5 major classes of tobacco product constituents were measured: nicotine, tobacco-specific nitrosamines (TSNAs), metals, polycyclic aromatic hydrocarbons (PAHs), and volatile organic compounds (VOCs). RESULTS Of the 5105 participants, most were aged 35 to 54 years (weighted percentage, 38%; 95% CI, 35%-40%), women (60%; 95% CI, 59%-62%), and non-Hispanic white (61%; 95% CI, 58%-64%). Compared with exclusive e-cigarette users, never users had 19% to 81% significantly lower concentrations of biomarkers of exposure to nicotine, TSNAs, some metals (eg, cadmium and lead), and some VOCs (including acrylonitrile). Exclusive e-cigarette users showed 10% to 98% significantly lower concentrations of biomarkers of exposure, including TSNAs, PAHs, most VOCs, and nicotine, compared with exclusive cigarette smokers; concentrations were comparable for metals and 3 VOCs. Exclusive cigarette users showed 10% to 36% lower concentrations of several biomarkers than dual users. Frequency of cigarette use among dual users was positively correlated with nicotine and toxicant exposure. CONCLUSIONS AND RELEVANCE Exclusive use of e-cigarettes appears to result in measurable exposure to known tobacco-related toxicants, generally at lower levels than cigarette smoking. Toxicant exposure is greatest among dual users, and frequency of combustible cigarette use is positively correlated with tobacco toxicant concentration. These findings provide evidence that using combusted tobacco cigarettes alone or in combination with e-cigarettes is associated with higher concentrations of potentially harmful tobacco constituents in comparison with using e-cigarettes alone.
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Affiliation(s)
- Maciej L. Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Danielle M. Smith
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | | | - Benjamin C. Blount
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kathleen L. Caldwell
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jun Feng
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lanqing Wang
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carol Christensen
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Bridget Ambrose
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Nicolette Borek
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Dana van Bemmel
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Karen Konkel
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Gladys Erives
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | | | | | | | | | | | - Raymond S. Niaura
- The Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC
| | - Mark Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | | | - Andrew J. Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York
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E-Cigarette Users' Attitudes on the Banning of Sales of Nicotine E-Liquid, Its Implication on E-Cigarette Use Behaviours and Alternative Sources of Nicotine E-Liquid. J Community Health 2018; 42:1225-1232. [PMID: 28589268 DOI: 10.1007/s10900-017-0374-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The banning of sales of nicotine e-liquid in e-cigarette shops has been implemented in several states in Malaysia. The distribution of nicotine e-liquid can only be allowed by licensed pharmacies or registered medical practitioners. This study aimed to evaluate e-cigarette users' responses to the control policy in a cross-sectional survey of 851 e-cigarette users by utilizing a self-report questionnaire that assessed (1) attitudes on regulation policy of e-cigarette banning; (2) e-cigarette use behaviors; and (3) sources of e-liquid after the regulation policy has been implemented. Participants from the state of Selangor where the banning policy was implemented were surveyed. The majority (95.8%) opposed the banning and believed e-cigarettes should be sold to anyone aged 18 years or above as with tobacco cigarettes, only a minority believed that nicotine e-liquid should only be available for sale over the counter in pharmacy stores (14.6%) and in clinics with a doctor's prescription (11.8%). The majority (44.2%) reported that they would continue their e-cigarette use as before the banning policy, while 20% plan to completely stop e-cigarette usage without replacing it with any alternatives. The vast majority (87.9%) was still able to obtained nicotine e-liquid from e-cigarette shops in spite of the ban and the second most common source was from online purchase (63.1%). The sales of nicotine e-liquid from black-market were evidenced as many reported obtaining zero nicotine e-liquid from the black market (54.4%). Self- or home-made (30.8%) nicotine e-liquid was also reported. Majority of respondents that self-made e-liquid were from the average monthly income group (below MYR3000). Obtaining nicotine from the pharmacy was least preferred (21.4%). Provision of professional advice to nicotine e-liquid users along with the ban may lessen the likelihood of users switching to tobacco cigarettes or other nicotine alternatives. Banning of sales of nicotine e-liquid in e-cigarette shops resulted in a boom in the black market supplying nicotine e-liquid and, self- or home-made nicotine e-liquid. Enforcing regulations and monitoring black market sales is warranted. Efforts to educate e-cigarette users of the danger of sourcing nicotine e-liquid from the black market and self- or home-made nicotine e-liquid are essential.
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Ramamurthi D, Chau C, Jackler RK. JUUL and other stealth vaporisers: hiding the habit from parents and teachers. Tob Control 2018; 28:tobaccocontrol-2018-054455. [PMID: 30219794 DOI: 10.1136/tobaccocontrol-2018-054455] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 08/21/2018] [Accepted: 08/29/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Some consumers wish to use vapour devices discreetly so that family members, teachers and coworkers do not recognise their use of nicotine ortetrahydrocannabinol (THC) laden vapour. METHODS Stealthy vapour devices, as well as low-odour and low-vapour e-juices, were identified via a comprehensive online search between March and June 2018. RESULTS As evidence of their popularity, a search for 'stealth vaping' on YouTube found 18 200 videos. A variety of cleverly designed vapour devices disguised as USB sticks, pens, remote controls, car fobs, smart phones, sweatshirt drawstrings and even asthma inhalers are on the market. JUUL, which resembles a USB stick, is the archetype of these devices and is especially popular among youth. A search of 'JUUL' on YouTube yielded 148 000 videos with 57 videos having >100 000 views. Searches on 'JUUL at school' (15 500), 'JUUL in class' (6840), 'hiding JUUL in school' (2030) and 'JUUL in school bathroom' (1040) illustrate the product's popularity among students. Some e-juices promote themselves as having low visibility plumes while others profess to be of subtle odour to avoid detection. Numerous techniques have been described to hide the exhaled vapour plume such as by swallowing it or blowing it into one's clothing or into a backpack. CONCLUSIONS The vaping industry has demonstrated much ingenuity in devising discreet vaporisers and de-emphasising exhaled vapour plumes and their aroma. The US market for vaping devices with stealthy characteristics is anything but inconspicuous, with JUUL alone accounting for 70.5% of sales (July 2018).
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Affiliation(s)
- Divya Ramamurthi
- Stanford Research into the Impact of Tobacco Advertising, Stanford University, Stanford, California, USA
| | - Cindy Chau
- Stanford Research into the Impact of Tobacco Advertising, Stanford University, Stanford, California, USA
| | - Robert K Jackler
- Stanford Research into the Impact of Tobacco Advertising, Stanford University, Stanford, California, USA
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24
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Egbe CO, Parry CDH, Myers B. Electronic cigarettes: the solution or yet another phase of the tobacco epidemic? SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2018. [DOI: 10.1177/0081246318794828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Tobacco use is the single largest preventable cause of death globally. For years, the tobacco industry sought to create a tobacco product that is less controversial than conventional cigarettes. Electronic cigarettes were created out of the supposed need to supply consumers of tobacco products with a less harmful tobacco product. The question remains, is it really less harmful for consumers of traditional cigarettes and other tobacco products to switch to electronic cigarettes? This article takes a closer look at the overall harm in relation to benefits of using electronic cigarettes for the individual and public health and the unintended negative consequences the introduction of electronic cigarette has had on overall public health. Given the evidence that the use of electronic cigarettes is a gateway to the use of other tobacco products especially among adolescents, we view electronic cigarettes as having the potential to cause a rebound of the tobacco use glut which the global public health community has been succeeding in reversing. We therefore support the World Health Organization’s suggestion that electronic cigarettes should be regulated as other tobacco products since there is, as yet, no harmless tobacco product. In the same vein, we view the new Tobacco Products and Electronic Delivery Systems Bill seeking to regulate electronic cigarettes in South Africa as other tobacco products as a step in the right direction.
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Affiliation(s)
- Catherine O Egbe
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, South Africa
| | - Charles DH Parry
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, South Africa
- Department of Psychiatry, Stellenbosch University, South Africa
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, South Africa
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25
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Kyriakos CN, Filippidis FT, Hitchman S, Girvalaki C, Tzavara C, Demjén T, Fernandez E, Mons U, Trofor A, Tountas Y, Zatoński M, Zatoński WA, Fong GT, Vardavas CI. Characteristics and correlates of electronic cigarette product attributes and undesirable events during e-cigarette use in six countries of the EUREST-PLUS ITC Europe Surveys. Tob Induc Dis 2018; 16:A1. [PMID: 31516457 PMCID: PMC6659560 DOI: 10.18332/tid/93545] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/13/2018] [Accepted: 07/17/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION This study assessed characteristics and correlates associated with e-cigarette product attributes and identified correlates of experiencing undesirable events during e-cigarette use among adult smokers across six European Union (EU) Members States (MS) prior to the implementation of the Tobacco Products Directive (TPD) in 2016. METHODS We conducted a cross-sectional survey with a nationally representative sample of adult cigarette smokers from six EU MS (Germany, Greece, Hungary, Poland, Romania, Spain) reporting e-cigarette use; randomly selected through a multistage cluster sampling design from June to September 2016. Stepwise logistic regressions were used to identify factors associated with use of flavors, noticing health warnings, mixing e-liquids, experiencing 'dry puff', e-liquid leaking during use and e-liquid spilling during refill. RESULTS Current daily or weekly prevalence of e-cigarette use among this sample of adult smokers was 7.5%. The most common attributes of e-cigarettes used included those that are flavored, contain nicotine, and are of tank style. Noticing health warnings on e-cigarette packaging and leaflets, respectively, was low (10.2% and 28%, respectively). Use of e-liquid refill nozzle caps, described as easy for a child to open, was associated with spilling during refill (OR=6.73; 95% CI: 2.02-22.37). Participants who adjusted occasionally or regularly the power (voltage) or temperature of their e-cigarette had greater odds of ever experiencing a 'dry puff' (OR=6.01; 95% CI: 2.68-13.46). Mixing different e-liquids was associated with leaking during use (OR=7.78; 95% CI: 2.45-24.73) and spilling during refill (OR=8.54; 95% CI: 2.29-31.88). CONCLUSIONS Ongoing evaluation of factors associated with e-cigarette attributes and of the correlates of experiencing e-cigarette undesirable events during use, related to product design, is crucial to monitoring the impact of the implementing Acts of the EU TPD.
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Affiliation(s)
- Christina N. Kyriakos
- European Network on Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
- University of Crete (UoC), Heraklion, Greece
| | | | | | | | | | - Tibor Demjén
- Smoking or Health Hungarian Foundation (SHHF), Budapest, Hungary
| | - Esteve Fernandez
- Institut Català d’Oncologia (ICO) and Bellvitge Biomedical Research Institute (IDIBELL), Catalonia, Spain
- School of Medicine and Health Sciences, Universitat de Barcelona, Catalonia, Spain
| | - Ute Mons
- Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Antigona Trofor
- University of Medicine and Pharmacy ‘Grigore T.Popa’, Iasi, Romania
- Aer Pur Romania, Bucharest, Romania
| | | | - Mateusz Zatoński
- Health Promotion Foundation (HPF), Warsaw, Poland
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Geoffrey T. Fong
- University of Waterloo (UW), Waterloo, Canada
- Ontario Institute for Cancer Research, Toronto, Canada
| | - Constantine I. Vardavas
- European Network on Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
- University of Crete (UoC), Heraklion, Greece
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26
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Getachew B, Payne JB, Vu M, Pillai D, Shah J, Levine H, Berg CJ. Perceptions of Alternative Tobacco Products, Anti-tobacco Media, and Tobacco Regulation among Young Adults: A Qualitative Study. Am J Health Behav 2018; 42:118-130. [PMID: 29973316 DOI: 10.5993/ajhb.42.4.11] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives With increased alternative tobacco product (ATP) use and lagging public health action, we explored perceptions of ATPs, anti-tobacco messaging, and tobacco regulation among young adults. Methods Semi-structured interviews were conducted with 60 Georgia college students aged 18-25 using: (1) cigarettes, little cigars/cigarillos (LCCs), smokeless tobacco, or e-cigarettes ≥15 days of the past 30; or (2) hookah ≥10 of the past 30 days (due to lower frequency of use). Of 99 participants recruited, 80 consented, and 60 participated. Results Participants were on average 21.01 years old (SD = 2.07), 56.7% women, and 65.0% black; 56.7% reported current use of cigarettes, 43.3% LCCs, 26.7% smokeless tobacco, 45.0% e-cigarettes, and 41.7% hookah. Cigarettes were perceived as most harmful to health and most addictive. E-cigarettes and hookah were generally regarded as lowest risk. Many indicated that ATP risk information was limited or inaccessible and that most anti-tobacco campaigns were irrelevant to ATPs. Participants requested more research and dissemination of evidence regarding ATP risks and need for ATP regulation. Conclusions In light of low risk perceptions regarding ATPs among young adults, research, anti-tobacco campaigns, and regulation must address their known and potential risks.
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27
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Meyns J, Brasil DM, Mazzi-Chaves JF, Politis C, Jacobs R. The clinical outcome of skeletal anchorage in interceptive treatment (in growing patients) for class III malocclusion. Int J Oral Maxillofac Surg 2018; 47:1003-1010. [PMID: 29709324 DOI: 10.1016/j.ijom.2018.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/01/2018] [Accepted: 04/08/2018] [Indexed: 12/28/2022]
Abstract
A systematic review of the literature was performed regarding the clinical outcome (effectiveness) of bone anchorage devices in interceptive treatment for class III malocclusion. A search of Embase, PubMed and Web of Science databases yielded 285 papers. An additional two articles were retrieved through manual searching of the reference lists. After initial abstract selection, 32 potentially eligible articles were screened in detail, resulting in a final number of eight articles included in this review. Insufficient evidence was found regarding the effects of skeletal anchorage in interceptive class III treatment to support definitive conclusions on long-term skeletal effects and stability. In the short term, it seems that bone anchors can provide more skeletal effect with less dentoalveolar compensations and less unwanted vertical changes. This does not always exclude the use of a face mask. The use of miniscrews as skeletal anchorage device does not seem to provide more skeletal effect, although it could minimize the unwanted dental effects in the upper jaw. No information regarding the need for orthognathic surgery, orthodontic treatment time or patient compliance and complications was found in the selected articles.
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Affiliation(s)
- J Meyns
- Division of Maxillofacial Surgery, General Hospital St-Jan Genk, Genk, Belgium; OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KULeuven, Leuven, Belgium.
| | - D M Brasil
- Oral Radiology Area, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil
| | - J F Mazzi-Chaves
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo (FORP/USP), Brazil
| | - C Politis
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KULeuven, Leuven, Belgium; Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - R Jacobs
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KULeuven, Leuven, Belgium; Oral Facial Diagnostics and Surgery, Department of Dental Medicine, Karolinska Institute, Huddinge, Sweden
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28
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Masiero M, Lucchiari C, Mazzocco K, Veronesi G, Maisonneuve P, Jemos C, Salè EO, Spina S, Bertolotti R, Pravettoni G. E-cigarettes May Support Smokers With High Smoking-Related Risk Awareness to Stop Smoking in the Short Run: Preliminary Results by Randomized Controlled Trial. Nicotine Tob Res 2018; 21:119-126. [DOI: 10.1093/ntr/nty047] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 03/29/2018] [Indexed: 11/12/2022]
Affiliation(s)
- Marianna Masiero
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy
| | | | - Ketti Mazzocco
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy
| | - Giulia Veronesi
- Humanitas Research Hospital, Division of Thoracic and General Surgery, Milan, Italy
| | - Patrick Maisonneuve
- European Institute of Oncology, Division of Epidemiology and Biostatistics, Milan, Italy
| | - Costantino Jemos
- European Institute of Oncology, Division of Pharmacy, Milan, Italy
| | | | - Stefania Spina
- Humanitas Research Hospital, Division of Thoracic and General Surgery, Milan, Italy
| | | | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy
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29
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Perikleous EP, Steiropoulos P, Paraskakis E, Constantinidis TC, Nena E. E-Cigarette Use Among Adolescents: An Overview of the Literature and Future Perspectives. Front Public Health 2018; 6:86. [PMID: 29632856 PMCID: PMC5879739 DOI: 10.3389/fpubh.2018.00086] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 03/05/2018] [Indexed: 12/15/2022] Open
Abstract
Background Electronic cigarettes (e-cigarettes) are rapidly emerging into a new trend among adolescents, signaling a new époque, that of vapers. E-cigarettes are battery-powered nicotine delivery devices that heat a typically flavoring liquid solution into an aerosol mist that users inhale, allowing them to imitate the act of conventional smoking. There are concerns about the impact of e-cigarettes at both individual and public health level. Aim To discuss the characteristics of the most vulnerable, to become e-cigarette users, group of adolescents and to further highlight their behaviors and characteristics. Methods An electronic search in PubMed, EMBASE, and Google Scholar databases was conducted, using combinations of the following keywords: adolescents, teenagers, e-cigarettes, vaping. The search included all types of articles written in English until August 2017. A total of 100 articles were found, and 25 were finally included in the present review. Results Older age, male gender, conventional smokers, peer influence, daily smoking, and heavier smoking are the most common characteristics of adolescent e-cigarette users. Conclusion E-cigarette use is common, especially between certain subgroups in the adolescent population. Since e-cigarette use is increasing and considering that the long term health effects are still under investigation, targeted interventions towards more susceptible individuals may be an effective prevention strategy.
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Affiliation(s)
| | - Paschalis Steiropoulos
- Medical School, Democritus University of Thrace, Alexandroupolis, Greece.,Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Emmanouil Paraskakis
- Medical School, Democritus University of Thrace, Alexandroupolis, Greece.,Department of Pediatrics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Theodoros C Constantinidis
- Medical School, Democritus University of Thrace, Alexandroupolis, Greece.,Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Evangelia Nena
- Medical School, Democritus University of Thrace, Alexandroupolis, Greece.,Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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30
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Ruprecht AA, De Marco C, Pozzi P, Munarini E, Mazza R, Angellotti G, Turla F, Boffi R. Comparison between Particulate Matter and Ultrafine Particle Emission by Electronic and Normal Cigarettes in Real-life Conditions. TUMORI JOURNAL 2018. [DOI: 10.1177/1430.15833] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ario Alberto Ruprecht
- Tobacco Control Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
- SIMG (Società Italiana di Medicina Generale), Sondrio
| | - Cinzia De Marco
- Tobacco Control Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Paolo Pozzi
- Tobacco Control Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Elena Munarini
- Tobacco Control Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Roberto Mazza
- Tobacco Control Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
- Patient Information Service, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giorgia Angellotti
- Tobacco Control Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Francesca Turla
- Tobacco Control Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Roberto Boffi
- Tobacco Control Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
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31
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Kaur G, Pinkston R, Mclemore B, Dorsey WC, Batra S. Immunological and toxicological risk assessment of e-cigarettes. Eur Respir Rev 2018; 27:27/147/170119. [PMID: 29491036 DOI: 10.1183/16000617.0119-2017] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 12/13/2017] [Indexed: 11/05/2022] Open
Abstract
Knowledge of the long-term toxicological and immunological effects of e-cigarette (e-cig) aerosols remains elusive due to the relatively short existence of vaping. Therefore, we performed a systematic search of articles published in public databases and analysed the research evidence in order to provide critical information regarding e-cig safety. Electronic nicotine delivery systems (or e-cigs) are an alternative to traditional cigarettes for the delivery of nicotine and are typically filled with glycerol or propylene glycol-based solutions known as e-liquids. Though present in lower quantities, e-cig aerosols are known to contain many of the harmful chemicals found in tobacco smoke. However, due to the paucity of experimental data and contradictory evidence, it is difficult to draw conclusive outcomes regarding toxicological, immunological and clinical impacts of e-cig aerosols. Excessive vaping has been reported to induce inflammatory responses including mitogen-activated protein kinase, Janus tyrosine kinase/signal transducer and activator of transcription and nuclear factor-κB signalling, similar to that induced by tobacco smoke. Based on recent evidence, prolonged exposure to some constituents of e-cig aerosols might result in respiratory complications such as asthma, chronic obstructive pulmonary disease and inflammation. Future studies are warranted that focus on establishing correlations between e-cig types, generations and e-liquid flavours and immunological and toxicological profiles to broaden our understanding about the effects of vaping.
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Affiliation(s)
- Gagandeep Kaur
- Laboratory of Pulmonary Immuno-toxicology, Dept of Environmental Toxicology, Health Research Center, College of Sciences and Engineering, Southern University and A&M College, Baton Rouge, LA, USA.,Both authors contributed equally
| | - Rakeysha Pinkston
- Laboratory of Pulmonary Immuno-toxicology, Dept of Environmental Toxicology, Health Research Center, College of Sciences and Engineering, Southern University and A&M College, Baton Rouge, LA, USA.,Both authors contributed equally
| | - Benathel Mclemore
- Laboratory of Pulmonary Immuno-toxicology, Dept of Environmental Toxicology, Health Research Center, College of Sciences and Engineering, Southern University and A&M College, Baton Rouge, LA, USA
| | - Waneene C Dorsey
- Dept of Biological Sciences, College of Arts and Sciences, Grambling State University, Grambling, LA, USA
| | - Sanjay Batra
- Laboratory of Pulmonary Immuno-toxicology, Dept of Environmental Toxicology, Health Research Center, College of Sciences and Engineering, Southern University and A&M College, Baton Rouge, LA, USA
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32
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Wei B, Goniewicz ML, O'Connor RJ, Travers MJ, Hyland AJ. Urinary Metabolite Levels of Flame Retardants in Electronic Cigarette Users: A Study Using the Data from NHANES 2013-2014. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15020201. [PMID: 29370113 PMCID: PMC5858270 DOI: 10.3390/ijerph15020201] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/22/2018] [Accepted: 01/22/2018] [Indexed: 11/16/2022]
Abstract
Evaluating the safety of e-cigarettes and making informed judgement about developing potential standards require sufficient scientific evidence. Since e-cigarettes are highly engineered products containing plastic, glass and metal parts, and e-liquids are largely different matrices, many toxic compounds which are not typical hazards for the users of combustible tobacco products (e.g., cigarettes), could exist in e-liquids, and consequently, posing potential health risk to e-cigarette users. We combined the measurements of urinary metabolites of organophosphate flame retardants (OPFRs) with questionnaire data collected in the National Health and Nutrition Examination Surveys (NHANES) from 2013 to 2014, and we compared adjusted geometric means (GM) for each biomarker in e-cigarette users with levels in non-users and users of various tobacco products using multiple regression analyses to adjust for potential confounders. We found diphenyl phosphate (DPhP), bis(1,3-dichloro-2-propyl) phosphate (BDCPP), bis(2-chloroethyl) phosphate (BCEP), and dibutyl phosphate (DBUP) were detected in all e-cigarette users. The adjusted GM of BCEP, the metabolite of tris(2-chloroethyl) phosphate (TCEP), was 81% higher than nonusers (p = 0.0124) and significantly higher than those for both cigarette and cigar users (p < 0.05). The findings in this pilot study suggest that certain OPFRs may present in e-cigarettes as contaminants, and consequently, resulting in higher exposure levels in e-cigarette users compared to nonusers. As we only identified 14 e-cigarette users in the survey, the findings in this study need to be confirmed in future study at a larger scale. A better examination of the types and levels of FRs and their potential contamination sources in e-cigarettes is also needed.
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Affiliation(s)
- Binnian Wei
- Roswell Park Comprehensive Cancer Center, Department of Health Behavior, Elm and Carlton Streets, Buffalo, NY 14263, USA.
| | - Maciej L Goniewicz
- Roswell Park Comprehensive Cancer Center, Department of Health Behavior, Elm and Carlton Streets, Buffalo, NY 14263, USA.
| | - Richard J O'Connor
- Roswell Park Comprehensive Cancer Center, Department of Health Behavior, Elm and Carlton Streets, Buffalo, NY 14263, USA.
| | - Mark J Travers
- Roswell Park Comprehensive Cancer Center, Department of Health Behavior, Elm and Carlton Streets, Buffalo, NY 14263, USA.
| | - Andrew J Hyland
- Roswell Park Comprehensive Cancer Center, Department of Health Behavior, Elm and Carlton Streets, Buffalo, NY 14263, USA.
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33
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King AC, Smith LJ, McNamara PJ, Cao D. Second Generation Electronic Nicotine Delivery System Vape Pen Exposure Generalizes as a Smoking Cue. Nicotine Tob Res 2018; 20:246-252. [PMID: 28082323 PMCID: PMC7207065 DOI: 10.1093/ntr/ntw327] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 01/03/2017] [Indexed: 11/17/2022]
Abstract
Introduction Second generation electronic nicotine delivery systems (ENDS; also known as e-cigarettes, vaporizers or vape pens) are designed for a customized nicotine delivery experience and have less resemblance to regular cigarettes than first generation "cigalikes." The present study examined whether they generalize as a conditioned cue and evoke smoking urges or behavior in persons exposed to their use. Methods Data were analyzed in N = 108 young adult smokers (≥5 cigarettes per week) randomized to either a traditional combustible cigarette smoking cue or a second generation ENDS vaping cue in a controlled laboratory setting. Cigarette and e-cigarette urge and desire were assessed pre- and post-cue exposure. Smoking behavior was also explored in a subsample undergoing a smoking latency phase after cue exposure (N = 26). Results The ENDS vape pen cue evoked both urge and desire for a regular cigarette to a similar extent as that produced by the combustible cigarette cue. Both cues produced similar time to initiate smoking during the smoking latency phase. The ENDS vape pen cue elicited smoking urge and desire regardless of ENDS use history, that is, across ENDS naїve, lifetime or current users. Inclusion of past ENDS or cigarette use as covariates did not significantly alter the results. Conclusions These findings demonstrate that observation of vape pen ENDS use generalizes as a conditioned cue to produce smoking urge, desire, and behavior in young adult smokers. As the popularity of these devices may eventually overtake those of first generation ENDS cigalikes, exposure effects will be of increasing importance. Implications This study shows that passive exposure to a second generation ENDS vape pen cue evoked smoking urge, desire, and behavior across a range of daily and non-daily young adult smokers. Smoking urge and desire increases after vape pen exposure were similar to those produced by exposure to a first generation ENDS cigalike and a combustible cigarette, a known potent cue. Given the increasing popularity of ENDS tank system products, passive exposures to these devices will no doubt increase, and may contribute to tobacco use in young adult smokers.
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Affiliation(s)
- Andrea C King
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago IL
| | - Lia J Smith
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago IL
| | - Patrick J McNamara
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago IL
| | - Dingcai Cao
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago IL
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34
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Berg CJ, Haardörfer R, Wagener TL, Kegler MC, Windle M. Correlates of Allowing Alternative Tobacco Product or Marijuana Use in the Homes of Young Adults. Pediatrics 2018; 141:S10-S20. [PMID: 29292302 PMCID: PMC5884091 DOI: 10.1542/peds.2017-1026e] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Given the increases in alternative tobacco product (ATP) and marijuana use, we examined self-reported likelihood of allowing ATP and marijuana use in the home among young adults. METHODS We analyzed data from a study of students aged 18 to 25 years (n = 2865) at 7 Georgia colleges and universities. Variables included: personal, household members', and friends' tobacco (cigarettes, little cigars and cigarillos [LCCs], e-cigarettes, hookah) and marijuana use and the perceived harm to health, harm of byproducts, addictiveness, and social acceptability of each. Regression models were specified to examine correlates of the likelihood of allowing use of each product in the home. RESULTS Personal use prevalence ranged from 5.5% for e-cigarettes to 12.5% for marijuana. E-cigarettes were most likely to be allowed in the home; cigarettes were least. Regression indicated that others' use and the perceived social acceptability of using each product was correlated with greater likelihood of allowing the use of a product. A greater likelihood of allowing cigarette and LCC use in the home was only associated with cigarette or LCC use, respectively; a greater likelihood of allowing e-cigarette use was associated with current e-cigarette use; greater likelihood of allowing hookah use was associated with using any product except e-cigarettes; and greater likelihood of allowing marijuana use was associated with LCC and marijuana use. Perceived harm to health, byproduct harms, and addictiveness were differentially related to the likelihood of allowing use of different products. CONCLUSIONS ATPs and marijuana may undermine efforts to protect against environmental toxins in the home, thus warranting interventions targeting young adults.
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Affiliation(s)
- Carla J. Berg
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia; and,Address correspondence to Carla J. Berg, PhD, Department of Behavioral Sciences and Health Education, Emory University School of Public Health, 1518 Clifton Rd NE, Room 524, Atlanta, GA 30322. E-mail:
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia; and
| | - Theodore L. Wagener
- Department of Pediatrics and Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, University of Oklahoma, Oklahoma City, Oklahoma
| | - Michelle C. Kegler
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia; and
| | - Michael Windle
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia; and
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Jin P, Jiang JY. E-cigarettes in ten Southeast Asian countries: a comparison of national regulations. GLOBAL HEALTH JOURNAL 2017. [DOI: 10.1016/s2414-6447(19)30097-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Barhdadi S, Canfyn M, Courselle P, Rogiers V, Vanhaecke T, Deconinck E. Development and validation of a HS/GC–MS method for the simultaneous analysis of diacetyl and acetylpropionyl in electronic cigarette refills. J Pharm Biomed Anal 2017; 142:218-224. [DOI: 10.1016/j.jpba.2017.04.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 04/27/2017] [Accepted: 04/29/2017] [Indexed: 10/19/2022]
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Zheng Y, Zhen C, Dench D, Nonnemaker JM. U.S. Demand for Tobacco Products in a System Framework. HEALTH ECONOMICS 2017; 26:1067-1086. [PMID: 27402419 DOI: 10.1002/hec.3384] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 11/27/2015] [Accepted: 06/13/2016] [Indexed: 06/06/2023]
Abstract
This study estimated a system of demand for cigarettes, little cigars/cigarillos, large cigars, e-cigarettes, smokeless tobacco, and loose smoking tobacco using market-level scanner data for convenience stores. We found that the unconditional own-price elasticities for the six categories are -1.188, -1.428, -1.501, -2.054, -0.532, and -1.678, respectively. Several price substitute (e.g., cigarettes and e-cigarettes) and complement (e.g., cigarettes and smokeless tobacco) relationships were identified. Magazine and television advertising increased demand for e-cigarettes, and magazine advertising increased demand for smokeless tobacco and had spillover effects on demand for other tobacco products. We also reported the elasticities by U.S. census regions and market size. These results may have important policy implications, especially viewed in the context of the rise of electronic cigarettes and the potential for harm reduction if combustible tobacco users switch to non-combustible tobacco products. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Yuqing Zheng
- University of Kentucky, Department of Agricultural Economics, Lexington, KY, USA
| | - Chen Zhen
- University of Georgia, Department of Agricultural and Applied Economics, Athens, GA, USA
| | - Daniel Dench
- City University of New York Graduate Center, New York City, NY, USA
| | - James M Nonnemaker
- RTI International, Public Health Research Division, Research Triangle Park, NC, USA
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Marynak KL, Gammon DG, King BA, Loomis BR, Fulmer EB, Wang TW, Rogers T. National and State Trends in Sales of Cigarettes and E-Cigarettes, U.S., 2011-2015. Am J Prev Med 2017; 53:96-101. [PMID: 28285828 PMCID: PMC5559880 DOI: 10.1016/j.amepre.2017.01.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 11/30/2016] [Accepted: 01/09/2017] [Indexed: 10/20/2022]
Abstract
INTRODUCTION In recent years, self-reported cigarette smoking has declined among youth and adults, while electronic cigarette (e-cigarette) use has increased. However, sales trends for these products are less certain. This study assessed national and state patterns of U.S. cigarette and e-cigarette unit sales. METHODS Trends in cigarette and e-cigarette unit sales were analyzed using retail scanner data from September 25, 2011 through January 9, 2016 for: (1) convenience stores; and (2) all other outlets combined, including supermarkets, mass merchandisers, drug, dollar, and club stores, and military commissaries (online, tobacco-only, and "vape" shops were not available). Data by store type were available for the total contiguous U.S. and 29 states; combined data were available for the remaining states, except Alaska, Hawaii, and DC. RESULTS During 2011-2015, cigarette sales exhibited a small, significant decrease; however, positive year-over-year growth occurred in convenience stores throughout most of 2015. E-cigarette unit sales significantly increased during 2011-2015, but year-over-year growth slowed and was occasionally negative. Cigarette unit sales exceeded e-cigarettes by 64:1 during the last 4-week period. During 2014-2015, cigarette sales increases occurred in 15 of 48 assessed states; e-cigarette sales increased in 18 states. CONCLUSIONS Despite overall declines during 2011-2015, cigarette sales in 2015 grew for the first time in a decade. E-cigarette sales growth was positive, but slowed over the study period in assessed stores. Cigarette sales continued to exceed e-cigarette sales, reinforcing the importance of efforts to reduce the appeal and accessibility of cigarettes and other combusted tobacco products.
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Affiliation(s)
- Kristy L Marynak
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Doris G Gammon
- Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, North Carolina
| | - Brian A King
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brett R Loomis
- Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, North Carolina
| | - Erika B Fulmer
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Teresa W Wang
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Todd Rogers
- Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, North Carolina
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Abstract
OBJECTIVES Despite extensive research into the determinants of electronic nicotine delivery system (ENDS) uptake, few studies have examined the psychosocial benefits ENDS users seek and experience. Using a consumer ritual framework, we explored how ENDS users recreated or replaced smoking practices, and considered implications for smoking cessation. DESIGN In-depth interviews; data analysed using thematic analysis. SETTING Dunedin, New Zealand. PARTICIPANTS 16 young adult ENDS users (age M=21.4, SD=1.9; 44% female). RESULTS Participants reported using different ENDS to achieve varying outcomes. Some used 'cigalikes' to recreate a physically and visually similar experience to smoking; they privileged device appearance over nicotine delivery. In contrast, others used personally crafted mods to develop new rituals that differentiated them from smokers and showcased their technical expertise. Irrespective of the device they used, several former smokers and dual users of cigarettes and ENDS experienced strong nostalgia for smoking attributes, particularly the elemental appeal of fire and the finiteness of a cigarette. Non-smoking participants used ENDS to maintain social connections with their peers. CONCLUSIONS Participants used ENDS to construct rituals that recreated or replaced smoking attributes, and that varied in the emphasis given to device appearance, nicotine delivery, and social performance. Identifying how ENDS users create new rituals and the components they privilege within these could help promote full transition from smoking to ENDS and identify those at greatest risk of dual use or relapse to cigarette smoking.
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Affiliation(s)
- Janet Hoek
- Department of Marketing, University of Otago, Dunedin, New Zealand
| | - Johannes Thrul
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California, USA
| | - Pamela Ling
- Center for Tobacco Control Research and Education and Division of General Internal Medicine, University of California San Francisco, San Francisco, California, USA
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Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, de Ferranti SD, Floyd J, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Mackey RH, Matsushita K, Mozaffarian D, Mussolino ME, Nasir K, Neumar RW, Palaniappan L, Pandey DK, Thiagarajan RR, Reeves MJ, Ritchey M, Rodriguez CJ, Roth GA, Rosamond WD, Sasson C, Towfighi A, Tsao CW, Turner MB, Virani SS, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation 2017; 135:e146-e603. [PMID: 28122885 PMCID: PMC5408160 DOI: 10.1161/cir.0000000000000485] [Citation(s) in RCA: 6014] [Impact Index Per Article: 859.1] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Freeman B. Is public health regulation the biggest factor influencing the use and uptake of vaporized nicotine products? Addiction 2017; 112:19-21. [PMID: 27444394 DOI: 10.1111/add.13446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 05/03/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Becky Freeman
- Prevention Research Collaboration, School of Public Health, Charles Perkins Centre, University of Sydney, Sydney, Australia
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Elhefny RA, Ali MA, Elessawy AF, El-Rab EG. Are we with e-cigarette as a friend or against it as a foe? THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2016. [DOI: 10.4103/1687-8426.193630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Leigh NJ, Lawton RI, Hershberger PA, Goniewicz ML. Flavourings significantly affect inhalation toxicity of aerosol generated from electronic nicotine delivery systems (ENDS). Tob Control 2016; 25:ii81-ii87. [PMID: 27633767 PMCID: PMC5784427 DOI: 10.1136/tobaccocontrol-2016-053205] [Citation(s) in RCA: 178] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 08/15/2016] [Accepted: 08/16/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND E-cigarettes or electronic nicotine delivery systems (ENDS) are designed to deliver nicotine-containing aerosol via inhalation. Little is known about the health effects of flavoured ENDS aerosol when inhaled. METHODS Aerosol from ENDS was generated using a smoking machine. Various types of ENDS devices or a tank system prefilled with liquids of different flavours, nicotine carrier, variable nicotine concentrations and with modified battery output voltage were tested. A convenience sample of commercial fluids with flavour names of tobacco, piña colada, menthol, coffee and strawberry were used. Flavouring chemicals were identified using gas chromatography/mass spectrometry. H292 human bronchial epithelial cells were directly exposed to 55 puffs of freshly generated ENDS aerosol, tobacco smoke or air (controls) using an air-liquid interface system and the Health Canada intense smoking protocol. The following in vitro toxicological effects were assessed: (1) cell viability, (2) metabolic activity and (3) release of inflammatory mediators (cytokines). RESULTS Exposure to ENDS aerosol resulted in decreased metabolic activity and cell viability and increased release of interleukin (IL)-1β, IL-6, IL-10, CXCL1, CXCL2 and CXCL10 compared to air controls. Cell viability and metabolic activity were more adversely affected by conventional cigarettes than most tested ENDS products. Product type, battery output voltage and flavours significantly affected toxicity of ENDS aerosol, with a strawberry-flavoured product being the most cytotoxic. CONCLUSIONS Our data suggest that characteristics of ENDS products, including flavours, may induce inhalation toxicity. Therefore, ENDS users should use the products with caution until more comprehensive studies are performed.
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Affiliation(s)
- Noel J. Leigh
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Ralph I. Lawton
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Pamela A. Hershberger
- Department of Pharmacology and Therapeutics, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Maciej L. Goniewicz
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY, USA
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Shi Y, Pierce JP, White M, Vijayaraghavan M, Compton W, Conway K, Hartman AM, Messer K. E-cigarette use and smoking reduction or cessation in the 2010/2011 TUS-CPS longitudinal cohort. BMC Public Health 2016; 16:1105. [PMID: 27769302 PMCID: PMC5073733 DOI: 10.1186/s12889-016-3770-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 10/13/2016] [Indexed: 11/10/2022] Open
Abstract
Background Electronic cigarettes (e-cigarettes) are heavily marketed and widely perceived as helpful for quitting or reducing smoking intensity. We test whether ever-use of e-cigarettes among early adopters was associated with: 1) increased cigarette smoking cessation; and 2) reduced cigarette consumption. Methods A representative cohort of U.S. smokers (N = 2454) from the 2010 Tobacco Use Supplement to the Current Population Survey (TUS-CPS) was re-interviewed 1 year later. Outcomes were smoking cessation for 30+ days and change in cigarette consumption at follow-up. E-cigarettes use was categorized as for cessation purposes or for another reason. Multivariate regression was used to adjust for demographics and baseline cigarette dependence level. Results In 2011, an estimated 12 % of adult U.S. smokers had ever used e-cigarettes, and 41 % of these reported use to help quit smoking. Smokers who had used e-cigarettes for cessation were less likely to be quit for 30+ days at follow-up, compared to never-users who tried to quit (11.1 % vs 21.6 %; ORadj = 0.44, 95 % CI = 0.2–0.8). Among heavier smokers at baseline (15+ cigarettes per day (CPD)), ever-use of e-cigarettes was not associated with change in smoking consumption. Lighter smokers (<15 CPD) who had ever used e-cigarettes for quitting had stable consumption, while increased consumption was observed among all other lighter smokers, although this difference was not statistically significant. Conclusions Among early adopters, ever-use of first generation e-cigarettes to aid quitting cigarette smoking was not associated with improved cessation or with reduced consumption, even among heavier smokers.
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Affiliation(s)
- Yuyan Shi
- Cancer Prevention and Control Program, Moores UC San Diego Cancer Center, 3855 Health Sciences Drive #0901, La Jolla, CA, 92093-0901, USA.,Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive #0628, La Jolla, CA, 92093-0628, USA
| | - John P Pierce
- Cancer Prevention and Control Program, Moores UC San Diego Cancer Center, 3855 Health Sciences Drive #0901, La Jolla, CA, 92093-0901, USA.,Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive #0628, La Jolla, CA, 92093-0628, USA
| | - Martha White
- Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive #0628, La Jolla, CA, 92093-0628, USA
| | - Maya Vijayaraghavan
- Division of General Internal Medicine/San Francisco General Hospital, University of California, San Francisco, 1545 Divisadero St, San Francisco, CA, 94115, USA
| | - Wilson Compton
- National Institute on Drug Abuse, National Institutes of Health, 6001 Executive Boulevard, Bethesda, MD, 20892-9589, USA
| | - Kevin Conway
- National Institute on Drug Abuse, National Institutes of Health, 6001 Executive Boulevard, Bethesda, MD, 20892-9589, USA
| | - Anne M Hartman
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA
| | - Karen Messer
- Cancer Prevention and Control Program, Moores UC San Diego Cancer Center, 3855 Health Sciences Drive #0901, La Jolla, CA, 92093-0901, USA. .,Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive #0628, La Jolla, CA, 92093-0628, USA.
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Czoli CD, Fong GT, Mays D, Hammond D. How do consumers perceive differences in risk across nicotine products? A review of relative risk perceptions across smokeless tobacco, e-cigarettes, nicotine replacement therapy and combustible cigarettes. Tob Control 2016; 26:e49-e58. [DOI: 10.1136/tobaccocontrol-2016-053060] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 08/05/2016] [Accepted: 08/10/2016] [Indexed: 11/03/2022]
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Berg CJ, Haardörfer R, Schauer G, Betelihem G, Masters M, McDonald B, Shah J, Payne J, Sarmah R, Thomas M, Windle M. Reasons for Polytobacco Use among Young Adults: Scale Development and Validation. Tob Prev Cessat 2016; 2. [PMID: 28111637 PMCID: PMC5242507 DOI: 10.18332/tpc/64238] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Limited research has examined reasons for polytobacco use, an increasing public health problem, particularly among young adults. We examined reasons for polytobacco use among users of more than one tobacco product in the past 4 months enrolled in an ongoing six-wave longitudinal study of 3,418 students aged 18-25 from seven US colleges and universities. METHODS An expert panel generated items related to reasons for polytobacco use, included in Wave 3 (administered in Summer 2015). Participants reporting use of more than one tobacco product in the past four months (n=540) were asked to complete the Reasons for Polytobacco Use scale and measures related to tobacco/nicotine use/dependence, use motives, perceptions of tobacco, parental/friend use, other substance use, and mental health. We conducted a factor analysis and then examined convergent and discriminant validity for the derived factors. RESULTS Our sample was an average age of 20.40 (SD=1.84), 48.0% male, and 21.9% Black. Four factors were identified: Instrumentality, Social Context, Displacement, and Experimentation. Instrumentality was the only factor associated with little cigar/cigarillo and marijuana use. Displacement and Social Context showed similar associations; however, Social Context was associated with having friends who used tobacco while Displacement was not. Experimentation was associated with greater perceived addictiveness and harm of using tobacco products as well as greater perceived social acceptability of tobacco use. CONCLUSIONS Each of the four factors identified demonstrated unique convergent and discriminant validity. The use of this scale to characterize polytobacco using young adults may help inform and target cessation or prevention interventions.
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Affiliation(s)
- Carla J Berg
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322
| | - Gillian Schauer
- Battelle Public Health Center for Tobacco Research, 1100 Dexter Avenue North, Suite 400 Seattle, WA 98109-3598
| | - Getachew Betelihem
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322
| | - Matthew Masters
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322
| | - Bennett McDonald
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322
| | - Jill Shah
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322
| | - Jackelyn Payne
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322
| | - Raina Sarmah
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322
| | - Matthew Thomas
- ICF Macro, 1725 I (Eye) Street NW, 10th Floor, International, Washington, DC 20006
| | - Michael Windle
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322
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Abstract
OBJECTIVES Given the increasing trend in use of electronic cigarettes ("e-cigarettes") among youth, it is crucial to understand how these products are perceived and how these perceptions are associated with their decision whether or not to use them. METHODS This is a cross-sectional analysis of data from a rapid response surveillance system of 6th, 8th and 10th grade students' tobacco use behaviors (sample [n] = 3704 from a population of students [N] = 434,601). We used weighted logistic regression models to investigate the relationship between perceptions of harm and addictiveness and e-cigarette use, including the use of flavored and non-flavored e-cigarettes. RESULTS Compared to youth who did not use e-cigarettes, ever and current e-cigarette users had higher odds of reporting that e-cigarettes were "not at all harmful" to health and "not at all addictive." Ever and current e-cigarette users had higher odds of reporting that flavored e-cigarettes were "less harmful" than non-flavored e-cigarettes, compared to youth who did not use e-cigarettes. CONCLUSIONS These findings warrant attention given that nicotine is an addictive substance whose effects on the adolescent brain are potentially negative. Youth e-cigarette users perceived lower harm from flavored e-cigarettes, which is worrisome given emerging research documenting harmful constituents in certain e-cigarette flavorings.
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Filippidis FT, Laverty AA, Gerovasili V, Vardavas CI. Two-year trends and predictors of e-cigarette use in 27 European Union member states. Tob Control 2016; 26:98-104. [PMID: 27220621 PMCID: PMC5256312 DOI: 10.1136/tobaccocontrol-2015-052771] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 02/03/2016] [Accepted: 02/05/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE This study assessed changes in levels of ever use, perceptions of harm from e-cigarettes and sociodemographic correlates of use among European Union (EU) adults during 2012-2014, as well as determinants of current use in 2014. METHODS We analysed data from the 2012 (n=26 751) and 2014 (n=26 792) waves of the adult Special Eurobarometer for Tobacco survey. Point prevalence of current and ever use was calculated and logistic regression assessed correlates of current use and changes in ever use, and perception of harm. Correlates examined included age, gender, tobacco smoking, education, area of residence, difficulties in paying bills and reasons for trying an e-cigarette. RESULTS The prevalence of ever use of e-cigarettes increased from 7.2% in 2012 to 11.6% in 2014 (adjusted OR (aOR)=1.91). EU-wide coefficient of variation in ever e-cigarette use was 42.1% in 2012 and 33.4% in 2014. The perception that e-cigarettes are harmful increased from 27.1% in 2012 to 51.6% in 2014 (aOR=2.99), but there were major differences in prevalence and trends between member states. Among those who reported that they had ever tried an e-cigarette in the 2014 survey, 15.3% defined themselves as current users. Those who tried an e-cigarette to quit smoking were more likely to be current users (aOR=2.82). CONCLUSIONS Ever use of e-cigarettes increased during 2012-2014. People who started using e-cigarettes to quit smoking tobacco were more likely to be current users, but the trends vary by country. These findings underscore the need for more research into factors influencing e-cigarette use and its potential benefits and harms.
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Affiliation(s)
- Filippos T Filippidis
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Anthony A Laverty
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Vasiliki Gerovasili
- Department of Ergospirometry and Rehabilitation, Medical School, University of Athens, Athens, Greece
| | - Constantine I Vardavas
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
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Merianos AL, Gittens OE, Mahabee-Gittens EM. Depiction of Health Effects of Electronic Cigarettes on YouTube. JOURNAL OF SUBSTANCE USE 2016; 21:614-619. [PMID: 28217030 DOI: 10.3109/14659891.2015.1118565] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND This study was conducted to assess the quantity, quality, and reach of e-cigarette health effects YouTube videos, and to quantify the description of positive and negative e-cigarette health effects and promotional content in each video. METHOD Searches for videos were conducted in 2015 using the YouTube search engine, and the top 20 search results by relevance and view count were identified. Videos were classified by educational/medical news, advertising/marketing, and personal/testimonial categories. A coding sheet was used to assess the presence or absence of negative and positive health effects, and promotional content. RESULTS Of the 320 videos retrieved, only 55 unique videos were included. The majority of videos (46.9%) were educational/medical/news, 29.7% were personal/testimonial, and 23.4% were advertising/marketing. The three most common negative health effects included discussing nicotine, e-cigarettes not being FDA regulated, and known and unknown health consequences related to e-cigarette use. The top positive health effects discussed were how e-cigarettes can help individuals quit smoking, e-cigarettes are healthier than smoking, and e-cigarettes have no smoke or secondhand smoke exposure. CONCLUSIONS It is critical to monitor YouTube health effects content and develop appropriate messages to inform consumers about the risks associated with use while mitigating misleading information presented.
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Affiliation(s)
| | | | - E Melinda Mahabee-Gittens
- Division of Emergency Medicine; Department of Pediatrics; Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Gallart-Mateu D, Elbal L, Armenta S, de la Guardia M. Passive exposure to nicotine from e-cigarettes. Talanta 2016; 152:329-34. [DOI: 10.1016/j.talanta.2016.02.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 01/29/2016] [Accepted: 02/02/2016] [Indexed: 10/22/2022]
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