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Edwards KC, St Helen G, Jacob P, Ozga JE, Stanton CA. Urinary anatalline and nicotelline cut-points to distinguish between exclusive and dual use of tobacco products. Biomarkers 2024:1-9. [PMID: 39105562 DOI: 10.1080/1354750x.2024.2389047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 07/31/2024] [Indexed: 08/07/2024]
Abstract
OBJECTIVE This study measured anatalline and nicotelline, two minor tobacco alkaloids, to discriminate between exclusive smokeless tobacco (SLT) use, exclusive electronic nicotine delivery systems (ENDS) use, exclusive cigarette use, dual SLT and cigarette use, and dual ENDS and cigarette use. METHODS N = 664 urine samples from participants in the Population Assessment of Tobacco and Health Study were analyzed for anatalline and nicotelline. Geometric means and 95% confidence intervals were calculated for biomarker levels and their ratios. Non-parametric Receiver Operating Characteristic analyses were used to determine optimal cut-points of natural log-transformed biomarker ratios for distinguishing between tobacco use groups. RESULTS The anatalline/nicotelline ratio distinguished exclusive cigarette from exclusive SLT use (threshold = 18.1, sensitivity = 89.3%, specificity = 86.4%, AUC = 0.90), and exclusive SLT from exclusive ENDS use (threshold = 12.8, sensitivity = 96.4%, specificity = 76.3%, AUC = 0.90) very well, but had reduced sensitivity and specificity when distinguishing exclusive cigarette from exclusive ENDS or any dual use with cigarettes. CONCLUSIONS This research fills a gap in understanding the public health consequences of SLT and ENDS use by providing objective measures that can signal use of these products alone or in combination with cigarettes.
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Affiliation(s)
| | - Gideon St Helen
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Peyton Jacob
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Jenny E Ozga
- Behavioral Health and Health Policy, Westat, Rockville, MD, USA
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Yoon W, Seo HG, Lee S, Lee ES, Xu SS, Meng G, Quah ACK, Fong GT, Lim S, Kim GY, Kim SY, Cho SI. Reasons for using e-cigarettes among adults who smoke: comparing the findings from the 2016 and 2020 ITC Korea Surveys. Tob Control 2024:tc-2023-058506. [PMID: 38879182 DOI: 10.1136/tc-2023-058506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 05/19/2024] [Indexed: 07/03/2024]
Abstract
INTRODUCTION Dual use of e-cigarettes and cigarettes is a growing usage pattern in adults, but little is known about the motivations underlying this trend. We investigated the reasons for e-cigarette use among adults who smoke, considering variation in sociodemographic subgroups. METHODS This repeated cross-sectional study analysed adults who smoked at least weekly and vaped at any frequency. Data were from the International Tobacco Control Korea Surveys conducted in 2016 (n=164) and 2020 (n=1088). Fourteen reasons for e-cigarette use were assessed in both waves. Subgroup analyses were performed by age, sex and educational level. RESULTS The top reasons for e-cigarette use in 2020 were curiosity (62.8%), less harmful than smoking (45.4%) and taste (43.2%). Curiosity was the most cited across age, sex and education subgroups. Significant differences were observed in 2020 compared with 2016, with lower percentages in goal-oriented reasons: helping quit smoking (36.3% vs 48.9%; p=0.017), helping cut down smoking (35.3% vs 52.7%; p=0.001), less harmful to others (39.0% vs 54.6%; p=0.003) and more acceptable (31.6% vs 61.2%; p<0.001). By contrast, non-goal-oriented reasons showed higher percentages in 2020, such as curiosity (62.8% vs 27.9%; p<0.001), taste (43.2% vs 22.1%; p<0.001) and enjoyment (26.8% vs 8.6%; p<0.001). In 2020, a majority of adults who smoked and vaped (53.3%) reported no intention to quit or reduce smoking. CONCLUSIONS E-cigarette use for curiosity and pleasure predominated among adults who smoked. The reasons for dual use in adults have shifted from goal-oriented to non-goal-oriented.
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Affiliation(s)
- Wonjeong Yoon
- Department of Public Health Science, Seoul National University Graduate School of Public Health, Seoul, Korea
| | - Hong Gwan Seo
- Department of Family Medicine, National Cancer Center, Goyang, Korea
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Sungkyu Lee
- Korea Center for Tobacco Control Research and Education, Seoul, Korea
| | - Eon Sook Lee
- Department of Family Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Steve S Xu
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Gang Meng
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Anne C K Quah
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Sujin Lim
- National Tobacco Control Center, Korean Health Promotion Institute, Seoul, Korea
| | - Gil-Yong Kim
- National Tobacco Control Center, Korean Health Promotion Institute, Seoul, Korea
| | - Su Young Kim
- National Tobacco Control Center, Korean Health Promotion Institute, Seoul, Korea
| | - Sung-Il Cho
- Department of Public Health Science, Seoul National University Graduate School of Public Health, Seoul, Korea
- Seoul National University Institute of Health and Environment, Seoul, Korea
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Batista DR, Coelho LS, Tanni SE, de Godoy I. Metal in biological samples from electronic cigarette users and those exposed to their second-hand aerosol: a narrative review. Front Med (Lausanne) 2024; 11:1349475. [PMID: 38841573 PMCID: PMC11150601 DOI: 10.3389/fmed.2024.1349475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 05/07/2024] [Indexed: 06/07/2024] Open
Abstract
Introduction Electronic nicotine delivery systems (ENDS) are gradually becoming more popular, particularly, among today's youth. Despite being marketed as safe by the tobacco industry, the notable absence of regulation in their composition is evident. Both the generated fluids and aerosol exhibit a wide variety of substances that are not yet fully identified. In addition to additives, the aerosol contains metals, the presence of which can be attributed to the excessive heating of metallic filaments used in vaporizing the liquid. Objective This review aimed to identify and describe studies that have assessed metal levels in biological samples obtained from electronic cigarette users and those exposed to their second-hand aerosol. This involved detailing the types and concentrations of metals identified and the biological samples in which the metals were detected. Methods Two independent researchers conducted searches in the MEDLINE and EMBASE databases to identify studies that measured the metal levels in human non-invasive biological samples from electronic cigarette users and second-hand exposure. Data were presented as a narrative review. Results In total, 18 articles were included in this review. Overall active and passive exposure to ENDS was related to higher levels of many metals, including lead and cadmium, in biological samples. ENDS users, in general, have lower metal concentrations in biological samples compared to the users of combustible cigarettes. Conclusion The exposure to primary and second-hand e-cigarette aerosol is related to higher metal concentrations in the biological samples. The adverse effects of this exposure on long-term users are yet to be determined.
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Affiliation(s)
- Diane Rezende Batista
- São Paulo State University (Unesp), Medical School, Botucatu, Department of Internal Medicine, Pulmonology Division, São Paulo, Brazil
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4
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Feng L, Huang G, Peng L, Liang R, Deng D, Zhang S, Li G, Wu S. Comparison of bladder carcinogenesis biomarkers in the urine of traditional cigarette users and e-cigarette users. Front Public Health 2024; 12:1385628. [PMID: 38716244 PMCID: PMC11075070 DOI: 10.3389/fpubh.2024.1385628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/08/2024] [Indexed: 05/24/2024] Open
Abstract
Background During the use of electronic cigarettes (e-cigarettes), users are still exposed to carcinogens similar to those found in tobacco products. Since these carcinogens are metabolized and excreted in urine, they may have carcinogenic effects on the bladder urinary tract epithelium. This meta-analysis aimed to compare bladder cancer carcinogens in the urine of tobacco users and e-cigarette users using a large number of samples. Methods A systematic meta-analysis was performed using data obtained from several scientific databases (up to November 2023). This cumulative analysis was performed following the Preferred Reporting Items for Systematic Evaluation and Meta-Analysis (PRISMA) and Assessing the Methodological Quality of Systematic Evaluations (AMSTAR) guidelines, according to a protocol registered with PROSPERO. This study was registered on PROSPERO and obtained the unique number: CRD42023455600. Results The analysis included 10 high-quality studies that considered polycyclic aromatic hydrocarbons (PAHs), volatile organic compounds (VOCs) and tobacco-specific nitrosamines (TSNAs). Statistical indicators show that there is a difference between the tobacco user group and the e-cigarette user group in terms of 1-Hydroxynaphthalene (1-NAP) [weighted mean difference (WMD)10.14, 95% confidence interval (CI) (8.41 to 11.88), p < 0.05], 1-Hydroxyphenanthrene (1-PHE) [WMD 0.08, 95% CI (-0.14 to 0.31), p > 0.05], 1-Hydroxypyrene (1-PYR) [WMD 0.16, 95% CI (0.12 to 0.20), p < 0.05], 2-Hydroxyfluorene (2-FLU) [WMD 0.69, 95% CI (0.58 to 0.80), p < 0.05], 2-Hydroxynaphthalene (2-NAP) [WMD 7.48, 95% CI (4.15 to 10.80), p < 0.05], 3-Hydroxyfluorene (3-FLU) [WMD 0.57, 95% CI (0.48 to 0.66), p < 0.05], 2-Carbamoylethylmercapturic acid (AAMA) [WMD 66.47, 95% CI (27.49 to 105.46), p < 0.05], 4-Hydroxy-2-buten-1-yl-mercapturic acid (MHBMA) [WMD 287.79, 95% CI (-54.47 to 630.04), p > 0.05], 4-(Methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNAL) [WMD 189.37, 95% CI (78.45 to 300.29), p < 0.05], or N0-nitrosonornicotine (NNN) [WMD 11.66, 95% CI (7.32 to 16.00), p < 0.05]. Conclusion Urinary bladder cancer markers were significantly higher in traditional tobacco users than in e-cigarette users.Systematic review registration: PROSPERO (CRD42023455600: https://www.crd.york.ac.uk/PROSPERO/).
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Affiliation(s)
- Lida Feng
- School of Medicine, Anhui University of Science and Technology, Huainan, Anhui, China
- Institute of Urology, The Affiliated Luohu Hospital of Shenzhen University, Shenzhen University, Shenzhen, China
- Department of Motor Robotics Institute (MRI), South China Hospital, Heath Science Center, Shenzhen University, Shenzhen, China
| | - Guixiao Huang
- Institute of Urology, The Affiliated Luohu Hospital of Shenzhen University, Shenzhen University, Shenzhen, China
| | - Lei Peng
- Department of Motor Robotics Institute (MRI), South China Hospital, Heath Science Center, Shenzhen University, Shenzhen, China
- Lanzhou University Second Hospital, Lanzhou, China
| | - Rui Liang
- Department of Motor Robotics Institute (MRI), South China Hospital, Heath Science Center, Shenzhen University, Shenzhen, China
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Dashi Deng
- Institute of Urology, The Affiliated Luohu Hospital of Shenzhen University, Shenzhen University, Shenzhen, China
| | - Shaohua Zhang
- Department of Motor Robotics Institute (MRI), South China Hospital, Heath Science Center, Shenzhen University, Shenzhen, China
| | - Guangzhi Li
- Institute of Urology, The Affiliated Luohu Hospital of Shenzhen University, Shenzhen University, Shenzhen, China
| | - Song Wu
- School of Medicine, Anhui University of Science and Technology, Huainan, Anhui, China
- Institute of Urology, The Affiliated Luohu Hospital of Shenzhen University, Shenzhen University, Shenzhen, China
- Department of Motor Robotics Institute (MRI), South China Hospital, Heath Science Center, Shenzhen University, Shenzhen, China
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Shiffman S, Oliveri DR, Goldenson NI, Liang Q, Black RA, Mishra S. Comparing Adult Smokers Who Switched to JUUL versus Continuing Smokers: Biomarkers of Exposure and of Potential Harm and Respiratory Symptoms. Nicotine Tob Res 2024; 26:494-502. [PMID: 37837438 DOI: 10.1093/ntr/ntad197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/31/2023] [Accepted: 10/01/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVES Real-world evidence on exposure to harmful and potentially harmful constituents (HPHCs) and on biological effects in cigarette smokers who switch to electronic nicotine delivery systems (ENDS) can inform the health effects of switching. AIMS AND METHODS This cross-sectional, observational study assessed adults who had smoked ≥10 cigarettes/day for ≥10 years, comparing 124 continuing cigarette smokers (Smokers) to 140 former smokers who switched to JUUL-brand ENDS exclusively for ≥6 months (Switchers). Assessments included biomarkers of exposure (BOEs) to select HPHCs, biomarkers of potential harm (BOPHs) related to smoking-related diseases, psychometric assessments of dependence on cigarettes and ENDS, respectively, and respiratory symptoms. Planned analyses compared geometric means, adjusted for demographic covariates; further analyses adjusted for additional lifestyle and smoking history covariates. RESULTS Nicotine levels were significantly higher in Switchers (median time switched = 3 years), who were unusually heavy users of JUUL. All other BOEs, including NNAL and HPMA3 (primary endpoints), were significantly lower in Switchers than Smokers. Most BOPHs (sICAM-1 [primary], and eg, white blood cell count, MCP1, HbA1c) were significantly lower in Switchers than Smokers; HDL was significantly higher. Switchers reported significantly lower dependence on JUUL than Smokers did on cigarettes, and respiratory symptom scores were significantly lower among Switchers than Smokers. CONCLUSIONS Compared to continuing smokers, smokers who switched to JUUL had substantially lower exposures to multiple HPHCs, favorable differences in markers of inflammation, endothelial function, oxidative stress, and cardiovascular risk, and fewer respiratory symptoms. These findings suggest that switching from cigarettes to JUUL likely reduces smokers' health risks. IMPLICATIONS Short-term confinement studies and randomized clinical trials demonstrate that adult smokers who switch completely to ENDS experience substantial reductions in exposure to many smoking-related toxicants. This study extends those findings to longer periods of switching to JUUL-brand ENDS (almost 3 years on average) under naturalistic use conditions in real-world settings and also found that switching to JUUL resulted in favorable differences in BOPHs more proximally related to smoking-induced disease, as well as in respiratory symptoms. Smokers who switch to ENDS reduce their exposure to toxicants, likely reducing their disease risk.
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Affiliation(s)
| | | | | | - Qiwei Liang
- Population and Clinical Sciences, Juul Labs, Inc., Washington, DC, USA
| | - Ryan A Black
- Behavioral and Clinical Sciences, Juul Labs, Inc., Washington, DC, USA
| | - Snigdha Mishra
- Regulatory Sciences, Juul Labs, Inc., Washington, DC, USA
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Glantz SA, Nguyen N, Oliveira da Silva AL. Population-Based Disease Odds for E-Cigarettes and Dual Use versus Cigarettes. NEJM EVIDENCE 2024; 3:EVIDoa2300229. [PMID: 38411454 DOI: 10.1056/evidoa2300229] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
BACKGROUND: E-cigarettes are promoted as less harmful than cigarettes. There has not been a direct comparison of health effects of e-cigarettes or dual use (concurrently using e-cigarettes and cigarettes) with those of cigarettes in the general population. METHODS: Studies in PubMed, EMBASE, Web of Science, and PsychINFO published through October 1, 2023, were pooled in a random-effects meta-analysis if five or more studies were identified with a disease outcome. We assessed risk of bias with Risk Of Bias In Non-randomized Studies of Exposure and certainty with Grading of Recommendations, Assessment, Development, and Evaluations. Outcomes with fewer studies were summarized but not pooled. RESULTS: We identified 124 odds ratios (94 cross-sectional and 30 longitudinal) from 107 studies. Pooled odds ratios for current e-cigarette versus cigarette use were not different for cardiovascular disease (odds ratio, 0.81; 95% confidence interval, 0.58 to 1.14), stroke (0.73; 0.47 to 1.13), or metabolic dysfunction (0.99; 0.91 to 1.09) but were lower for asthma (0.84; 0.74 to 0.95), chronic obstructive pulmonary disease (0.53; 0.38 to 0.74), and oral disease (0.87; 0.76 to 1.00). Pooled odds ratios for dual use versus cigarettes were increased for all outcomes (range, 1.20 to 1.41). Pooled odds ratios for e-cigarettes and dual use compared with nonuse of either product were increased (e-cigarette range, 1.24 to 1.47; dual use, 1.49 to 3.29). All included studies were assessed as having a low risk of bias. Results were generally not sensitive to study characteristics. Limited studies of other outcomes suggest that e-cigarette use is associated with additional diseases. CONCLUSIONS: There is a need to reassess the assumption that e-cigarette use provides substantial harm reduction across all cigarette-caused diseases, particularly accounting for dual use.
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Affiliation(s)
| | - Nhung Nguyen
- Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco
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Taylor E, Simonavičius E, McNeill A, Brose LS, East K, Marczylo T, Robson D. Exposure to Tobacco-Specific Nitrosamines Among People Who Vape, Smoke, or do Neither: A Systematic Review and Meta-Analysis. Nicotine Tob Res 2024; 26:257-269. [PMID: 37619211 PMCID: PMC10882431 DOI: 10.1093/ntr/ntad156] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 08/02/2023] [Accepted: 08/21/2023] [Indexed: 08/26/2023]
Abstract
INTRODUCTION Smoking exposes people to high levels of Tobacco-Specific Nitrosamines (TSNAs), which include potent carcinogens. We systematically reviewed TSNA exposure between people smoking, vaping, and doing neither. AIMS AND METHODS Databases were searched between August 2017-March 2022, using vaping-related terms. Peer-reviewed articles reporting TSNA metabolites (NNAL, NNN, NAB, and NAT) levels in bio-samples among adults exclusively vaping, exclusively smoking, or doing neither were included. Where possible, meta-analyses were conducted. RESULTS Of 12 781 identified studies, 22 were included. TSNA levels fell substantially when people who smoke switched to vaping in longitudinal studies and were lower among people who vaped compared to smoked in cross-sectional studies. Levels of TSNAs were similar when comparing people who switched from smoking to vaping, to those who switched to no use of nicotine products, in longitudinal studies. Levels were higher among people who vaped compared to people who neither vaped nor smoked in cross-sectional studies.When comparing people who vaped to smoked: pooled urinary NNAL was 79% lower across three randomized controlled trials and 96% lower across three cross-sectional studies; pooled NAB was 87% lower and NAT 94% lower in two cross-sectional studies. When comparing people who neither vaped nor smoked to people who vaped, pooled urinary NNAL was 80%, NAB 26%, and NAT 27% lower in two cross-sectional studies. Other longitudinal data, and NNN levels could not be pooled. CONCLUSIONS Exposure to all TSNAs was lower among people who vaped compared to people who smoked. Levels were higher among people who vaped compared to people who neither vaped nor smoked. IMPLICATIONS As well as TSNAs, there are many other toxicant exposures from smoking and vaping that can increase the risk of disease. However, it is likely that the reduced exposure to TSNAs from vaping relative to smoking reduces the risk to health of those who use vaping products to quit smoking. Future high-quality research, with robust definitions of exclusive vaping and smoking, and accounting for TSNAs half-lives, is needed to fully assess exposure to TSNAs among people who vape.
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Affiliation(s)
- Eve Taylor
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College, London, UK
- NIHR HPRU Environmental Exposures and Health, London, UK
| | - Erikas Simonavičius
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College, London, UK
| | - Ann McNeill
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College, London, UK
- NIHR HPRU Environmental Exposures and Health, London, UK
- SPECTRUM Consortium, London, UK
- NIHR ARC SouthLondon, Oxford, UK
| | - Leonie S Brose
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College, London, UK
- SPECTRUM Consortium, London, UK
| | - Katherine East
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College, London, UK
| | - Tim Marczylo
- NIHR HPRU Environmental Exposures and Health, London, UK
- Radiation, Chemical and Environmental Hazards, UK Health Security Agency (UKHSA)
| | - Debbie Robson
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College, London, UK
- NIHR HPRU Environmental Exposures and Health, London, UK
- SPECTRUM Consortium, London, UK
- NIHR ARC SouthLondon, Oxford, UK
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 175] [Impact Index Per Article: 175.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Auer R, Schoeni A, Humair JP, Jacot-Sadowski I, Berlin I, Stuber MJ, Haller ML, Tango RC, Frei A, Strassmann A, Bruggmann P, Baty F, Brutsche M, Tal K, Baggio S, Jakob J, Sambiagio N, Hopf NB, Feller M, Rodondi N, Berthet A. Electronic Nicotine-Delivery Systems for Smoking Cessation. N Engl J Med 2024; 390:601-610. [PMID: 38354139 DOI: 10.1056/nejmoa2308815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
BACKGROUND Electronic nicotine-delivery systems - also called e-cigarettes - are used by some tobacco smokers to assist with quitting. Evidence regarding the efficacy and safety of these systems is needed. METHODS In this open-label, controlled trial, we randomly assigned adults who were smoking at least five tobacco cigarettes per day and who wanted to set a quit date to an intervention group, which received free e-cigarettes and e-liquids, standard-of-care smoking-cessation counseling, and optional (not free) nicotine-replacement therapy, or to a control group, which received standard counseling and a voucher, which they could use for any purpose, including nicotine-replacement therapy. The primary outcome was biochemically validated, continuous abstinence from smoking at 6 months. Secondary outcomes included participant-reported abstinence from tobacco and from any nicotine (including smoking, e-cigarettes, and nicotine-replacement therapy) at 6 months, respiratory symptoms, and serious adverse events. RESULTS A total of 1246 participants underwent randomization; 622 participants were assigned to the intervention group, and 624 to the control group. The percentage of participants with validated continuous abstinence from tobacco smoking was 28.9% in the intervention group and 16.3% in the control group (relative risk, 1.77; 95% confidence interval, 1.43 to 2.20). The percentage of participants who abstained from smoking in the 7 days before the 6-month visit was 59.6% in the intervention group and 38.5% in the control group, but the percentage who abstained from any nicotine use was 20.1% in the intervention group and 33.7% in the control group. Serious adverse events occurred in 25 participants (4.0%) in the intervention group and in 31 (5.0%) in the control group; adverse events occurred in 272 participants (43.7%) and 229 participants (36.7%), respectively. CONCLUSIONS The addition of e-cigarettes to standard smoking-cessation counseling resulted in greater abstinence from tobacco use among smokers than smoking-cessation counseling alone. (Funded by the Swiss National Science Foundation and others; ESTxENDS ClinicalTrials.gov number, NCT03589989.).
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Affiliation(s)
- Reto Auer
- From the Institute of Primary Health Care (BIHAM) (R.A., A. Schoeni, M.J.S., M.L.H., K.T., S.B., J.J., M.F., N.R.) and the Departments of General Internal Medicine (M.J.S., N.R.) and Pediatrics (J.J.), Bern University Hospital (Inselspital), University of Bern, Bern, the University Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (R.A., I.J.-S., I.B., N.S., N.B.H., A.B.), the Department of Primary Care Medicine, University Hospitals of Geneva, Geneva (J.-P.H., R.C.T.), the Epidemiology, Biostatistics and Prevention Institute, University of Zurich (A.F., A. Strassmann), Arud Center for Addiction Medicine (P.B.), and the Institute of Primary Care, University and University Hospital of Zurich (P.B.), Zurich, the Lung Center, Kantonsspital St. Gallen, St. Gallen (F.B., M.B.), the University of Basel, Basel (F.B., M.B.), and the Population Health Laboratory, University of Fribourg, Fribourg (S.B.) - all in Switzerland; and the Department of Medical Pharmacology, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris (I.B.)
| | - Anna Schoeni
- From the Institute of Primary Health Care (BIHAM) (R.A., A. Schoeni, M.J.S., M.L.H., K.T., S.B., J.J., M.F., N.R.) and the Departments of General Internal Medicine (M.J.S., N.R.) and Pediatrics (J.J.), Bern University Hospital (Inselspital), University of Bern, Bern, the University Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (R.A., I.J.-S., I.B., N.S., N.B.H., A.B.), the Department of Primary Care Medicine, University Hospitals of Geneva, Geneva (J.-P.H., R.C.T.), the Epidemiology, Biostatistics and Prevention Institute, University of Zurich (A.F., A. Strassmann), Arud Center for Addiction Medicine (P.B.), and the Institute of Primary Care, University and University Hospital of Zurich (P.B.), Zurich, the Lung Center, Kantonsspital St. Gallen, St. Gallen (F.B., M.B.), the University of Basel, Basel (F.B., M.B.), and the Population Health Laboratory, University of Fribourg, Fribourg (S.B.) - all in Switzerland; and the Department of Medical Pharmacology, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris (I.B.)
| | - Jean-Paul Humair
- From the Institute of Primary Health Care (BIHAM) (R.A., A. Schoeni, M.J.S., M.L.H., K.T., S.B., J.J., M.F., N.R.) and the Departments of General Internal Medicine (M.J.S., N.R.) and Pediatrics (J.J.), Bern University Hospital (Inselspital), University of Bern, Bern, the University Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (R.A., I.J.-S., I.B., N.S., N.B.H., A.B.), the Department of Primary Care Medicine, University Hospitals of Geneva, Geneva (J.-P.H., R.C.T.), the Epidemiology, Biostatistics and Prevention Institute, University of Zurich (A.F., A. Strassmann), Arud Center for Addiction Medicine (P.B.), and the Institute of Primary Care, University and University Hospital of Zurich (P.B.), Zurich, the Lung Center, Kantonsspital St. Gallen, St. Gallen (F.B., M.B.), the University of Basel, Basel (F.B., M.B.), and the Population Health Laboratory, University of Fribourg, Fribourg (S.B.) - all in Switzerland; and the Department of Medical Pharmacology, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris (I.B.)
| | - Isabelle Jacot-Sadowski
- From the Institute of Primary Health Care (BIHAM) (R.A., A. Schoeni, M.J.S., M.L.H., K.T., S.B., J.J., M.F., N.R.) and the Departments of General Internal Medicine (M.J.S., N.R.) and Pediatrics (J.J.), Bern University Hospital (Inselspital), University of Bern, Bern, the University Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (R.A., I.J.-S., I.B., N.S., N.B.H., A.B.), the Department of Primary Care Medicine, University Hospitals of Geneva, Geneva (J.-P.H., R.C.T.), the Epidemiology, Biostatistics and Prevention Institute, University of Zurich (A.F., A. Strassmann), Arud Center for Addiction Medicine (P.B.), and the Institute of Primary Care, University and University Hospital of Zurich (P.B.), Zurich, the Lung Center, Kantonsspital St. Gallen, St. Gallen (F.B., M.B.), the University of Basel, Basel (F.B., M.B.), and the Population Health Laboratory, University of Fribourg, Fribourg (S.B.) - all in Switzerland; and the Department of Medical Pharmacology, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris (I.B.)
| | - Ivan Berlin
- From the Institute of Primary Health Care (BIHAM) (R.A., A. Schoeni, M.J.S., M.L.H., K.T., S.B., J.J., M.F., N.R.) and the Departments of General Internal Medicine (M.J.S., N.R.) and Pediatrics (J.J.), Bern University Hospital (Inselspital), University of Bern, Bern, the University Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (R.A., I.J.-S., I.B., N.S., N.B.H., A.B.), the Department of Primary Care Medicine, University Hospitals of Geneva, Geneva (J.-P.H., R.C.T.), the Epidemiology, Biostatistics and Prevention Institute, University of Zurich (A.F., A. Strassmann), Arud Center for Addiction Medicine (P.B.), and the Institute of Primary Care, University and University Hospital of Zurich (P.B.), Zurich, the Lung Center, Kantonsspital St. Gallen, St. Gallen (F.B., M.B.), the University of Basel, Basel (F.B., M.B.), and the Population Health Laboratory, University of Fribourg, Fribourg (S.B.) - all in Switzerland; and the Department of Medical Pharmacology, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris (I.B.)
| | - Mirah J Stuber
- From the Institute of Primary Health Care (BIHAM) (R.A., A. Schoeni, M.J.S., M.L.H., K.T., S.B., J.J., M.F., N.R.) and the Departments of General Internal Medicine (M.J.S., N.R.) and Pediatrics (J.J.), Bern University Hospital (Inselspital), University of Bern, Bern, the University Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (R.A., I.J.-S., I.B., N.S., N.B.H., A.B.), the Department of Primary Care Medicine, University Hospitals of Geneva, Geneva (J.-P.H., R.C.T.), the Epidemiology, Biostatistics and Prevention Institute, University of Zurich (A.F., A. Strassmann), Arud Center for Addiction Medicine (P.B.), and the Institute of Primary Care, University and University Hospital of Zurich (P.B.), Zurich, the Lung Center, Kantonsspital St. Gallen, St. Gallen (F.B., M.B.), the University of Basel, Basel (F.B., M.B.), and the Population Health Laboratory, University of Fribourg, Fribourg (S.B.) - all in Switzerland; and the Department of Medical Pharmacology, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris (I.B.)
| | - Moa Lina Haller
- From the Institute of Primary Health Care (BIHAM) (R.A., A. Schoeni, M.J.S., M.L.H., K.T., S.B., J.J., M.F., N.R.) and the Departments of General Internal Medicine (M.J.S., N.R.) and Pediatrics (J.J.), Bern University Hospital (Inselspital), University of Bern, Bern, the University Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (R.A., I.J.-S., I.B., N.S., N.B.H., A.B.), the Department of Primary Care Medicine, University Hospitals of Geneva, Geneva (J.-P.H., R.C.T.), the Epidemiology, Biostatistics and Prevention Institute, University of Zurich (A.F., A. Strassmann), Arud Center for Addiction Medicine (P.B.), and the Institute of Primary Care, University and University Hospital of Zurich (P.B.), Zurich, the Lung Center, Kantonsspital St. Gallen, St. Gallen (F.B., M.B.), the University of Basel, Basel (F.B., M.B.), and the Population Health Laboratory, University of Fribourg, Fribourg (S.B.) - all in Switzerland; and the Department of Medical Pharmacology, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris (I.B.)
| | - Rodrigo Casagrande Tango
- From the Institute of Primary Health Care (BIHAM) (R.A., A. Schoeni, M.J.S., M.L.H., K.T., S.B., J.J., M.F., N.R.) and the Departments of General Internal Medicine (M.J.S., N.R.) and Pediatrics (J.J.), Bern University Hospital (Inselspital), University of Bern, Bern, the University Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (R.A., I.J.-S., I.B., N.S., N.B.H., A.B.), the Department of Primary Care Medicine, University Hospitals of Geneva, Geneva (J.-P.H., R.C.T.), the Epidemiology, Biostatistics and Prevention Institute, University of Zurich (A.F., A. Strassmann), Arud Center for Addiction Medicine (P.B.), and the Institute of Primary Care, University and University Hospital of Zurich (P.B.), Zurich, the Lung Center, Kantonsspital St. Gallen, St. Gallen (F.B., M.B.), the University of Basel, Basel (F.B., M.B.), and the Population Health Laboratory, University of Fribourg, Fribourg (S.B.) - all in Switzerland; and the Department of Medical Pharmacology, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris (I.B.)
| | - Anja Frei
- From the Institute of Primary Health Care (BIHAM) (R.A., A. Schoeni, M.J.S., M.L.H., K.T., S.B., J.J., M.F., N.R.) and the Departments of General Internal Medicine (M.J.S., N.R.) and Pediatrics (J.J.), Bern University Hospital (Inselspital), University of Bern, Bern, the University Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (R.A., I.J.-S., I.B., N.S., N.B.H., A.B.), the Department of Primary Care Medicine, University Hospitals of Geneva, Geneva (J.-P.H., R.C.T.), the Epidemiology, Biostatistics and Prevention Institute, University of Zurich (A.F., A. Strassmann), Arud Center for Addiction Medicine (P.B.), and the Institute of Primary Care, University and University Hospital of Zurich (P.B.), Zurich, the Lung Center, Kantonsspital St. Gallen, St. Gallen (F.B., M.B.), the University of Basel, Basel (F.B., M.B.), and the Population Health Laboratory, University of Fribourg, Fribourg (S.B.) - all in Switzerland; and the Department of Medical Pharmacology, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris (I.B.)
| | - Alexandra Strassmann
- From the Institute of Primary Health Care (BIHAM) (R.A., A. Schoeni, M.J.S., M.L.H., K.T., S.B., J.J., M.F., N.R.) and the Departments of General Internal Medicine (M.J.S., N.R.) and Pediatrics (J.J.), Bern University Hospital (Inselspital), University of Bern, Bern, the University Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (R.A., I.J.-S., I.B., N.S., N.B.H., A.B.), the Department of Primary Care Medicine, University Hospitals of Geneva, Geneva (J.-P.H., R.C.T.), the Epidemiology, Biostatistics and Prevention Institute, University of Zurich (A.F., A. Strassmann), Arud Center for Addiction Medicine (P.B.), and the Institute of Primary Care, University and University Hospital of Zurich (P.B.), Zurich, the Lung Center, Kantonsspital St. Gallen, St. Gallen (F.B., M.B.), the University of Basel, Basel (F.B., M.B.), and the Population Health Laboratory, University of Fribourg, Fribourg (S.B.) - all in Switzerland; and the Department of Medical Pharmacology, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris (I.B.)
| | - Philip Bruggmann
- From the Institute of Primary Health Care (BIHAM) (R.A., A. Schoeni, M.J.S., M.L.H., K.T., S.B., J.J., M.F., N.R.) and the Departments of General Internal Medicine (M.J.S., N.R.) and Pediatrics (J.J.), Bern University Hospital (Inselspital), University of Bern, Bern, the University Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (R.A., I.J.-S., I.B., N.S., N.B.H., A.B.), the Department of Primary Care Medicine, University Hospitals of Geneva, Geneva (J.-P.H., R.C.T.), the Epidemiology, Biostatistics and Prevention Institute, University of Zurich (A.F., A. Strassmann), Arud Center for Addiction Medicine (P.B.), and the Institute of Primary Care, University and University Hospital of Zurich (P.B.), Zurich, the Lung Center, Kantonsspital St. Gallen, St. Gallen (F.B., M.B.), the University of Basel, Basel (F.B., M.B.), and the Population Health Laboratory, University of Fribourg, Fribourg (S.B.) - all in Switzerland; and the Department of Medical Pharmacology, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris (I.B.)
| | - Florent Baty
- From the Institute of Primary Health Care (BIHAM) (R.A., A. Schoeni, M.J.S., M.L.H., K.T., S.B., J.J., M.F., N.R.) and the Departments of General Internal Medicine (M.J.S., N.R.) and Pediatrics (J.J.), Bern University Hospital (Inselspital), University of Bern, Bern, the University Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (R.A., I.J.-S., I.B., N.S., N.B.H., A.B.), the Department of Primary Care Medicine, University Hospitals of Geneva, Geneva (J.-P.H., R.C.T.), the Epidemiology, Biostatistics and Prevention Institute, University of Zurich (A.F., A. Strassmann), Arud Center for Addiction Medicine (P.B.), and the Institute of Primary Care, University and University Hospital of Zurich (P.B.), Zurich, the Lung Center, Kantonsspital St. Gallen, St. Gallen (F.B., M.B.), the University of Basel, Basel (F.B., M.B.), and the Population Health Laboratory, University of Fribourg, Fribourg (S.B.) - all in Switzerland; and the Department of Medical Pharmacology, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris (I.B.)
| | - Martin Brutsche
- From the Institute of Primary Health Care (BIHAM) (R.A., A. Schoeni, M.J.S., M.L.H., K.T., S.B., J.J., M.F., N.R.) and the Departments of General Internal Medicine (M.J.S., N.R.) and Pediatrics (J.J.), Bern University Hospital (Inselspital), University of Bern, Bern, the University Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (R.A., I.J.-S., I.B., N.S., N.B.H., A.B.), the Department of Primary Care Medicine, University Hospitals of Geneva, Geneva (J.-P.H., R.C.T.), the Epidemiology, Biostatistics and Prevention Institute, University of Zurich (A.F., A. Strassmann), Arud Center for Addiction Medicine (P.B.), and the Institute of Primary Care, University and University Hospital of Zurich (P.B.), Zurich, the Lung Center, Kantonsspital St. Gallen, St. Gallen (F.B., M.B.), the University of Basel, Basel (F.B., M.B.), and the Population Health Laboratory, University of Fribourg, Fribourg (S.B.) - all in Switzerland; and the Department of Medical Pharmacology, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris (I.B.)
| | - Kali Tal
- From the Institute of Primary Health Care (BIHAM) (R.A., A. Schoeni, M.J.S., M.L.H., K.T., S.B., J.J., M.F., N.R.) and the Departments of General Internal Medicine (M.J.S., N.R.) and Pediatrics (J.J.), Bern University Hospital (Inselspital), University of Bern, Bern, the University Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (R.A., I.J.-S., I.B., N.S., N.B.H., A.B.), the Department of Primary Care Medicine, University Hospitals of Geneva, Geneva (J.-P.H., R.C.T.), the Epidemiology, Biostatistics and Prevention Institute, University of Zurich (A.F., A. Strassmann), Arud Center for Addiction Medicine (P.B.), and the Institute of Primary Care, University and University Hospital of Zurich (P.B.), Zurich, the Lung Center, Kantonsspital St. Gallen, St. Gallen (F.B., M.B.), the University of Basel, Basel (F.B., M.B.), and the Population Health Laboratory, University of Fribourg, Fribourg (S.B.) - all in Switzerland; and the Department of Medical Pharmacology, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris (I.B.)
| | - Stéphanie Baggio
- From the Institute of Primary Health Care (BIHAM) (R.A., A. Schoeni, M.J.S., M.L.H., K.T., S.B., J.J., M.F., N.R.) and the Departments of General Internal Medicine (M.J.S., N.R.) and Pediatrics (J.J.), Bern University Hospital (Inselspital), University of Bern, Bern, the University Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (R.A., I.J.-S., I.B., N.S., N.B.H., A.B.), the Department of Primary Care Medicine, University Hospitals of Geneva, Geneva (J.-P.H., R.C.T.), the Epidemiology, Biostatistics and Prevention Institute, University of Zurich (A.F., A. Strassmann), Arud Center for Addiction Medicine (P.B.), and the Institute of Primary Care, University and University Hospital of Zurich (P.B.), Zurich, the Lung Center, Kantonsspital St. Gallen, St. Gallen (F.B., M.B.), the University of Basel, Basel (F.B., M.B.), and the Population Health Laboratory, University of Fribourg, Fribourg (S.B.) - all in Switzerland; and the Department of Medical Pharmacology, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris (I.B.)
| | - Julian Jakob
- From the Institute of Primary Health Care (BIHAM) (R.A., A. Schoeni, M.J.S., M.L.H., K.T., S.B., J.J., M.F., N.R.) and the Departments of General Internal Medicine (M.J.S., N.R.) and Pediatrics (J.J.), Bern University Hospital (Inselspital), University of Bern, Bern, the University Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (R.A., I.J.-S., I.B., N.S., N.B.H., A.B.), the Department of Primary Care Medicine, University Hospitals of Geneva, Geneva (J.-P.H., R.C.T.), the Epidemiology, Biostatistics and Prevention Institute, University of Zurich (A.F., A. Strassmann), Arud Center for Addiction Medicine (P.B.), and the Institute of Primary Care, University and University Hospital of Zurich (P.B.), Zurich, the Lung Center, Kantonsspital St. Gallen, St. Gallen (F.B., M.B.), the University of Basel, Basel (F.B., M.B.), and the Population Health Laboratory, University of Fribourg, Fribourg (S.B.) - all in Switzerland; and the Department of Medical Pharmacology, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris (I.B.)
| | - Nicolas Sambiagio
- From the Institute of Primary Health Care (BIHAM) (R.A., A. Schoeni, M.J.S., M.L.H., K.T., S.B., J.J., M.F., N.R.) and the Departments of General Internal Medicine (M.J.S., N.R.) and Pediatrics (J.J.), Bern University Hospital (Inselspital), University of Bern, Bern, the University Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (R.A., I.J.-S., I.B., N.S., N.B.H., A.B.), the Department of Primary Care Medicine, University Hospitals of Geneva, Geneva (J.-P.H., R.C.T.), the Epidemiology, Biostatistics and Prevention Institute, University of Zurich (A.F., A. Strassmann), Arud Center for Addiction Medicine (P.B.), and the Institute of Primary Care, University and University Hospital of Zurich (P.B.), Zurich, the Lung Center, Kantonsspital St. Gallen, St. Gallen (F.B., M.B.), the University of Basel, Basel (F.B., M.B.), and the Population Health Laboratory, University of Fribourg, Fribourg (S.B.) - all in Switzerland; and the Department of Medical Pharmacology, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris (I.B.)
| | - Nancy B Hopf
- From the Institute of Primary Health Care (BIHAM) (R.A., A. Schoeni, M.J.S., M.L.H., K.T., S.B., J.J., M.F., N.R.) and the Departments of General Internal Medicine (M.J.S., N.R.) and Pediatrics (J.J.), Bern University Hospital (Inselspital), University of Bern, Bern, the University Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (R.A., I.J.-S., I.B., N.S., N.B.H., A.B.), the Department of Primary Care Medicine, University Hospitals of Geneva, Geneva (J.-P.H., R.C.T.), the Epidemiology, Biostatistics and Prevention Institute, University of Zurich (A.F., A. Strassmann), Arud Center for Addiction Medicine (P.B.), and the Institute of Primary Care, University and University Hospital of Zurich (P.B.), Zurich, the Lung Center, Kantonsspital St. Gallen, St. Gallen (F.B., M.B.), the University of Basel, Basel (F.B., M.B.), and the Population Health Laboratory, University of Fribourg, Fribourg (S.B.) - all in Switzerland; and the Department of Medical Pharmacology, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris (I.B.)
| | - Martin Feller
- From the Institute of Primary Health Care (BIHAM) (R.A., A. Schoeni, M.J.S., M.L.H., K.T., S.B., J.J., M.F., N.R.) and the Departments of General Internal Medicine (M.J.S., N.R.) and Pediatrics (J.J.), Bern University Hospital (Inselspital), University of Bern, Bern, the University Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (R.A., I.J.-S., I.B., N.S., N.B.H., A.B.), the Department of Primary Care Medicine, University Hospitals of Geneva, Geneva (J.-P.H., R.C.T.), the Epidemiology, Biostatistics and Prevention Institute, University of Zurich (A.F., A. Strassmann), Arud Center for Addiction Medicine (P.B.), and the Institute of Primary Care, University and University Hospital of Zurich (P.B.), Zurich, the Lung Center, Kantonsspital St. Gallen, St. Gallen (F.B., M.B.), the University of Basel, Basel (F.B., M.B.), and the Population Health Laboratory, University of Fribourg, Fribourg (S.B.) - all in Switzerland; and the Department of Medical Pharmacology, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris (I.B.)
| | - Nicolas Rodondi
- From the Institute of Primary Health Care (BIHAM) (R.A., A. Schoeni, M.J.S., M.L.H., K.T., S.B., J.J., M.F., N.R.) and the Departments of General Internal Medicine (M.J.S., N.R.) and Pediatrics (J.J.), Bern University Hospital (Inselspital), University of Bern, Bern, the University Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (R.A., I.J.-S., I.B., N.S., N.B.H., A.B.), the Department of Primary Care Medicine, University Hospitals of Geneva, Geneva (J.-P.H., R.C.T.), the Epidemiology, Biostatistics and Prevention Institute, University of Zurich (A.F., A. Strassmann), Arud Center for Addiction Medicine (P.B.), and the Institute of Primary Care, University and University Hospital of Zurich (P.B.), Zurich, the Lung Center, Kantonsspital St. Gallen, St. Gallen (F.B., M.B.), the University of Basel, Basel (F.B., M.B.), and the Population Health Laboratory, University of Fribourg, Fribourg (S.B.) - all in Switzerland; and the Department of Medical Pharmacology, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris (I.B.)
| | - Aurélie Berthet
- From the Institute of Primary Health Care (BIHAM) (R.A., A. Schoeni, M.J.S., M.L.H., K.T., S.B., J.J., M.F., N.R.) and the Departments of General Internal Medicine (M.J.S., N.R.) and Pediatrics (J.J.), Bern University Hospital (Inselspital), University of Bern, Bern, the University Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne (R.A., I.J.-S., I.B., N.S., N.B.H., A.B.), the Department of Primary Care Medicine, University Hospitals of Geneva, Geneva (J.-P.H., R.C.T.), the Epidemiology, Biostatistics and Prevention Institute, University of Zurich (A.F., A. Strassmann), Arud Center for Addiction Medicine (P.B.), and the Institute of Primary Care, University and University Hospital of Zurich (P.B.), Zurich, the Lung Center, Kantonsspital St. Gallen, St. Gallen (F.B., M.B.), the University of Basel, Basel (F.B., M.B.), and the Population Health Laboratory, University of Fribourg, Fribourg (S.B.) - all in Switzerland; and the Department of Medical Pharmacology, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris (I.B.)
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McCaughey CJ, Murphy G, Jones J, Mirza KB, Hensey M. Safety and efficacy of e-cigarettes in those with atherosclerotic disease: a review. Open Heart 2023; 10:e002341. [PMID: 38065586 PMCID: PMC10711928 DOI: 10.1136/openhrt-2023-002341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 10/11/2023] [Indexed: 12/18/2023] Open
Abstract
Smoking cessation is the most effective intervention to reduce mortality in patients with established atherosclerotic cardiovascular disease (ASCVD), with 'e-cigarettes' becoming an increasingly used intervention to achieve smoking cessation. The current review aims to summarise the current evidence base for their efficacy and safety in the ASCVD cohort. A search of the PUBMED and MEDLINE databases using the terms 'e-cigarette', 'cessation', 'safety' and 'efficacy' since 2012 yielded 706 results. Both observational and experimental studies were included, while those with an unavailable full text, non-English or duplicates were excluded, yielding 78 relevant articles, with 13 subsequent additional articles included from a search of reference lists, for a total of 91 included papers. E-cigarette vapour contains many known pro-atherosclerotic substances and has been demonstrated to potentiate traditional atherosclerotic mechanisms. While e-cigarettes may be more effective in promoting smoking cessation in the general population over a medium term (>6 months), when compared with nicotine replacement therapy (NRT), few studies specifically examined those with ASCVD, despite the latter having a higher baseline quit rate (52% vs 2%). Most studies compare e-cigarettes with NRT alone and do not include pharmacotherapy, which may be more effective in the ASCVD cohort. The single randomised controlled trial addressing the research question favoured traditional methods. Those that successfully quit smoking using e-cigarettes are more likely to continue to use the intervention at 1 year (90% vs 9%). Conflicting advice exists regarding the utilisation of e-cigarettes for smoking cessation. E-cigarettes may be inferior to standard care for smoking cessation in those with ASCVD, and their use is likely to promote the key drivers of the atherosclerotic process already active in this cohort.
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Affiliation(s)
| | - Greg Murphy
- Cardiology, St James Hospital, Dublin, Ireland
| | - Jennifer Jones
- National Institute of Preventive Cardiology, National University of Ireland Galway, Galway, Ireland
| | | | - Mark Hensey
- Cardiology, St James Hospital, Dublin, Ireland
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Caponnetto P, Spicuzza L, Campagna D, Ahluwalia JS, Russell C, Maglia M, Riela PM, Longo CF, Caci G, Quattropani MC, Signorelli MS, Polosa R. Varenicline for smoking cessation in individuals who smoke cigarettes and use electronic cigarettes: a double-blind, randomised, placebo-controlled phase 3 trial. EClinicalMedicine 2023; 66:102316. [PMID: 38192585 PMCID: PMC10772233 DOI: 10.1016/j.eclinm.2023.102316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 10/24/2023] [Accepted: 10/30/2023] [Indexed: 01/10/2024] Open
Abstract
Background The efficacy and safety of varenicline for smoking cessation among individuals who smoke tobacco cigarettes and also use electronic cigarettes (known e-cigarettes or vapes) have not been studied. We aimed to address this knowledge gap and examine predictors for smoking abstinence. Methods In this double-blind, placebo-controlled, single-centre randomised trial in Italy, we enrolled adults who had used an e-cigarette daily for at least 12 months and who also smoked at least one tobacco cigarette per day and had a willingness to quit smoking. 155 participants were randomly assigned to receive either varenicline (n = 78) or matched placebo (n = 77). Varenicline (1 mg, administered twice daily for 12 weeks) was given in combination with smoking cessation counseling in dual users with an intention to quit smoking. Participants in both treatment groups received the same smoking cessation counselling throughout the whole duration of the study. The trial consisted of a 12-week treatment phase followed by a 12-week follow-up. The primary efficacy endpoint was continuous abstinence rate (CAR) in weeks 4-12. Secondary efficacy endpoints were the CAR in weeks 4-24 and 7-day point prevalence of smoking abstinence at weeks 12 and 24. This study is registered in EUDRACT, 2016-000339-42. Findings Between November 2018, and February 2020, 114 participants (61 in the varenicline group and 53 in the placebo group) completed the intervention phase at week 12 and 88 participants (52 in the varenicline group and 36 in the placebo group) completed the follow-up phase at week 24. CARs were significantly higher for the varenicline vs placebo at each time-point: 50.0% vs 16.9% (OR = 4.9; 95% CI, 2.3-10.4; P < 0.0001) between weeks 4 and 12; and 48.7% vs 14.3% (OR = 5.7; 95% CI, 2.6-12.3; P < 0.0001) between weeks 4 and 24. The 7-day point prevalence of smoking abstinence was also higher for the varenicline than placebo at each time point. Adverse events were rated as mild or moderate and rarely led to treatment discontinuation. Interpretation Our findings indicate that inclusion of varenicline in a cessation programme for adults who smoke and use e-cigarettes with an intention to quit smoking could result in smoking abstinence without serious adverse events. In the absence of evidence from other smoking cessation methods, it could be useful to suggest the use of varenicline in cessation programmes specifically designed to help dual users stop smoking. Further research in larger and more generalisable populations is required to strengthen such a suggestion. Funding Global Research Award for Nicotine Dependence, an independently reviewed competitive grants programmeme funded by Pfizer.
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Affiliation(s)
- Pasquale Caponnetto
- Department of Science of Education, Section of Psychology, University of Catania, Italy
- Centre of Excellence for the Acceleration of HArm Reduction (CoEHAR), University of Catania, Italy
- Centre for the Prevention and Treatment of Tobacco Addiction (CPCT), University Teaching Hospital “Policlinico-S.Marco”, University of Catania, Italy
| | - Lucia Spicuzza
- Centre of Excellence for the Acceleration of HArm Reduction (CoEHAR), University of Catania, Italy
- Respiratory Unit - University Teaching Hospital “Policlinico-S.Marco”, University of Catania, Italy
- Department of Clinical & Experimental Medicine, University of Catania, Italy
| | - Davide Campagna
- Centre of Excellence for the Acceleration of HArm Reduction (CoEHAR), University of Catania, Italy
- Department of Clinical & Experimental Medicine, University of Catania, Italy
- UOC MCAU, University Teaching Hospital “Policlinico-S.Marco”, University of Catania, Italy
| | - Jasjit S. Ahluwalia
- Brown University School of Public Health and Alpert School of Medicine, Providence, RI, USA
| | | | - Marilena Maglia
- Centre for the Prevention and Treatment of Tobacco Addiction (CPCT), University Teaching Hospital “Policlinico-S.Marco”, University of Catania, Italy
- ECLAT Srl, Spin-off of the University of Catania, Italy
| | - Paolo Marco Riela
- Department of Mathematics and Informatics, University of Catania, Catania, Italy
| | - Carmelo Fabio Longo
- Department of Mathematics and Informatics, University of Catania, Catania, Italy
| | - Grazia Caci
- UOC MCAU, University Teaching Hospital “Policlinico-S.Marco”, University of Catania, Italy
| | - Maria Catena Quattropani
- Department of Science of Education, Section of Psychology, University of Catania, Italy
- Centre of Excellence for the Acceleration of HArm Reduction (CoEHAR), University of Catania, Italy
| | | | - Riccardo Polosa
- Centre of Excellence for the Acceleration of HArm Reduction (CoEHAR), University of Catania, Italy
- Centre for the Prevention and Treatment of Tobacco Addiction (CPCT), University Teaching Hospital “Policlinico-S.Marco”, University of Catania, Italy
- Department of Clinical & Experimental Medicine, University of Catania, Italy
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Cho YJ, Brinkman MC, Hinton A, Nshimiyimana JD, Mehta T, Adeniji A, Norton K, El Hellani A, Wagener TL. The sweet spot study-Developing e-liquid product standards for nicotine form and concentration to improve public health: Protocol for a randomized, double-blinded, crossover study. PLoS One 2023; 18:e0291522. [PMID: 37699050 PMCID: PMC10497122 DOI: 10.1371/journal.pone.0291522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/01/2023] [Indexed: 09/14/2023] Open
Abstract
OBJECTIVES E-cigarettes pose significant risks to youth, but smokers may benefit from switching to e-cigarettes by reducing their exposure to toxicants, which creates a challenge for the Food and Drug Administration (FDA) in regulating e-cigarettes to protect population health. This study aims to develop e-liquid product standards for nicotine form and concentration that reduce the appeal of e-cigarettes to young people while keeping e-cigarettes available as a safer alternative for smokers. DESIGN AND PARTICIPANTS A single-visit, double-blinded, randomized crossover design will be used to examine the effects of e-liquids with varying fractions of free-base nicotine (5%, 25%, 45%, 65%, 85%) among a sample of 66 young adult EC users and 66 older adult smokers, across ecologically valid total nicotine concentrations (20 mg or 50 mg/mL). INTERVENTIONS AND OUTCOMES A 2-puff session will be conducted to test each of the 10 e-liquids in randomly assigned sequences, followed by a 10-minute washout period and participant ratings on appeal and sensory attributes such as throat hit and harshness, as well as behavioral intentions for continued use. Generalized linear mixed models will be used to determine a free-base nicotine level that has limited or no appeal to young adult e-cigarette users while remaining acceptable to smokers. CONCLUSIONS This study will provide the FDA with scientific evidence regarding the effect of product standards that mandate a minimum threshold for the fraction of free-base nicotine. TRIAL REGISTRATION The study is registered on clinicaltrials.gov under the identifier NCT05864586.
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Affiliation(s)
- Yoo Jin Cho
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Marielle C. Brinkman
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, United States of America
| | - Alice Hinton
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, United States of America
| | - Jean D. Nshimiyimana
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Toral Mehta
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Ayomipo Adeniji
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH, United States of America
| | - Kaila Norton
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Ahmad El Hellani
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH, United States of America
| | - Theodore L. Wagener
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
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Boakye E, Erhabor J, Obisesan O, Tasdighi E, Mirbolouk M, Osuji N, Osei AD, Lee J, DeFilippis AP, Stokes AC, Hirsch GA, Benjamin EJ, Robertson RM, Bhatnagar A, El Shahawy O, Blaha MJ. Comprehensive review of the national surveys that assess E-cigarette use domains among youth and adults in the United States. LANCET REGIONAL HEALTH. AMERICAS 2023; 23:100528. [PMID: 37497394 PMCID: PMC10366460 DOI: 10.1016/j.lana.2023.100528] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 07/28/2023]
Abstract
Surveillance of e-cigarette use among different population groups is important for the timely implementation and evaluation of tobacco regulatory policies. In this review, we identified 13 nationally representative, repeatedly conducted epidemiologic surveys that assess e-cigarette use among U.S. youth and/or adults and have been instrumental in e-cigarette surveillance. These surveys included National Youth Tobacco Survey, Youth Risk Behavior Surveillance System, Monitoring the Future Survey, International Tobacco Control Policy Evaluation Project (ITC) Youth Tobacco and Vaping Survey, Behavioral Risk Factor Surveillance System, National Health Interview Survey, Tobacco Use Supplement of the Current Population Survey, Health Information National Trends Survey, Tobacco Products and Risk Perception Surveys, ITC Four Country Smoking and Vaping Survey, National Health and Nutrition Examination Survey, National Survey on Drug Use and Health, and Population Assessment of Tobacco and Health. These surveys vary in scope and detail, with their unique strengths and the regulatory questions that can be answered using each survey data. We also highlighted the gaps in these surveys and made recommendations for improvement.
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Affiliation(s)
- Ellen Boakye
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD, USA
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
| | - John Erhabor
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD, USA
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
| | | | - Erfan Tasdighi
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | | | - Ngozi Osuji
- Department of Internal Medicine, University of Pittsburg Medical Center, Pittsburg, PA, USA
| | - Albert D. Osei
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Jieun Lee
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrew P. DeFilippis
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andrew C. Stokes
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Glenn A. Hirsch
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Emelia J. Benjamin
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Cardiovascular Medicine, Department of Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Rose Marie Robertson
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Aruni Bhatnagar
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Omar El Shahawy
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD, USA
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
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Xu Y, Sen A, Chen T, Harris CM, Prakash S. The impact of JUUL market entry on cigarette sales: evidence from a major chain retailer in Canada. Harm Reduct J 2023; 20:65. [PMID: 37161460 PMCID: PMC10170713 DOI: 10.1186/s12954-023-00790-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 04/28/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Electronic nicotine delivery systems (ENDS), such as the JUUL system, are nicotine products for adults who currently smoke cigarettes but are looking for an alternative to combustible cigarettes. Sales of ENDS products were legislatively acknowledged and authorized federally in Canada with the Royal Assent of the Tobacco and Vaping Products Act in 2018. METHODS With the unique dataset from a major chain retailer in Canada, we evaluated the impacts of JUUL market entry on cigarette sales across Canada from January 2017 to August 2019 using two-way fixed effects panel regression models by leveraging on the entry time variation at the city level. We conducted various robustness checks and a permutation test to validate our results. RESULTS Our estimates suggested that JUUL market entry was, on average, significantly correlated with a 1.65% per-month decrease in cigarette sales during the initial months, and with a potentially larger impact on urban areas. Our results were robust across various specifications and tests. These findings implied that JUUL and combustible cigarettes act as economic substitutes during the study time period in Canada. CONCLUSIONS These results suggested that local availability of ENDS products, such as JUUL, has the potential to reduce local cigarette consumption.
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Affiliation(s)
| | - Anindya Sen
- Department of Economics, University of Waterloo, Waterloo, Canada
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15
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Holt NM, Shiffman S, Black RA, Goldenson NI, Sembower MA, Oldham MJ. Comparison of biomarkers of exposure among US adult smokers, users of electronic nicotine delivery systems, dual users and nonusers, 2018-2019. Sci Rep 2023; 13:7297. [PMID: 37147399 PMCID: PMC10163269 DOI: 10.1038/s41598-023-34427-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/29/2023] [Indexed: 05/07/2023] Open
Abstract
The harm caused by cigarette smoking is overwhelmingly due to byproducts of tobacco combustion. Electronic Nicotine Delivery Systems (ENDS) provide nicotine to users without combustion, and may support tobacco harm reduction among cigarette smokers who would not otherwise quit in the near term. Analyses of Wave 5 of the Population Assessment of Tobacco and Health (PATH) Study compared biomarkers of exposure (BOE) levels for nicotine, 3 metals, 2 tobacco-specific nitrosamines and 14 smoking-related volatile organic compounds in 151 exclusive ENDS users, 1341 exclusive cigarette smokers, 115 dual users (cigarettes and ENDS), and 1846 past 30-day nonusers of tobacco, adjusting for demographics. Nicotine exposure in ENDS users and dual users did not significantly differ from smokers. Among ENDS users, 16 of 18 other BOEs were significantly lower than smokers'; 9 BOEs were not significantly different from nonusers. Among dual users smoking < 10 cigarettes/day, 15 of 18 non-nicotine BOEs were significantly lower than smokers', whereas in dual users smoking ≥ 10 cigarettes per day none of the BOEs significantly differed from smokers'. In this representative sample of US adults, exclusive use of ENDS (vs. cigarette smoking) was associated with much lower exposures to many harmful chemicals associated with smoking-related disease. BOE levels in dual users were directly related to their cigarette consumption. These BOE data provide further evidence that ENDS expose users to substantially lower levels of toxicants than combustible cigarettes, confirming their potential for harm reduction.
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Rubenstein D, Denlinger-Apte RL, Cornacchione Ross J, Carroll DM, McClernon FJ. Older age is associated with greater misperception of the relative health risk of e-cigarettes and cigarettes among US adults who smoke. Tob Control 2023:tc-2023-057943. [PMID: 37137702 PMCID: PMC10622327 DOI: 10.1136/tc-2023-057943] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/25/2023] [Indexed: 05/05/2023]
Abstract
INTRODUCTION The prevalence of cigarette smoking among adults aged ≥55 has remained stagnant over the past decade. National data modelling suggests no reduction in cigarette smoking prevalence attributable to e-cigarette use in the USA among people aged ≥45. Misperceptions about the absolute risks (ie, cigarettes are not harmful) and relative risks (ie, e-cigarettes are more harmful than cigarettes) of tobacco products may contribute to sustained smoking prevalence and hesitancy to switch from cigarettes to e-cigarettes among older adults. METHODS Participants reported cigarette use (n=8072) at Wave 5 (2018-2019) of the Population Assessment of Tobacco and Health Study. Weighted multivariable logistic regressions included six age categories (independent variable) and cigarette and e-cigarette risk perceptions (outcomes). Additional models assessed the associations between dichotomous age (≥55 vs 18-54), risk perceptions and an interaction term (independent variables) with past 12-month quit attempts and past-month e-cigarette use (outcomes). RESULTS Adults aged ≥65 were less likely than adults aged 18-24 to rate cigarettes as very/extremely harmful (p<0.05). Odds of rating e-cigarettes as more harmful than cigarettes among adults aged 55-64 and ≥65 were 1.71 (p<0.001) and 1.43 (p=0.024) greater than for adults aged 18-24. This misperception was negatively associated with past-month e-cigarette use and was stronger among adults aged ≥55 (p<0.001) than adults aged <55 (p<0.001). DISCUSSION Adults aged ≥55 are more likely to have misperceptions about the absolute and relative risks of tobacco products, which may contribute to continued smoking. Health communications targeting this age group could modify beliefs about the perceived harms of tobacco products.
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Affiliation(s)
- Dana Rubenstein
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Clinical and Translational Science Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rachel L Denlinger-Apte
- Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jennifer Cornacchione Ross
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Dana Mowls Carroll
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Clinical and Translational Science Institute, Duke University School of Medicine, Durham, North Carolina, USA
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Melero-Ollonarte JL, Lidón-Moyano C, Perez-Ortuño R, Fu M, Ballbè M, Martín-Sánchez JC, González-Marrón A, Cartanyà-Hueso À, Pascual JA, Fernández E, Martínez-Sánchez JM. Specific biomarker comparison in current smokers, e-cigarette users, and non-smokers. Addict Behav 2023; 140:107616. [PMID: 36680837 DOI: 10.1016/j.addbeh.2023.107616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/19/2022] [Accepted: 01/06/2023] [Indexed: 01/09/2023]
Abstract
INTRODUCTION This study aims to address the existing gap in the literature, while adding evidence, by comparing tobacco-specific biomarkers (cotinine and nitrosamines: NNK, NNAL, NNN), and other biomarkers of e-cigarette use (humectants: glycerol, 1,2-PD, 1,3-PD) according to five study groups. METHODS A pooling analysis including two different studies was conducted. In both analyses, we took saliva samples from smokers (n = 409) and non-smokers (n = 154), dual tobacco and e-cig users (n = 92), exclusive e-cig user with nicotine (n = 158), and exclusive e-cig users without nicotine (n = 38). We analyzed and compared the geometric means (GM) and geometric standard deviations (GSD) of the concentration of tobacco-specific biomarkers, and e-cigarette biomarkers among groups. We used log-linear models adjusted for sex and age to model the change percentage and their 95% confidence intervals. RESULTS Cotinine was significantly higher in nicotine consumers and in e-cigarette users without nicotine when compared to non-smokers. TSNAs were generally significantly lower in non-smokers and higher in nicotine consumers. NNN and NNAL were lower in e-cigarette users with nicotine comparted to smokers, and NNN was higher in e-cigarette users without nicotine when compared to non-smokers. No differences were found in humectant biomarkers between e-cigarette groups. CONCLUSIONS Although there was a reduction in TSNAs in e-cigarette exclusive users compared to smokers, and a reduction of cotinine concentrations in e-cigarette exclusive users without nicotine compared to smokers, there are still high levels of these biomarkers when compared to non-smokers, which may be a clue towards the harmful effect of e-cigarettes.
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Affiliation(s)
- Juan Luis Melero-Ollonarte
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - Cristina Lidón-Moyano
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain.
| | - Raúl Perez-Ortuño
- Group of Integrative Pharmacology and Systems Neuroscience, Neurosciences Programme, IMIM (Hospital del Mar Medical Research Institute), Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain
| | - Marcela Fu
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, l'Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Research Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Programme, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, l'Hospitalet de Llobregat, Barcelona, Spain; Department of Public Health, Mental Health, and Maternal and Child Health Nursing, Faculty of Medicine and Health Sciences - Bellvitge Campus, Universitat de Barcelona, Barcelona, Spain; Center for Biomedical Research in Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Montse Ballbè
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, l'Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Research Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Programme, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, l'Hospitalet de Llobregat, Barcelona, Spain; Center for Biomedical Research in Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Juan Carlos Martín-Sánchez
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - Adrián González-Marrón
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - Àurea Cartanyà-Hueso
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain; Group of Perinatal Epidemiology, Environmental Health, and Clinical Research, Department of Medicine, School of Health Sciences, Universitat Jaume I, Av. Vicent Sos Baynat, s/n 12071 Castelló de la Plana, Spain
| | - José A Pascual
- Group of Integrative Pharmacology and Systems Neuroscience, Neurosciences Programme, IMIM (Hospital del Mar Medical Research Institute), Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain; Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain
| | - Esteve Fernández
- Department of Clinical Sciences, Faculty of Medicine and Health Sciences - Bellvitge Campus, Universitat de Barcelona, Barcelona, Spain; Tobacco Control Research Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Programme, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, l'Hospitalet de Llobregat, Barcelona, Spain; Department of Public Health, Mental Health, and Maternal and Child Health Nursing, Faculty of Medicine and Health Sciences - Bellvitge Campus, Universitat de Barcelona, Barcelona, Spain; Center for Biomedical Research in Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Jose M Martínez-Sánchez
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain; Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, l'Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Research Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Programme, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, l'Hospitalet de Llobregat, Barcelona, Spain
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Lund I, Sæbø G. Vaping among Norwegians who smoke or formerly smoked: reasons, patterns of use, and smoking cessation activity. Harm Reduct J 2023; 20:35. [PMID: 36944994 PMCID: PMC10031918 DOI: 10.1186/s12954-023-00768-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/15/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND The majority of Norwegians who use e-cigarettes are adults who have smoked. Little is known about vaping reasons and -patterns in this group. The aim of this paper was to study vaping prevalence, patterns, and motivations among adults who smoke. Furthermore, to investigate smoking intensity and smoking cessation behaviour differences between those who vape and those who do not. METHODS This study was based on two separate Norwegian samples: People who had ever smoked, from 2017 (N = 2099), and people who currently smoked and recent quitters, from 2018/2019 (N = 1336). Measures of vape frequencies, vape motives, and smoking cessation behaviours were utilised in descriptive analyses of relationships between vaping and smoking behaviour. RESULTS Less than 1 in 10 in the ever-smoked group, 1 in 5 of the currently smoked or recently quit group, were currently vaping. Ever trial rates for vaping were much higher at 1 in 3 in the ever-smoked group, and 1 in 2 in the currently smoked or recently quit group. Dual use with combustible cigarettes was common, but people who smoked tended to use e-cigarettes less frequently while those who formerly smoked tended to use them more frequently. Both quitting attempts and smoking intensity reduction were positively associated with vaping, and the most common reasons for e-cigarette use were reported to be desires to reduce harm, to stop smoking, or to reduce smoking intensity. CONCLUSION The results indicate that Norwegians who smoke tend to see e-cigarettes as a tool to reduce or completely stop smoking. The predominance of use-motivations related to reducing harm points at the importance of conveying correct information about relative harmfulness of tobacco- and nicotine products.
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Affiliation(s)
- Ingeborg Lund
- Department for Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health (NIPH), Folkehelseinstituttet, Postboks 222, 0213, Skøyen, Oslo, Norway.
| | - Gunnar Sæbø
- Department for Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health (NIPH), Folkehelseinstituttet, Postboks 222, 0213, Skøyen, Oslo, Norway
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Wang X, Lee NL, Burstyn I. Exposure-response analysis of the association of maternal smoking and use of electronic cigarettes (vaping) in relation to preterm birth and small-for-gestational-age in a national US sample, 2016-2018. GLOBAL EPIDEMIOLOGY 2022; 4:100079. [PMID: 37637017 PMCID: PMC10446111 DOI: 10.1016/j.gloepi.2022.100079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction The US experienced a surge in use of e-cigarettes. Smoking women may consider e-cigarettes during pregnancy as an alternative to smoking. E-cigarettes typically contain nicotine, an established cause of reduction in fetal growth in animal studies. Methods This cohort study included 99,201 mothers who delivered live singletons in 2016-2018 from the Pregnancy Risk Assessment Monitoring System. We created exposure categories based on self-reported number of cigarettes smoked per day and vaping frequency and evaluated their associations with preterm birth and small-for-gestational-age (SGA) birth (two established cigarette smoking-related risks). Results Dual users in late pregnancy were a heterogeneous group: 29% lightly smoked and occasionally vaped; 19% lightly smoked and frequently vaped; 36% heavily smoked and occasionally vaped; and 15% heavily smoked and frequently vaped. While dual users who heavily smoked and occasionally vaped had the highest adjusted OR for SGA (3.4, 95% CI 2.0, 5.7), all the dual users had, on average, about twice the odds of having SGA than non-users. While the risks of preterm birth were higher among sole light smokers (adjusted OR 1.3, 95% CI 1.1, 1.5) and sole heavy smokers (adjusted OR 1.5. 95% CI 1.2, 1.8) than non-users, the adjusted odds of preterm birth for dual users were not noticeably higher than those of non-users. Conclusion Relative to non-users, both smoking and vaping during pregnancy appear to increase risk of SGA, but excess risk of preterm birth appears to be primarily attributable to smoking alone. Higher levels of exposure tended to confer more risk.
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Affiliation(s)
- Xi Wang
- PolicyLab, Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA 19146, USA
| | - Nora L. Lee
- Department of Epidemiology and Biostatistics, Drexel University, 3215 Market Street, Philadelphia, PA 19104, USA
| | - Igor Burstyn
- Department of Environmental and Occupational Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, USA
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20
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Dai HD, Leventhal AM, Khan AS. Trends in Urinary Biomarkers of Exposure to Nicotine and Carcinogens Among Adult e-Cigarette Vapers vs Cigarette Smokers in the US, 2013-2019. JAMA 2022; 328:1864-1866. [PMID: 36346420 PMCID: PMC9644255 DOI: 10.1001/jama.2022.14847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study assesses temporal trends of biomarkers among adult nicotine and nonnicotine e-cigarette users and cigarette smokers.
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Affiliation(s)
| | - Adam M. Leventhal
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles
| | - Ali S. Khan
- College of Public Health, University of Nebraska Medical Center, Omaha
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21
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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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22
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Pipe AL, Mir H. E-Cigarettes Reexamined: Product Toxicity. Can J Cardiol 2022; 38:1395-1405. [PMID: 36089290 DOI: 10.1016/j.cjca.2022.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 08/03/2022] [Accepted: 08/03/2022] [Indexed: 12/24/2022] Open
Abstract
The introduction of e-cigarettes, or electronic nicotine delivery systems (ENDS), has been accompanied by controversy regarding their safety and effectiveness as a cessation aid and by an explosion in their use by youth. Their use does not involve the combustion of tobacco and the creation of harmful combustion products; they have been seen as a "harm reduction" tool that may be of assistance in promoting smoking cessation. Recognition that ENDS can deliver an array of chemicals and materials with known adverse consequences has spurred more careful examination of these products. Nicotine, nitrosamines, carbonyl compounds, heavy metals, free radicals, reactive oxygen species, particulate matter, and "emerging chemicals of concern" are among the constituents of the heated chemical aerosol that is inhaled when ENDS are used. They raise concerns for cardiovascular and respiratory health that merit the attention of clinicians and regulatory agencies. Frequently cited concerns include evidence of disordered respiratory function, altered hemodynamics, endothelial dysfunction, vascular reactivity, and enhanced thrombogenesis. The absence of evidence of the consequences of their long-term use is of additional concern. Their effectiveness as cessation aids and beneficial impact on health outcomes continue to be examined. It is important to ensure that their production and availability are thoughtfully regulated to optimise their safety and permit their use as harm reduction devices and potentially as smoking-cessation aids. It is equally vital to effectively prevent them from becoming ubiquitous consumer products with the potential to rapidly induce nicotine addiction among large numbers of youth. Clinicians should understand the nature of these products and the implications of their use.
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Affiliation(s)
- Andrew L Pipe
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
| | - Hassan Mir
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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23
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Assessment of the exposure to polycyclic aromatic hydrocarbons in users of various tobacco/nicotine products by suitable urinary biomarkers. Arch Toxicol 2022; 96:3113-3126. [DOI: 10.1007/s00204-022-03349-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/21/2022] [Indexed: 11/02/2022]
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