1
|
Palmer AM, Rojewski AM, Carpenter MJ, Klemperer EM, Baker NL, Sanford BT, Toll BA. Interest in quitting e-cigarette use by device type and smoking history in US adults. Tob Control 2024; 33:537-540. [PMID: 36650050 PMCID: PMC10350465 DOI: 10.1136/tc-2022-057710] [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: 08/24/2022] [Accepted: 01/05/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND The use of e-cigarettes has been increasing, especially since the introduction of 'pod' devices to the marketplace since 2018. Most adults who vape report interest in quitting. The present study examined level of interest in e-cigarette cessation between users with varying cigarette smoking histories and device types. METHODS Data obtained from wave 5 (2018-2019) of the Population Assessment of Tobacco and Health study (n=34 309). Analyses were conducted on adult current established e-cigarette users, categorised on cigarette smoking history (current, former or never) and device type (disposable, cartridge/pod, tank or mod). Participants reported if they planned to ever quit e-cigarettes, attempted to quit in the past year and attempted to quit by cutting back in the past year. RESULTS Of the 2922 established e-cigarette users, 68.21% reported plans to quit vaping; 17.27% reported attempting to quit e-cigarettes in the past year; and 29.28% reported attempting to quit by cutting back in the past year. Cartridge users had higher odds of interest in quitting than tank and mod users. Disposable and cartridge users had higher odds of reporting a past year quit attempt than tank and mod users. Individuals with no smoking history had higher odds of reporting a past year quit attempt or cutting back relative to those reporting dual use (of both e-cigarettes and cigarettes) and former smoking. CONCLUSIONS Tobacco control should consider the type of e-cigarette device that is being used, alongside users' cigarette smoking history, when developing interventions and other resources for vaping cessation.
Collapse
Affiliation(s)
- Amanda M Palmer
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alana M Rojewski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Hollings Cancer Center, Medical Univeristy of South Carolina, Charleston, South Carolina, USA
| | - Matthew J Carpenter
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Hollings Cancer Center, Medical Univeristy of South Carolina, Charleston, South Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Elias M Klemperer
- Department of Psychiatry, University of Vermont, Burlington, Vermont, USA
| | - Nathaniel L Baker
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Hollings Cancer Center, Medical Univeristy of South Carolina, Charleston, South Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Brandon T Sanford
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Benjamin A Toll
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Hollings Cancer Center, Medical Univeristy of South Carolina, Charleston, South Carolina, USA
- Department of Psychiatry, University of Vermont, Burlington, Vermont, USA
| |
Collapse
|
2
|
Kock LS, Higgins ST, Heil SH. Commentary on Ussher et al.: Duration and magnitude of postpartum financial incentives for the maintenance of cigarette smoking abstinence. Addiction 2024. [PMID: 38837806 DOI: 10.1111/add.16580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 05/17/2024] [Indexed: 06/07/2024]
Affiliation(s)
- Loren S Kock
- Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont, USA
- Department of Psychiatry, University of Vermont, Burlington, Vermont, USA
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont, USA
- Department of Psychiatry, University of Vermont, Burlington, Vermont, USA
- Department of Psychological Science, University of Vermont, Burlington, Vermont, USA
| | - Sarah H Heil
- Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont, USA
- Department of Psychiatry, University of Vermont, Burlington, Vermont, USA
- Department of Psychological Science, University of Vermont, Burlington, Vermont, USA
| |
Collapse
|
3
|
Campagna D, Farsalinos K, Costantino G, Carpinteri G, Caponnetto P, Cucuzza F, Polosa R. Tobacco Smoking or Nicotine Phenotype and Severity of Clinical Presentation at the Emergency Department (SMOPHED): Protocol for a Noninterventional Observational Study. JMIR Res Protoc 2024; 13:e54041. [PMID: 38657239 PMCID: PMC11079756 DOI: 10.2196/54041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/24/2024] [Accepted: 02/19/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND In the last few years, several nicotine products have become available as alternatives to smoking tobacco. While laboratory and limited clinical studies suggest that these devices are less toxic compared to classic tobacco cigarettes, very little is known about their epidemiological impact. Visiting the emergency department (ED) often represents the first or even the only contact of patients with the health care system. Therefore, a study conducted at the ED to assess the impact of these products on health can be reliable and reflect a real-life setting. OBJECTIVE The aim of this noninterventional observational study (SMOPHED study) is to analyze the association between the severity of clinical presentation observed during ED visits among patients using various nicotine products and the subsequent outcomes, specifically hospitalization and mortality. METHODS Outcomes (hospitalization and mortality in the ED) will be examined in relation to various patterns of nicotine products use. We plan to enroll approximately 2000 participants during triage at the ED. These individuals will be characterized based on their patterns of tobacco and nicotine consumption, identified through a specific questionnaire. This categorization will allow for a detailed analysis of how different usage patterns of nicotine products correlate with the clinical diagnosis made during the ED visits and the consequent outcomes. RESULTS Enrollment into the study started in March 2024. We enrolled a total of 901 participants in 1 month (approximately 300 potential participants did not provide the informed consent to participate). The data will be analyzed by a statistician as soon as the database is completed. Full data will be published by December 2024. CONCLUSIONS There is substantial debate about the harm reduction potential of alternative nicotine products in terms of their smoking-cessation and risk-reduction potential. This study represents an opportunity to document epidemiological data on the link between the use of different types of nicotine products and disease diagnosis and severity during an ED visit, and thus evaluate the harm reduction potential claims for these products. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/54041.
Collapse
Affiliation(s)
- Davide Campagna
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Center of Excellence for the Acceleration of Harm Reduction, University of Catania, Catania, Italy
- Emergency Department, Policlinico Teaching Hospital, Catania, Italy
| | - Konstantinos Farsalinos
- Department of Public and Community Health, School of Public Health, University of West Attica, Athens, Greece
| | - Giorgio Costantino
- Scientific Institute for Research, Hospitalization and Healthcare Ca' Granda Ospedale Maggiore Policlinico, Unità Operativa Complessa Pronto Soccorso e Medicina d'Urgenza, University of Milan, Milan, Italy
| | | | - Pasquale Caponnetto
- Department of Educational Sciences, Section of Psychology, University of Catania, Catania, Italy
| | | | - Riccardo Polosa
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Center of Excellence for the Acceleration of Harm Reduction, University of Catania, Catania, Italy
| |
Collapse
|
4
|
Belderson P, Ward E, Pope I, Notley C. Selecting an e-cigarette for use in smoking cessation interventions and healthcare services: findings from patient and public consultation for the COSTED trial. BMJ Open 2024; 14:e078677. [PMID: 38443079 PMCID: PMC11146363 DOI: 10.1136/bmjopen-2023-078677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/25/2024] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVES The Cessation of Smoking Trial in the Emergency Department (COSTED) trial aims to ascertain whether brief advice, the provision of an e-cigarette starter kit and referral to stop smoking services (SSS), increases smoking cessation in people attending the emergency department. Patient and public involvement (PPI) and scoping work were undertaken to select an appropriate e-cigarette for the trial. DESIGN AND SETTING PPI consultation and feasibility scoping about potential devices with a professional and lay panel, all based in England. Consultation was via email, telephone or video interview. This work took place between April and July 2021, prior to recruitment commencing for the COSTED trial. PARTICIPANTS A professional panel (n=7) including representatives from academia, SSS and the independent vaping industry, and a PPI lay panel (n=3) who smoke or vape. RESULTS The professional panel recommended a shortlist of devices which were tested by the PPI lay panel. Key criteria for selecting an appropriate e-cigarette for smoking cessation intervention include satisfaction, usability, affordability and availability. Simplicity of use was highlighted by the PPI lay panel, who found refillable devices complex, and availability of consumables was highlighted as more important than price by both panels. The pod device selected for inclusion was rated highly for satisfaction and usability and had mid-price range and consumables which were widely available. CONCLUSIONS To select the most appropriate device for the COSTED trial, each criterion required assessment to ensure the best fit to the intervention context and needs of the target population. There is a need for guidance to help enable decision-making about choice of vape products, tailored to service users' needs. We propose a bespoke checklist template, based on our findings, to assist with this process. This has applicability to the recent government announcement of a 'Swap to Stop' programme, offering a vaping starter kit to smokers across England, allowing services flexibility to shape their own programmes and models of delivery. TRIAL REGISTRATION NUMBER Clinical trial number NCT04854616; pre-results.
Collapse
Affiliation(s)
| | - Emma Ward
- Medical School, University of East Anglia, Norwich, UK
| | - Ian Pope
- Department of Emergency Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- University of East Anglia, Norwich, UK
| | - Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich, UK
| |
Collapse
|
5
|
Gallus S, Stival C, McKee M, Carreras G, Gorini G, Odone A, van den Brandt PA, Pacifici R, Lugo A. Impact of electronic cigarette and heated tobacco product on conventional smoking: an Italian prospective cohort study conducted during the COVID-19 pandemic. Tob Control 2024; 33:267-270. [PMID: 36207129 DOI: 10.1136/tc-2022-057368] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 09/22/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Debate continues about whether electronic cigarettes (e-cigarettes) and heated tobacco products (HTP) reduce or increase the probability of smoking, with many studies compromised by stated or unstated conflicts of interest. We undertook a longitudinal study in Italy. METHODS 3185 Italian participants aged 18-74 years provided baseline (April-May) and follow-up (November-December) responses in 2020, reporting smoking status and use of e-cigarettes and HTP. We tracked transitions over that period and reported risk ratios (RR) and corresponding 95% CIs for changes in smoking in relation to baseline use of e-cigarettes and HTPs. RESULTS Never cigarette smokers who used e-cigarettes at baseline were much more likely to start smoking (compared with never users, RR 8.78; 95% CI: 5.65 to 13.65) and current HTP users (RR 5.80; 95% CI: 3.65 to 9.20). Among ex-smokers, relapse (17.2%) at follow-up was more likely among e-cigarette (RR 4.25; 95% CI: 2.40 to 7.52) and HTP users (RR 3.32; 95% CI: 2.05 to 5.37). Among current smokers at baseline, those who had continued smoking at follow-up were 85.4% overall. These were more frequently current novel product users (compared with non-users, RR 1.10; 95% CI: 1.02 to 1.19 for e-cigarette users; RR 1.17; 95% CI: 1.10 to 1.23 for HTP users). CONCLUSIONS Both e-cigarette and HTP use predict starting smoking and relapse, and appear to reduce smoking cessation. Due to the limited sample size within specific strata, the association with quitting smoking should be confirmed by larger prospective studies. These findings do not support the use of e-cigarettes and HTPs in tobacco control as a consumer product, at least in Italy.
Collapse
Affiliation(s)
- Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Chiara Stival
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Martin McKee
- London School of Hygiene & Tropical Medicine, London, UK
| | - Giulia Carreras
- Oncologic Network, Prevention and Research Institute, Florence, Italy
| | - Giuseppe Gorini
- Oncologic Network, Prevention and Research Institute, Florence, Italy
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia Faculty of Medicine and Surgery, Pavia, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Piet A van den Brandt
- Department of Epidemiology, GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
- Department of Epidemiology, CAPHRI-School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Roberta Pacifici
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy
| | - Alessandra Lugo
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| |
Collapse
|
6
|
Mercier C, Pourchez J, Leclerc L, Forest V. In vitro toxicological evaluation of aerosols generated by a 4th generation vaping device using nicotine salts in an air-liquid interface system. Respir Res 2024; 25:75. [PMID: 38317149 PMCID: PMC10845662 DOI: 10.1186/s12931-024-02697-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/22/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Electronic cigarettes (EC) have gained popularity, especially among young people, with the introduction of fourth-generation devices based on e-liquids containing nicotine salts that promise a smoother vaping experience than freebase nicotine. However, the toxicological effects of nicotine salts are still largely unknown, and the chemical diversity of e-liquids limits the comparison between different studies to determine the contribution of each compound to the cytotoxicity of EC aerosols. Therefore, the aim of this study was to evaluate the toxicological profile of controlled composition e-liquid aerosols to accurately determine the effects of each ingredient based on exposure at the air-liquid interface. METHODS Human lung epithelial cells (A549) were exposed to undiluted aerosols of controlled composition e-liquids containing various ratios of propylene glycol (PG)/vegetable glycerin (VG) solvents, freebase nicotine, organic acids, nicotine salts, and flavoured commercial e-liquids. Exposure of 20 puffs was performed at the air-liquid interface following a standard vaping regimen. Toxicological outcomes, including cytotoxicity, inflammation, and oxidative stress, were assessed 24 h after exposure. RESULTS PG/VG aerosols elicited a strong cytotoxic response characterised by a 50% decrease in cell viability and a 200% increase in lactate dehydrogenase (LDH) production, but had no effects on inflammation and oxidative stress. These effects occurred only at a ratio of 70/30 PG/VG, suggesting that PG is the major contributor to aerosol cytotoxicity. Both freebase nicotine and organic acids had no greater effect on cell viability and LDH release than at a 70/30 PG/VG ratio, but significantly increased inflammation and oxidative stress. Interestingly, the protonated form of nicotine in salt showed a stronger proinflammatory effect than the freebase nicotine form, while benzoic acid-based nicotine salts also induced significant oxidative stress. Flavoured commercial e-liquids was found to be cytotoxic at a threshold dose of ≈ 330 µg/cm². CONCLUSION Our results showed that aerosols of e-liquids consisting only of PG/VG solvents can cause severe cytotoxicity depending on the concentration of PG, while nicotine salts elicit a stronger pro-inflammatory response than freebase nicotine. Overall, aerosols from fourth-generation devices can cause different toxicological effects, the nature of which depends on the chemical composition of the e-liquid.
Collapse
Affiliation(s)
- Clément Mercier
- Mines Saint-Etienne, Université Jean Monnet, INSERM, U1059 Sainbiose, Centre CIS, Saint-Etienne, 42023, France.
| | - Jérémie Pourchez
- Mines Saint-Etienne, Université Jean Monnet, INSERM, U1059 Sainbiose, Centre CIS, Saint-Etienne, 42023, France
| | - Lara Leclerc
- Mines Saint-Etienne, Université Jean Monnet, INSERM, U1059 Sainbiose, Centre CIS, Saint-Etienne, 42023, France
| | - Valérie Forest
- Mines Saint-Etienne, Université Jean Monnet, INSERM, U1059 Sainbiose, Centre CIS, Saint-Etienne, 42023, France
| |
Collapse
|
7
|
Shruti T, Sharma P, Budukh A, Khanna D. Electronic nicotine delivery system: a narrative review on growing threat to tobacco control and health of the young Indian population. Int J Adolesc Med Health 2024; 36:17-24. [PMID: 38369380 DOI: 10.1515/ijamh-2023-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/30/2024] [Indexed: 02/20/2024]
Abstract
The electronic cigarette (EC) was developed as an alternative to cigarette smoking. In less than a decade, the prevalence of past-month EC usage increased from 1.5 to 27.5 % among US high-school students. In the coming years, Asia-Pacific countries will have the highest sales of electronic nicotine/non-nicotine delivery systems (ENDS/ENNDS) after Western Europe. Based on the World Health Organization and Indian Council of Medical Research recommendations, India approved a complete ban on EC in 2019. Even though it has been three years since the ban, EC is still being sold in India's grey markets, where marketing is not regulated. In this narrative review, we discuss that vaping is not just a harm reduction strategy for tobacco smoking cessation but poses a serious threat to India's existing tobacco control efforts as well as the health of the country's young people.
Collapse
Affiliation(s)
- Tulika Shruti
- Department of Preventive Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) and Homi Bhabha Cancer Hospital (HBCH), Tata Memorial Centres, Varanasi, India
| | - Priyanka Sharma
- Department of Preventive Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) and Homi Bhabha Cancer Hospital (HBCH), Tata Memorial Centres, Varanasi, India
| | - Atul Budukh
- Centre for Cancer Epidemiology, ACTREC, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Divya Khanna
- Department of Preventive Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) and Homi Bhabha Cancer Hospital (HBCH), Tata Memorial Centres, Varanasi, India
| |
Collapse
|
8
|
Lindson N, Butler AR, McRobbie H, Bullen C, Hajek P, Begh R, Theodoulou A, Notley C, Rigotti NA, Turner T, Livingstone-Banks J, Morris T, Hartmann-Boyce J. Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev 2024; 1:CD010216. [PMID: 38189560 PMCID: PMC10772980 DOI: 10.1002/14651858.cd010216.pub8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
BACKGROUND Electronic cigarettes (ECs) are handheld electronic vaping devices which produce an aerosol by heating an e-liquid. People who smoke, healthcare providers and regulators want to know if ECs can help people quit smoking, and if they are safe to use for this purpose. This is a review update conducted as part of a living systematic review. OBJECTIVES To examine the safety, tolerability and effectiveness of using electronic cigarettes (ECs) to help people who smoke tobacco achieve long-term smoking abstinence, in comparison to non-nicotine EC, other smoking cessation treatments and no treatment. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's Specialized Register to 1 February 2023, and Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PsycINFO to 1 July 2023, and reference-checked and contacted study authors. SELECTION CRITERIA We included trials in which people who smoke were randomized to an EC or control condition. We also included uncontrolled intervention studies in which all participants received an EC intervention as these studies have the potential to provide further information on harms and longer-term use. Studies had to report an eligible outcome. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods for screening and data extraction. Critical outcomes were abstinence from smoking after at least six months, adverse events (AEs), and serious adverse events (SAEs). We used a fixed-effect Mantel-Haenszel model to calculate risk ratios (RRs) with a 95% confidence interval (CI) for dichotomous outcomes. For continuous outcomes, we calculated mean differences. Where appropriate, we pooled data in pairwise and network meta-analyses (NMA). MAIN RESULTS We included 88 completed studies (10 new to this update), representing 27,235 participants, of which 47 were randomized controlled trials (RCTs). Of the included studies, we rated ten (all but one contributing to our main comparisons) at low risk of bias overall, 58 at high risk overall (including all non-randomized studies), and the remainder at unclear risk. There is high certainty that nicotine EC increases quit rates compared to nicotine replacement therapy (NRT) (RR 1.59, 95% CI 1.29 to 1.93; I2 = 0%; 7 studies, 2544 participants). In absolute terms, this might translate to an additional four quitters per 100 (95% CI 2 to 6 more). There is moderate-certainty evidence (limited by imprecision) that the rate of occurrence of AEs is similar between groups (RR 1.03, 95% CI 0.91 to 1.17; I2 = 0%; 5 studies, 2052 participants). SAEs were rare, and there is insufficient evidence to determine whether rates differ between groups due to very serious imprecision (RR 1.20, 95% CI 0.90 to 1.60; I2 = 32%; 6 studies, 2761 participants; low-certainty evidence). There is moderate-certainty evidence, limited by imprecision, that nicotine EC increases quit rates compared to non-nicotine EC (RR 1.46, 95% CI 1.09 to 1.96; I2 = 4%; 6 studies, 1613 participants). In absolute terms, this might lead to an additional three quitters per 100 (95% CI 1 to 7 more). There is moderate-certainty evidence of no difference in the rate of AEs between these groups (RR 1.01, 95% CI 0.91 to 1.11; I2 = 0%; 5 studies, 1840 participants). There is insufficient evidence to determine whether rates of SAEs differ between groups, due to very serious imprecision (RR 1.00, 95% CI 0.56 to 1.79; I2 = 0%; 9 studies, 1412 participants; low-certainty evidence). Due to issues with risk of bias, there is low-certainty evidence that, compared to behavioural support only/no support, quit rates may be higher for participants randomized to nicotine EC (RR 1.88, 95% CI 1.56 to 2.25; I2 = 0%; 9 studies, 5024 participants). In absolute terms, this represents an additional four quitters per 100 (95% CI 2 to 5 more). There was some evidence that (non-serious) AEs may be more common in people randomized to nicotine EC (RR 1.22, 95% CI 1.12 to 1.32; I2 = 41%, low-certainty evidence; 4 studies, 765 participants) and, again, insufficient evidence to determine whether rates of SAEs differed between groups (RR 0.89, 95% CI 0.59 to 1.34; I2 = 23%; 10 studies, 3263 participants; very low-certainty evidence). Results from the NMA were consistent with those from pairwise meta-analyses for all critical outcomes, and there was no indication of inconsistency within the networks. Data from non-randomized studies were consistent with RCT data. The most commonly reported AEs were throat/mouth irritation, headache, cough, and nausea, which tended to dissipate with continued EC use. Very few studies reported data on other outcomes or comparisons, hence, evidence for these is limited, with CIs often encompassing both clinically significant harm and benefit. AUTHORS' CONCLUSIONS There is high-certainty evidence that ECs with nicotine increase quit rates compared to NRT and moderate-certainty evidence that they increase quit rates compared to ECs without nicotine. Evidence comparing nicotine EC with usual care/no treatment also suggests benefit, but is less certain due to risk of bias inherent in the study design. Confidence intervals were for the most part wide for data on AEs, SAEs and other safety markers, with no difference in AEs between nicotine and non-nicotine ECs nor between nicotine ECs and NRT. Overall incidence of SAEs was low across all study arms. We did not detect evidence of serious harm from nicotine EC, but the longest follow-up was two years and the number of studies was small. The main limitation of the evidence base remains imprecision due to the small number of RCTs, often with low event rates. Further RCTs are underway. To ensure the review continues to provide up-to-date information to decision-makers, this review is a living systematic review. We run searches monthly, with the review updated when relevant new evidence becomes available. Please refer to the Cochrane Database of Systematic Reviews for the review's current status.
Collapse
Affiliation(s)
- Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ailsa R Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Hayden McRobbie
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Chris Bullen
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Peter Hajek
- Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Rachna Begh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Tari Turner
- Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Tom Morris
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Jamie Hartmann-Boyce
- Department of Health Promotion and Policy, University of Massachusetts, Amherst, MA, USA
| |
Collapse
|
9
|
Boulton A. New Zealand's decision to scrap anti-smoking legislation will do immeasurable harm. BMJ 2023; 383:2956. [PMID: 38110240 DOI: 10.1136/bmj.p2956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Affiliation(s)
- Amohia Boulton
- Whakauae Research for Māori Health and Development, New Zealand
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Linden J, Fletcher R. Clearing the smoke: are tobacco cessation interventions by the dental team successful? Evid Based Dent 2023; 24:190-191. [PMID: 37644194 DOI: 10.1038/s41432-023-00926-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/08/2023] [Indexed: 08/31/2023]
Abstract
AIMS This study aimed to assess the outcomes of tailored tobacco cessation interventions in a dental clinic setting over one year. DESIGN This interventional study recruited 1206 tobacco users who attended a smoking cessation clinic within an Oral Medicine Department in Bangalore, India. Baseline characteristics were recorded followed by a tailored smoking cessation intervention, delivered by trained faculty members and students. This followed the 3Es and 6As model - including a combination of personalised counselling, pharmacotherapy and one year follow up. CASE SELECTION 1206 participants were recruited. 95% were already receiving treatment within the dental hospital and 5% were walk-in patients, attempting to quit tobacco use. Participants who had been smoking or using smokeless tobacco more than twice daily for greater than 6 months were included in the study. Participants were excluded from the study if they were currently using nicotine replacement therapy (NRT) or non-NRT therapy for tobacco cessation, pregnant and lactating women, a recent history of myocardial infarction or a history of gastric ulcers. RESULTS Outcomes were categorised into the following four groups; Complete abstinence, Harm reduction (>50% reduction), No change and lost to follow up. Of the patients who completed the 12 month follow up, 18% quit tobacco use (n = 180), 34.2% reduced their tobacco usage by greater than 50% (n = 342), 41.5% exhibited no change (n = 415) and 6.2% relapsed (n = 62). Salivary nicotine levels were used to confirm self-reported abstinence. CONCLUSION This study shows that dental professional led tobacco cessation programmes can be successful in supporting patients to quit or reduce tobacco usage.
Collapse
Affiliation(s)
- John Linden
- Public Dental Officer, Howden Dental Centre, Livingston, NHS Lothian, Scotland.
| | - Rosie Fletcher
- Post Dental Core Training Fellow in OMFS, St John's Hospital, Livingston, NHS Lothian, Scotland
| |
Collapse
|
12
|
Pinho-Gomes AC, Santos JA, Jones A, Thout SR, Pettigrew S. E-cigarette attitudes and behaviours amongst 15-30-year-olds in the UK. J Public Health (Oxf) 2023; 45:e763-e775. [PMID: 37525566 PMCID: PMC10687603 DOI: 10.1093/pubmed/fdad138] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 07/08/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND The use of e-cigarettes has been rising in the UK, particularly by young people. This study investigated behaviours, attitudes and beliefs about e-cigarettes amongst 15-30-year-olds in the UK. METHODS An online survey was administered to a sample of 1009 15-30-year-olds in the UK. RESULTS About one in five participants currently used e-cigarettes at least monthly, with 1 in 10 using them daily. Amongst those using e-cigarettes at least monthly, 90% had used e-cigarettes containing nicotine. E-cigarettes were mainly obtained from vape shops and used at home. Having friends who used e-cigarettes and using them to help quit/reduce smoking were the most common reasons for vaping. About half of participants had been exposed to e-cigarette advertising, especially online, and warning labels on e-cigarettes. Most participants agreed that e-cigarettes are addictive (75%), help people quitting smoking (64%) and are bad for health (63%). Previous or current tobacco smokers were 9 and 22 times more likely to use e-cigarettes than never smokers, respectively. Perceiving e-cigarettes as harmful was associated with a 40% lower likelihood of use. CONCLUSION Raising awareness on the uncertain long-term consequences of vaping and regulation of marketing and sales are crucial to protect young people in the UK.
Collapse
Affiliation(s)
- Ana-Catarina Pinho-Gomes
- The George Institute for Global Health, School of Public Health, Imperial College London, 58 Wood Lane London, W12 7RZ, UK
- Institute of Health Informatics, University College London, 222 Euston Road London, NW1 2DA, UK
| | - Joseph A Santos
- The George Institute for Global Health, University of New South Wales, Level 5, 1 King Street Newtown 2042, Sydney, NSW, Australia
| | - Alexandra Jones
- The George Institute for Global Health, University of New South Wales, Level 5, 1 King Street Newtown 2042, Sydney, NSW, Australia
| | - Sudhir Raj Thout
- The George Institute for Global Health, 308, Third Floor, Elegance Tower, Plot No. 8, Jasola District Centre New Delhi 110025, India
| | - Simone Pettigrew
- The George Institute for Global Health, University of New South Wales, Level 5, 1 King Street Newtown 2042, Sydney, NSW, Australia
| |
Collapse
|
13
|
Monshi SS, Alqahtani MM, Alangari AS, Sinky TH, Al-Zalabani AH, Alanazi AM. The association between cultural and social occasions and smoking cessation: The case of Saudi Arabia. Tob Induc Dis 2023; 21:153. [PMID: 38026497 PMCID: PMC10655210 DOI: 10.18332/tid/174490] [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: 08/14/2023] [Revised: 10/21/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Tobacco use remains high in Saudi Arabia, necessitating an understanding of the influence of cultural and social events on smoking cessation. This study examined whether cultural and social events like Ramadan, Eids, and birthdays, motivate Saudi adults to quit smoking. METHODS Convenience sampling of 742 Saudi tobacco users was conducted between July 2021 and May 2022. A cross-sectional survey was used to assess self-reported desire to quit (1 = 'least desire' to 10 = 'highest desire') and behaviors in relation to special occasions. Multiple linear regression was performed to examine the association between cultural and social occasions and the desire to quit, while logistic regression was used to assess the relationship between cultural and social occasions and historical quit attempts, medicinal nicotine product use, visiting smoking cessation clinics, and calling the national Quitline. Demographic variables and tobacco types were controlled for in the analyses. RESULTS Considering quitting during Ramadan, Eids, and birthdays was associated with a higher desire to quit (Ramadan: B=2.99; 95% CI: 2.51-3.47, Eids: B=2.83; 95% CI: 2.12-3.54, and birthdays: B=2.76; 95% CI: 1.93-3.60, p<0.01) and a greater likelihood of past quit attempts (Ramadan: AOR=8.2; 95% CI: 5.5-12.1, Eids: AOR=5.8; 95% CI: 3.2-10.5, and birthdays: AOR=4.8; 95% CI: 2.4-9.4). Only considering quitting during Ramadan was associated with calling the national Quitline (AOR=2.9; 95% CI: 1.8-4.9). CONCLUSIONS Cultural and social events like Ramadan and Eids motivate adults in Saudi Arabia to attempt tobacco cessation. Targeting interventions around meaningful cultural occasions may promote successful quitting. These findings highlight the importance of understanding cultural and religious influences on cessation behaviors in Saudi Arabia and in other countries.
Collapse
Affiliation(s)
- Sarah S Monshi
- Department of Health Services Management, College of Public Health and Health Informatics, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Mohammed M Alqahtani
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Abdulaziz S Alangari
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Tassnym H Sinky
- Department of Health Promotion and Education, College of Public Health and Health Informatics, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Abdulmohsen H Al-Zalabani
- Department of Family and Community Medicine, College of Medicine, Taibah University, Medina, Saudi Arabia
| | - Abdullah M Alanazi
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| |
Collapse
|
14
|
Trigg J, Rich J, Williams E, Gartner CE, Guillaumier A, Bonevski B. Perspectives on limiting tobacco access and supporting access to nicotine vaping products among clients of residential drug and alcohol treatment services in Australia. Tob Control 2023:tc-2023-058094. [PMID: 37821220 DOI: 10.1136/tc-2023-058094] [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: 04/04/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Tobacco endgame strategies aim to drive down population smoking rates, the success of which can be improved with public buy-in, including from populations with high smoking rates such as alcohol and other drug (AOD) service clients. This study aimed to explore acceptability of tobacco retail and nicotine reduction, and subsidised nicotine vaping to support AOD service clients following a smoking cessation attempt. METHODS We interviewed 31 Australian AOD service clients who currently or previously smoked, following a 12-week randomised trial comparing nicotine replacement therapy with nicotine vaping product (NVP) for smoking cessation. Participants were asked how effectively three scenarios would support tobacco cessation: tobacco retailer reduction, very low-nicotine cigarette standard and subsidised NVP access. We thematically analysed participant views on how each approach would support tobacco abstinence. RESULTS Tobacco retailer reduction raised concerns about increasing travel and accessing cigarettes from alternate sources, with generally lower acceptability, though a range of perspectives were provided. Reducing nicotine in tobacco products was described as reducing appeal of smoking and potentially increasing illicit purchases of non-reduced nicotine products. Clients of AOD services were highly accepting of subsidised NVP access for tobacco cessation, as this would partly address financial and socioeconomic barriers. CONCLUSIONS Australian tobacco control policy should consider how these approaches impact ease and likelihood of tobacco access by AOD service clients in relation to the general population. Understanding clients' acceptability of tobacco control and endgame measures can inform how to avoid potential unintended consequences for these clients.
Collapse
Affiliation(s)
- Joshua Trigg
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Jane Rich
- School of Medicine and Public Health, College of Medicine, Health and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Edwina Williams
- School of Medicine and Public Health, College of Medicine, Health and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Coral E Gartner
- School of Public Health, Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Ashleigh Guillaumier
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Billie Bonevski
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| |
Collapse
|
15
|
Song MA, Mori KM, McElroy JP, Freudenheim JL, Weng DY, Reisinger SA, Brasky TM, Wewers MD, Shields PG. Accelerated epigenetic age, inflammation, and gene expression in lung: comparisons of smokers and vapers with non-smokers. Clin Epigenetics 2023; 15:160. [PMID: 37821974 PMCID: PMC10568901 DOI: 10.1186/s13148-023-01577-8] [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: 03/11/2023] [Accepted: 10/01/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Cigarette smoking and aging are the main risk factors for pulmonary diseases, including cancer. Epigenetic aging may explain the relationship between smoking, electronic cigarette vaping, and pulmonary health. No study has examined smoking and vaping-related epigenetic aging in relation to lung biomarkers. METHODS Lung epigenetic aging measured by DNA methylation (mAge) and its acceleration (mAA) was assessed in young (age 21-30) electronic cigarette vapers (EC, n = 14, including 3 never-smoking EC), smokers (SM, n = 16), and non-EC/non-SM (NS, n = 39). We investigated relationships of mAge estimates with chronological age (Horvath-mAge), lifespan/mortality (Grim-mAge), telomere length (TL-mAge), smoking/EC history, urinary biomarkers, lung cytokines, and transcriptome. RESULTS Compared to NS, EC and SM had significantly older Grim-mAge, shorter TL-mAge, significantly accelerated Grim-mAge and decelerated TL-mAge. Among SM, Grim-mAA was associated with nicotine intake and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL). For EC, Horvath-mAA was significantly correlated with puffs per day. Overall, cytokines (IL-1β, IL-6, and IL-8) and 759 transcripts (651 unique genes) were significantly associated with Grim-mAA. Grim-mAA-associated genes were highly enriched in immune-related pathways and genes that play a role in the morphology and structures of cells/tissues. CONCLUSIONS Faster lung mAge for SM is consistent with prior studies of blood. Faster lung mAge for EC compared to NS indicates possible adverse pulmonary effects of EC on biological aging. Our findings support further research, particularly on epigenetic markers, on effects of smoking and vaping on pulmonary health. Given that most EC are former smokers, further study is needed to understand unique effects of electronic cigarettes on biological aging.
Collapse
Affiliation(s)
- Min-Ae Song
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, 404 Cunz Hall, 1841 Neil Ave., Columbus, OH, 43210, USA.
| | - Kellie M Mori
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, 404 Cunz Hall, 1841 Neil Ave., Columbus, OH, 43210, USA
| | - Joseph P McElroy
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Jo L Freudenheim
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Daniel Y Weng
- Comprehensive Cancer Center, The Ohio State University and James Cancer Hospital, Columbus, OH, USA
| | - Sarah A Reisinger
- Comprehensive Cancer Center, The Ohio State University and James Cancer Hospital, Columbus, OH, USA
| | - Theodore M Brasky
- Comprehensive Cancer Center, The Ohio State University and James Cancer Hospital, Columbus, OH, USA
| | - Mark D Wewers
- Comprehensive Cancer Center, The Ohio State University and James Cancer Hospital, Columbus, OH, USA
| | - Peter G Shields
- Comprehensive Cancer Center, The Ohio State University and James Cancer Hospital, Columbus, OH, USA
| |
Collapse
|
16
|
Qureshi MA, Vernooij RWM, La Rosa GRM, Polosa R, O'Leary R. Respiratory health effects of e-cigarette substitution for tobacco cigarettes: a systematic review. Harm Reduct J 2023; 20:143. [PMID: 37794458 PMCID: PMC10552385 DOI: 10.1186/s12954-023-00877-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 09/24/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND E-cigarettes (electronic nicotine delivery system, ENDS) have been presented as a harm reduction strategy for people who smoke tobacco cigarettes but who cannot achieve abstinence, or for those who wish to continue to enjoy nicotine and the habit of smoking. What are the health effects of the substitution of ENDS for tobacco cigarettes? This systematic review evaluates the evidence of human clinical tests on the respiratory effects of ENDS use in participants who smoke tobacco cigarettes. METHODS A registered and published protocol was developed conforming to PRISMA 2020 and AMSTAR2 standards. The literature search was conducted in PubMed, Scopus, and the CENTRAL Cochrane Library and updated to May 2022. Three supplementary searches and a grey literature search were performed. Studies were evaluated with the JBI quality tools and the Oxford Catalogue of Bias. Due to the heterogeneity (diversity) of the studies, a narrative data synthesis was performed on the test findings plus three sub-group analyses. RESULTS The review consists of sixteen studies and twenty publications. Spirometry tests comprised the majority of the data. In total, 66 respiratory test measurements were reported, out of which 43 (65%) were not significant. Statistically significant findings were mixed, with 9 tests showing improvements and 14 measuring declines, none of which was clinically relevant. Ten studies were rated at a high risk of bias, and six had some concerns primarily due to inadequate research designs and the conduct of the studies. Reporting bias was documented in thirteen studies. CONCLUSIONS Most of the studies showed no difference in respiratory parameters. This indicates that ENDS substitution for smoking likely does not result in additional harm to respiratory health. Due to the low quality of the studies, confidence in the conclusions is rated as low. Robust studies with a longer duration and sufficient power are required to validate any potential benefits or possible harms of ENDS substitution. Registration PROSPERO #CRD42021239094, International Registered Report Identifier (IRRID): DERR1-10.2196/29084.
Collapse
Affiliation(s)
- Maria Ahmed Qureshi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Centre of Excellence for the Acceleration of Harm Reduction, University of Catania, Via Santa Sofia, 89 Torre Biologica 11 Piano, 95123, Catania, Italy
| | - Robin W M Vernooij
- Department of Nephrology and Hypertension, University Medical Center Utrecht and Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands
| | | | - Riccardo Polosa
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Centre of Excellence for the Acceleration of Harm Reduction, University of Catania, Via Santa Sofia, 89 Torre Biologica 11 Piano, 95123, Catania, Italy
| | - Renee O'Leary
- Centre of Excellence for the Acceleration of Harm Reduction, University of Catania, Via Santa Sofia, 89 Torre Biologica 11 Piano, 95123, Catania, Italy.
| |
Collapse
|
17
|
Fearon IM. Human abuse liability assessment of e-cigarettes: Why, what and how? Drug Test Anal 2023; 15:1211-1221. [PMID: 35302289 DOI: 10.1002/dta.3251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/04/2022] [Accepted: 02/08/2022] [Indexed: 11/12/2022]
Abstract
Cigarette smoking is the world's leading cause of preventable death and disease. Alternative nicotine products such as e-cigarettes have tobacco harm reduction potential, by providing smokers with an alternative form of nicotine delivery but with either the reduced presence or absence of the numerous harmful chemicals found in combustible cigarette smoke. One aspect of importance in determining the potential of e-cigarettes to provide a viable alternative to combustible cigarettes for smokers is their ability to cause dependence, also known as their abuse liability. E-cigarettes with little or no abuse liability would be unlikely to be used as a substitute for cigarettes, whereas at least some degree of abuse liability is acknowledged as supportive both to aiding cigarette substitution or complete cessation and to preventing relapse. Given this link between abuse liability and substitution efficacy, human studies assessing the abuse liability of e-cigarettes are important to determine their true harm reduction potential. In this review, the concept of tobacco product abuse liability is discussed, along with the primary elements-pharmacokinetics and pharmacodynamics (subjective effects)-that need to be assessed to determine abuse liability. The review also presents a number of human abuse liability study design considerations and discusses what existing studies in the literature tell us about the abuse liability and harm reduction potential of e-cigarettes.
Collapse
|
18
|
Fearon IM, Seltzer RGN, Houser TL, Tope A, Cahours X, Verron T, Malt L, Nahde T, O'Connell G, Nides M. Curiosity and intentions to use myblu e-cigarettes and an examination of the 'gateway' theory: Data from cross-sectional nationally representative surveys. Drug Test Anal 2023; 15:1257-1269. [PMID: 36876729 DOI: 10.1002/dta.3450] [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: 04/13/2022] [Revised: 01/19/2023] [Accepted: 01/29/2023] [Indexed: 03/07/2023]
Abstract
Encouraging adult smokers who are uninterested or unwilling to quit, and would otherwise continue to smoke, to transition to potentially less harmful nicotine products such as electronic nicotine delivery systems (ENDS) may positively impact population health. However, counterbalancing this benefit is the societal concern that ENDS may be used by never smokers and youth and serve as a 'gateway' into cigarette smoking. Data were analysed from two independent surveys of the prevalence and perceptions of myblu ENDS use in the United States. Total sample size was 22,232 young adults and 23,264 adults. Being curious to use myblu was 1.6-2.0 times more likely in young adult current smokers than young adult never smokers. This likelihood was 2.8 times greater for adult current smokers compared with adult never smokers in the perceptions survey, while in the prevalence survey, there was no difference between adult current and never smokers. Intentions to use myblu were significantly greater in young adult current smokers compared with young adult never smokers in both surveys and in adults in the prevalence survey. In all surveys and age cohorts, 124 of 45,496 participants (0.1% of the total survey population) reported first using myblu prior to smoking cigarettes and went on to become established smokers. Curiosity and intentions to use myblu were generally higher in current smokers compared with never smokers. There was minimal evidence to suggest the existence of a 'gateway' effect to established cigarette smoking among never-smoking myblu users.
Collapse
Affiliation(s)
| | | | - Trisha L Houser
- Houser Clinical Research Writing and Consulting, LLC, Durham, North Carolina, USA
| | | | | | | | | | - Thomas Nahde
- Reemtsma Cigarettenfabriken GmbH, Hamburg, Germany
| | | | | |
Collapse
|
19
|
Nian T, Guo K, Liu W, Deng X, Hu X, Xu M, E F, Wang Z, Song G, Yang K, Li X, Shang W. Non-pharmacological interventions for smoking cessation: analysis of systematic reviews and meta-analyses. BMC Med 2023; 21:378. [PMID: 37775745 PMCID: PMC10542700 DOI: 10.1186/s12916-023-03087-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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 09/20/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Although non-pharmacological smoking cessation measures have been widely used among smokers, current research evidence on the effects of smoking cessation is inconsistent and of mixed quality. Moreover, there is a lack of comprehensive evidence synthesis. This study seeks to systematically identify, describe, and evaluate the available evidence for non-pharmacological interventions in smoking populations through evidence mapping (EM), and to search for best-practice smoking cessation programs. METHODS A comprehensive search for relevant studies published from the establishment of the library to January 8, 2023, was conducted in PubMed, Web of Science, Embase, the Cochrane Library, CNKI, CBM, Wan Fang, and VIP. Two authors independently assessed eligibility and extracted data. The PRISMA statement and AMSTAR 2 tool were used to evaluate the report quality and methodology quality of systematic reviews/meta-analyses (SRs/MAs), respectively. Bubble plots were utilized to display information, such as the study population, intervention type, evidence quality, and original study sample size. RESULTS A total of 145 SRs/MAs regarding non-pharmacological interventions for smoking cessation were investigated, with 20 types of interventions identified. The most commonly used interventions were cognitive behaviour education (n = 32, 22.07%), professional counselling (n = 20, 13.79%), and non-nicotine electronic cigarettes (e-cigarettes) (n = 13, 8.97%). Among them, counselling and behavioural support can improve smoking cessation rates, but the effect varies depending on the characteristics of the support provided. These findings are consistent with previous SRs/MAs. The general population (n = 108, 74.48%) was the main cohort included in the SRs/MAs. The total score of PRISMA for the quality of the reports ranged from 8 to 27, and 13 studies (8.97%) were rated as high confidence, and nine studies (6.21%) as moderate confidence, in the AMSTAR 2 confidence rating. CONCLUSIONS The abstinence effect of cognitive behaviour education and money incentive intervention has advantages, and non-nicotine e-cigarettes appear to help some smokers transition to less harmful replacement tools. However, the methodological shortcomings of SRs/MAs should be considered. Therefore, to better guide future practice in the field of non-pharmacological smoking cessation, it is essential to improve the methodological quality of SRs and carry out high-quality randomized controlled trials (RCTs).
Collapse
Affiliation(s)
- Tao Nian
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
| | - Kangle Guo
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
| | - Wendi Liu
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
| | - Xinxin Deng
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
| | - Xiaoye Hu
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
| | - Meng Xu
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
| | - Fenfen E
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
| | - Ziyi Wang
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
| | - Guihang Song
- Gansu Provincial Medical Security Bureau, Lanzhou, 730000, People's Republic of China
| | - Kehu Yang
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
- Vidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, People's Republic of China
| | - Xiuxia Li
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
| | - Wenru Shang
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China.
- Vidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, People's Republic of China.
- Collaborative Innovation Center of First Hospital, Lanzhou University, Lanzhou, 730000, People's Republic of China.
| |
Collapse
|
20
|
Goulette MR, Gravely S, Xu SS, Meng G, Quah AC, Lee S, Cho SI, Kim Y, Lim S, Bansal-Travers M, Hyland A, Fong GT, Seo HG. Perceptions of harmfulness of heated tobacco and nicotine vaping products compared to cigarettes, and the association of advertising exposure on harm perceptions among adults who smoke in South Korea: Cross-sectional findings from the 2020 ITC Korea Survey. Tob Induc Dis 2023; 21:121. [PMID: 37781238 PMCID: PMC10535845 DOI: 10.18332/tid/170252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 10/03/2023] Open
Abstract
INTRODUCTION Heated tobacco products (HTPs) and nicotine vaping products (NVPs) both are legal consumer products in the Republic of Korea. Little is known about perceptions of harmfulness of HTPs and NVPs relative to cigarettes in South Korea among adults who smoke, and how exposure to marketing may be associated with harmfulness perceptions. METHODS This study used data from the 2020 International Tobacco Control (ITC) Korea Survey, and included 3713 adult (aged 19 years) cigarette smokers who were: 1) exclusive smokers (n=1845); 2) dual HTP + cigarette consumers (n=1130); 3) dual NVP + cigarette consumers (n=224); and 4) triple consumers (all three products, n=514). Weighted multinomial regression models were conducted to estimate smokers' perceptions of harmfulness of HTPs and NVPs compared to cigarettes, NVPs to HTPs, and self-reported exposure to HTP/NVP advertising. Analyses compared the perceptions of harmfulness between the four different consumer groups, and tested whether exposure to HTP/NVP advertising was associated with perceptions of lower relative harm. RESULTS Among all respondents, 27.5% believe that HTPs are less harmful than cigarettes and 23.4% believe that NVPs are less harmful than cigarettes. Exclusive cigarettes smokers were significantly less likely to perceive that HTPs and NVPs are less harmful than cigarettes compared to dual HTP + cigarette consumers, dual NVP + cigarette consumers, and triple consumers (all p<0.001). Half of respondents perceive NVPs as equally harmful as HTPs (14.1% perceive NVPs as more harmful than HTPs). Exposure to HTP/NVP advertising was associated with perceiving these products as less harmful than cigarettes. CONCLUSIONS About one-quarter of Korean cigarette smokers perceive HTPs and NVPs as less harmful than cigarettes. Further investigation is required to understand how harm perceptions and HTP/NVP advertising are related to changes in product use, such as switching between products, using multiple products, or discontinuing all product use.
Collapse
Affiliation(s)
- Michelle R. Goulette
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, United States
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Steve S. Xu
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Gang Meng
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Anne C.K. Quah
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Sungkyu Lee
- Korea Center for Tobacco Control Research and Education, Seoul, Republic of Korea
| | - Sung-il Cho
- Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Yeol Kim
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang-si, Republic of Korea
| | - Sujin Lim
- National Tobacco Control Center, Korean Health Promotion Institute, Seoul, Republic of Korea
| | - Maansi Bansal-Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, United States
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, United States
| | - Geoffrey T. Fong
- Department of Psychology, University of Waterloo, Waterloo, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
- Ontario Institute for Cancer Research, Toronto, Canada
| | - Hong G. Seo
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang-si, Republic of Korea
| |
Collapse
|
21
|
Notley C, Barry S, Parrott S. Do respiratory physicians not care about people who smoke? Clin Med (Lond) 2023; 23:531-532. [PMID: 37775168 PMCID: PMC10541277 DOI: 10.7861/clinmed.2023-0270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
Nicotine containing vapes (e-cigarettes) are an effective tool to support people who smoke to quit tobacco. Despite this clinicians are wary of promoting vaping to their patients due to concerns that there may not be 'enough' evidence and about youth uptake of vaping. In this opinion article we discuss clinicians' views of vaping and consider the implications that harm misperceptions may have for public health.
Collapse
Affiliation(s)
- Caitlin Notley
- Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Simon Barry
- Cardiff and Vale University Health Board and Lead, National Respiratory Health Implementation Group, Wales
| | | |
Collapse
|
22
|
Sreeramareddy CT, Shroff SM, Gunjal S. Nicotine dependence and associated factors among persons who use electronic e-cigarettes in Malaysia - an online survey. Subst Abuse Treat Prev Policy 2023; 18:51. [PMID: 37644524 PMCID: PMC10466701 DOI: 10.1186/s13011-023-00558-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/05/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Nicotine dependence, factors associated with dependence, and self-reported side effects among people who use e-cigarettes are scarce in developing countries. METHODS A sample of 302 persons who currently use e-cigarettes was recruited from discussion forums on Reddit, Facebook, and the forum 'lowyat'. The online Google form survey collected data on demographics, e-cigarette use, and the reasons, for cigarette smoking, Fagerstorm Test for Nicotine Dependence adapted for e-cigarettes (eFTND), and side effects experienced. RESULTS The mean age was 25.5 years (6.5), 60.6% were males and 86% had higher education. About 47% were using e-cigarettes only, 27.8% were currently using dual products (both electronic and conventional cigarettes), and 25.2% had also smoked cigarettes in the past. 'Less harmful than cigarettes' (56.3%), 'because I enjoy it' (46.7%), and 'it has a variety of flavors (40.4%) were the common reasons for e-cigarette use. The mean eFTND score was 3.9 (SD = 2.2), with a median of four side effects (IQR 3-6), sore or dry mouth/throat (41.4%), cough 33.4%, headache (20.5%), dizziness (16.2%) were commonly reported side effects. eFTND score and side effects were higher among persons using dual products. By multiple linear regression analysis, males (β = 0.56 95% CI 0.45, 1.05, p = 0.033), dual-use (β = 0.95 95% CI 0.34, 1.56, p < 0.003), and use of nicotine-containing e-cigarettes (β = 0.66 95% CI 0.07, 1.25 p = 0.024) had higher eFTND score. CONCLUSION Our findings of the study call for the placement of disclaimers about possible nicotine addiction and side effects of e-cigarette products.
Collapse
Affiliation(s)
| | - Sameeha Misriya Shroff
- School of Postgraduate Studies, International Medical University, Kuala Lumpur, Malaysia
| | - Shilpa Gunjal
- Clinical Oral Health Sciences, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| |
Collapse
|
23
|
Nottage MK, Taylor EV, Kim Y, Soh N, Hammond D, Simonavicius E, McNeill A, Arnott D, East K. Marketing claims on the websites of leading e-cigarette brands in England. Tob Control 2023:tc-2023-057934. [PMID: 37402577 DOI: 10.1136/tc-2023-057934] [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: 01/11/2023] [Accepted: 06/26/2023] [Indexed: 07/06/2023]
Abstract
INTRODUCTION Exposure to electronic cigarette (EC) marketing is associated with EC use, particularly among youth. In England, the Tobacco and Related Products Regulations and Committee of Advertising Practice (CAP) regulate EC marketing to reduce appeal to youth; however, there are little published data on EC marketing claims used online. This study therefore provides an overview of marketing claims present on the websites of EC brands popular in England. METHODS From January to February 2022, a content analysis of 10 of England's most popular EC brand websites was conducted, including violation of CAP codes. RESULTS Of the 10 websites, all presented ECs as an alternative to smoking, 8 as a smoking cessation aid and 6 as less harmful than smoking. Four websites presented ECs as risk-free. All mentioned product quality, modernity, convenience, sensory experiences and vendor promotions. Nine featured claims about flavours, colours, customisability and nicotine salts. Seven featured claims concerning social benefits, personal identity, sustainability, secondhand smoke and nicotine strength. Six featured claims about fire safety. Some claimed ECs are cheaper than tobacco (n=5), cited health professionals (n=4) or featured collaborations with brands/icons (n=4). All were assessed by the research team to violate one or more CAP code(s) by featuring medicinal claims (n=8), contents which may appeal to non-smokers (n=7), associations with youth culture (n=6), depictions of youth using ECs (n=6) or media targeting youth (n=5). CONCLUSION Among 10 top EC brand websites in England, marketing elements that might appeal to youth were commonly identified and CAP code compliance was low.
Collapse
Affiliation(s)
| | | | - Yebin Kim
- Addictions Department, King's College London, London, UK
| | - Nicole Soh
- Addictions Department, King's College London, London, UK
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Ann McNeill
- Addictions Department, King's College London, London, UK
- Shaping Public Health Policies to Reduce Inequalities and Harm (SPECTRUM) Consortium, Edinburgh, UK
| | | | - Katherine East
- Addictions Department, King's College London, London, UK
| |
Collapse
|
24
|
Przulj D, Pesola F, Myers Smith K, McRobbie H, Coleman T, Lewis S, Griffith C, Walton R, Whitemore R, Clark M, Ussher M, Sinclair L, Seager E, Cooper S, Bauld L, Naughton F, Sasieni P, Manyonda I, Hajek P. Helping pregnant smokers quit: a multi-centre randomised controlled trial of electronic cigarettes versus nicotine replacement therapy. Health Technol Assess 2023; 27:1-53. [PMID: 37840301 PMCID: PMC10599072 DOI: 10.3310/agth6901] [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] [Indexed: 10/17/2023] Open
Abstract
Background Some pregnant smokers try e-cigarettes, but effectiveness and safety of such use are unknown. Objectives To compare effectiveness and safety of nicotine patches and e-cigarettes in pregnancy. Design A pragmatic multi-centre randomised controlled trial. Setting Twenty-three hospitals across England, and a Stop Smoking Service in Scotland. Participants One thousand one hundred and forty pregnant daily smokers (12-24 weeks' gestation) motivated to stop smoking, with no strong preference for using nicotine patches or e-cigarettes. Interventions Participants in the e-cigarette arm were posted a refillable e-cigarette device with two 10 ml bottles of tobacco-flavoured e-liquid (18 mg nicotine). Participants in the nicotine patches arm were posted a 2-week supply of 15 mg/16-hour nicotine patches. Supplies were provided for up to 8 weeks. Participants sourced further supplies themselves as needed. Participants in both arms received support calls prior to their target quit date, on the quit date, and weekly for the next 4 weeks. Outcome measures The primary outcome was validated prolonged abstinence at the end of pregnancy. Participants lost to follow-up or not providing biochemical validation were included as non-abstainers. Secondary outcomes included self-reported abstinence at different time points, treatment adherence and safety outcomes. Results Only 55% of self-reported abstainers mailed back useable saliva samples. Due to this, validated sustained abstinence rates were low (6.8% vs. 4.4% in the e-cigarettes and nicotine patches arms, respectively, risk ratio = 1.55, 95% confidence interval 0.95 to 2.53; Bayes factor = 2.7). In a pre-specified sensitivity analysis that excluded abstainers using non-allocated products, the difference became significant (6.8% vs. 3.6%, risk ratio = 1.93, 95% confidence interval 1.14 to 3.26; Bayes factor = 10). Almost a third of the sample did not set a target quit date and the uptake of support calls was low, as was the initial product use. At end of pregnancy, 33.8% versus 5.6% of participants were using their allocated product in the e-cigarettes versus nicotine patches arm (risk ratio = 6.01, 95% confidence interval 4.21 to 8.58). Regular use of e-cigarettes in the nicotine patches arm was more common than use of nicotine replacement products in the e-cigarette arm (17.8% vs. 2.8%). Rates of adverse events and adverse birth outcomes were similar in the two study arms, apart from participants in the e-cigarette arm having fewer infants with low birthweight (<2500 g) (9.6% vs. 14.8%, risk ratio = 0.65, 95% confidence interval 0.47 to 0.90; Bayes factor = 10.3). Limitations Low rates of validation reduced the study power. A substantial proportion of participants did not use the support on offer sufficiently to test its benefits. Sample size may have been too small to detect differences in less frequent adverse effects. Conclusions E-cigarettes were not significantly more effective than nicotine patches in the primary analysis, but when e-cigarettes use in the nicotine patches arm was accounted for, e-cigarettes were almost twice as effective as patches in all abstinence outcomes. In pregnant smokers seeking help, compared to nicotine patches, e-cigarettes are probably more effective, do not pose more risks to birth outcomes assessed in this study and may reduce the incidence of low birthweight. Future work Routine monitoring of smoking cessation and birth outcomes in pregnant women using nicotine patches and e-cigarettes and further studies are needed to confirm these results. Trial registration This trial is registered as ISRCTN62025374 and Eudract 2017-001237-65. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 13. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Dunja Przulj
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Francesca Pesola
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Katie Myers Smith
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Hayden McRobbie
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Tim Coleman
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Sarah Lewis
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Christopher Griffith
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Robert Walton
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | | | - Miranda Clark
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Michael Ussher
- Population Health Research Institute, St George's University of London, London, UK; Institute of Social Marketing and Health, University of Stirling, Stirling, UK
| | - Lesley Sinclair
- Usher Institute and SPECTRUM Consortium, Centre for Population Health Sciences, Old Medical School, Edinburgh, UK
| | - Emily Seager
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Sue Cooper
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Linda Bauld
- Usher Institute and SPECTRUM Consortium, Centre for Population Health Sciences, Old Medical School, Edinburgh, UK
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Peter Sasieni
- The Cancer Research UK and King's College London Cancer Prevention Trials Unit, King's College London, Institute of Psychiatry, London, UK
| | - Isaac Manyonda
- St George's University Hospital NHS Foundation Trust, London, UK
| | - Peter Hajek
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| |
Collapse
|
25
|
Campion J, Johnston G, Shiers D, Chew-Graham C. Why should we prioritise smoking cessation for people with mental health conditions? Br J Gen Pract 2023; 73:251-253. [PMID: 37230792 PMCID: PMC10229168 DOI: 10.3399/bjgp23x732921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Affiliation(s)
- Jonathan Campion
- South London and Maudsley NHS Foundation Trust, London, UK; Clinical and Strategic Codirector of Public Mental Health Implementation Centre, Royal College of Psychiatrists, London, UK; Public Mental Health Advisor, World Health Organization Europe; Chair of Public Mental Health Working Group, World Psychiatric Association; Honorary Professor of Public Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - David Shiers
- Psychosis Research Unit, Greater Manchester Mental Health NHS Trust, Manchester, UK; Honorary Reader in early psychosis, Division of Psychology and Mental Health, University of Manchester, Manchester, UK; Honorary Senior Research Fellow, School of Medicine, Keele University, Keele, UK
| | - Carolyn Chew-Graham
- GP, Manchester, UK; Professor of General Practice Research, School of Medicine, Keele University, Keele, UK
| |
Collapse
|
26
|
Vuong JT, Ruedisueli I, Beaudin CS, Middlekauff HR. Electronic Cigarettes: an Overlooked Tool to Alleviate Disparities in Tobacco Use Disorder Among People with Mental Health and Substance Use Disorders. J Gen Intern Med 2023; 38:1970-1974. [PMID: 36952082 PMCID: PMC10271991 DOI: 10.1007/s11606-023-08137-z] [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] [Received: 11/14/2022] [Accepted: 03/01/2023] [Indexed: 03/24/2023]
Abstract
The remarkable decline in cigarette smoking since 1964 has plateaued; approximately 12.5% of Americans still smoke. People who continue to smoke are largely members of marginalized groups, such as people with behavioral health conditions (BHC), encompassing both mental health and substance use disorders. Certified smoking cessation interventions can increase smoking abstinence in trials in people with BHC, yet smoking rates remain markedly increased, leading to increased mortality from smoking-related diseases, and worsening health disparities. A novel approach tailored to the unique needs, characteristics, and circumstances of people with BHC is mandated. One promising approach, the electronic cigarette, has not been embraced in the USA, likely due to an understandable concern for non-smoking young people among whom electronic cigarettes have been popular. Recent data confirm that electronic cigarette use is declining among young people, yet cigarette smoking is not declining among people with BHC. We propose smoking cessation trials utilizing electronic cigarettes in people with BHC. To this goal, the UK has already begun allowing companies to submit their products for approval as medically licensed electronic cigarettes that can be prescribed as smoking cessation aids. Our proposal is timely, backed by evidence, and aims to save hundreds of thousands of American lives.
Collapse
Affiliation(s)
- Jacqueline T Vuong
- Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Isabelle Ruedisueli
- Division of Cardiology, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
- Department of Physiology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Catherine S Beaudin
- Division of Cardiology, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Holly R Middlekauff
- Division of Cardiology, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
- Department of Physiology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
| |
Collapse
|
27
|
Jayes L, Waddingham J, Britton J, Murray R. A Qualitative Study of the Implementation and Continued Delivery of Complete and Partial Smoke-Free Policies Across England's Prison Estate. Nicotine Tob Res 2023; 25:1099-1108. [PMID: 36629042 PMCID: PMC10202636 DOI: 10.1093/ntr/ntac296] [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: 03/30/2022] [Revised: 10/17/2022] [Accepted: 01/10/2023] [Indexed: 01/12/2023]
Abstract
INTRODUCTION In the United Kingdom, smoking among prisoners is up to five times more prevalent than the national average. Between 2015 and 2018, HMPPS introduced a complete smoke-free policy in all closed prisons, and a partial policy permitting smoking only in smoking shelters in open prisons. AIMS AND METHODS This study aimed to explore the views of stakeholders regarding the implementation and continuation of smoke-free policies, including the management of nicotine addiction during imprisonment and after release. Individuals with key strategic and/or operational roles in delivering smoke-free prison policies across England were purposively sampled to complete a semi-structured interview. Twenty-eight interviews were analyzed thematically. RESULTS The smoke-free implementation across the closed prison estate was viewed as a success, though there were reports of reduced availability of smoking cessation support since the roll out. Participants thought the majority of tobacco smokers living in closed prison environments were now using an electronic cigarette, typically as a temporary means to manage nicotine addiction until release. In open prisons the partial policy has been less successful; high rates of smoking resumption on moving from closed to open conditions were reported, with many participants arguing that the open estate should also go completely smoke free. It was envisaged that most prisoners would resume smoking on community release. CONCLUSIONS The smoke-free policies provide a unique opportunity to promote lifelong cessation in this highly disadvantaged group. However more could be done to adopt a consistent smoke-free policy across all prisons, and to support prisoners in quitting smoking and nicotine use during and after imprisonment. IMPLICATIONS Our results identify the urgent need for more work to explore rates and reasons for relapse to smoking on transfer to the open estate and after release. With the majority of smokers in the closed prison estate now using e-cigarettes to manage their nicotine addiction, one way to support long-term tobacco abstinence could be to place greater emphasis on this switching behavior as a way of reducing tobacco-related harm within this population.
Collapse
Affiliation(s)
- Leah Jayes
- Institute of Health and Allied Professions, Nottingham Trent University, Clifton Campus, Nottingham NG11 8NS, UK
| | - Jessica Waddingham
- JJR Macleod Centre for Diabetes, Endocrinology and Metabolism, NHS Grampian, Aberdeen, UK
| | - John Britton
- Population and Lifespan Sciences, School of Medicine, The University of Nottingham, Nottingham, UK
| | - Rachael Murray
- Population and Lifespan Sciences, School of Medicine, The University of Nottingham, Nottingham, UK
| |
Collapse
|
28
|
Perez MF, Yurieva M, Poddutoori S, Mortensen EM, Crotty Alexander LE, Williams A. Transcriptomic responses in the blood and sputum of cigarette smokers compared to e-cigarette vapers. Respir Res 2023; 24:134. [PMID: 37208747 PMCID: PMC10196320 DOI: 10.1186/s12931-023-02438-x] [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: 07/14/2022] [Accepted: 04/27/2023] [Indexed: 05/21/2023] Open
Abstract
RATIONALE Electronic (e)-cigarettes are popular among youth and cigarette smokers attempting to quit. Studies to date have focused on the utility of e-cigarettes as a smoking cessation tool, but the biological effects are largely unknown. OBJECTIVES To identify transcriptomic differences in the blood and sputum of e-cigarette users compared to conventional cigarettes smokers and healthy controls and describe biological pathways affected by these tobacco products. METHODS Cross-sectional analysis of whole blood and sputum RNA-sequencing data from 8 smokers, 9 e-cigarette users (e-cigs) and 4 controls. Weighted gene co-network analysis (WGCNA) identified gene module associations. Ingenuity Pathway Analysis (IPA) identified canonical pathways associated with tobacco products. MAIN RESULTS In blood, a three-group comparison showed 16 differentially expressed genes (DEGs); pair-wise comparison showed 7 DEGs between e-cigs and controls, 35 DEGs between smokers and controls, and 13 DEGs between smokers and e-cigs. In sputum, 438 DEGs were in the three-group comparison. In pair-wise comparisons, there were 2 DEGs between e-cigs and controls, 270 DEGs between smokers and controls, and 468 DEGs between smokers and e-cigs. Only 2 genes in the smokers vs. control comparison overlapped between blood and sputum. Most gene modules identified through WGCNA associated with tobacco product exposures also were associated with cotinine and exhaled CO levels. IPA showed more canonical pathways altered by conventional cigarette smoking than by e-cigarette use. CONCLUSION Cigarette smoking and e-cigarette use led to transcriptomic changes in both blood and sputum. However, conventional cigarettes induced much stronger transcriptomic responses in both compartments.
Collapse
Affiliation(s)
- Mario F Perez
- Department of Pulmonary, Critical Care and Sleep Medicine, University of Connecticut School of Medicine, Farmington, CT, USA.
| | - Marina Yurieva
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | | | - Eric M Mortensen
- Department of Pulmonary, Critical Care and Sleep Medicine, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Laura E Crotty Alexander
- Division of Pulmonary Critical Care, Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Adam Williams
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
29
|
Hardie I, Green MJ. Vaping and socioeconomic inequalities in smoking cessation and relapse: a longitudinal analysis of the UK Household Longitudinal Study. Tob Control 2023:tc-2022-057728. [PMID: 37041075 DOI: 10.1136/tc-2022-057728] [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: 08/31/2022] [Accepted: 03/21/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND Smoking is a key cause of socioeconomic health inequalities. Vaping is considered less harmful than smoking and has become a popular smoking cessation aid, and therefore has potential to reduce inequalities in smoking. METHODS We used longitudinal data from 25 102 participants in waves 8-10 (2016 to early 2020) of the UK Household Longitudinal Study to examine how vaping affects socioeconomic inequalities in smoking cessation and relapse. Marginal structural models were used to investigate whether vaping mediates or moderates associations between educational attainment and smoking cessation and relapse over time. Multiple imputation and weights were used to adjust for missing data. RESULTS Respondents without degrees were less likely to stop smoking than those with a degree (OR: 0.65; 95% CI 0.54-0.77), and more likely to relapse (OR: 1.74; 95% CI 1.37-2.22), but this inequality in smoking cessation was not present among regular vapers (OR: 0.99; 95% CI 0.54-1.82). Sensitivity analyses suggested that this finding did not hold when comparing those with or without any qualifications. Inequalities in smoking relapse did not clearly differ by vaping status. CONCLUSIONS Vaping may be especially helpful as a cessation aid for smokers without degree level education and therefore may help reduce inequalities in smoking. Nevertheless, other supports or aids may be needed to reach the most disadvantaged (ie, those with no qualifications) and to help people avoid relapse after cessation, though we did not find clear evidence suggesting that vaping would increase inequalities in relapse.
Collapse
Affiliation(s)
- Iain Hardie
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
- Department of Psychology, School of Philosophy, Psychology and Language Sciences, The University of Edinburgh, Edinburgh, UK
| | - Michael James Green
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina, USA
| |
Collapse
|
30
|
Payán DD, Burke NJ, Persinger J, Martinez J, Jones Barker L, Song AV. Public support for policies to regulate flavoured tobacco and e-cigarette products in rural California. Tob Control 2023; 32:e125-e129. [PMID: 35064014 PMCID: PMC10086505 DOI: 10.1136/tobaccocontrol-2021-057031] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/05/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Flavoured tobacco control policy exemptions and electronic cigarette products may contribute to increased youth access and tobacco use disparities. METHODS We assessed public support among California Central Valley residents for four policies to regulate flavoured tobacco products and e-cigarettes. The probability-based, multimode survey was conducted with English-speaking and Spanish-speaking registered voters (n=845) across 11 counties between 13 and 18 August 2020. Weighted logistic regression analyses measured odds of policy support, adjusting for predictor variables (attitudes and beliefs) and covariates. RESULTS The weighted sample was 50% female and predominantly Latino (30%) or non-Hispanic white (46%); 26% had a high school education or less, and 22% an annual household income DISCUSSION Findings add to mounting evidence of support for policies to regulate flavoured tobacco and e-cigarette products. Results on attitudes and beliefs elucidate how these factors influence support.
Collapse
Affiliation(s)
- Denise Diaz Payán
- Department of Public Health, University of California Merced, Merced, California, USA
- Nicotine & Cannabis Policy Center, University of California Merced, Merced, California, USA
| | - Nancy J Burke
- Department of Public Health, University of California Merced, Merced, California, USA
- Nicotine & Cannabis Policy Center, University of California Merced, Merced, California, USA
| | - Jamie Persinger
- American Heart Association, California, Los Angeles, California, USA
| | - Juliette Martinez
- American Heart Association, California, Los Angeles, California, USA
| | - Lisa Jones Barker
- American Heart Association, California, Los Angeles, California, USA
| | - Anna V Song
- Department of Psychological Sciences, University of California Merced, Merced, California, USA
- Nicotine & Cannabis Policy Center, University of California Merced, Merced, California, USA
| |
Collapse
|
31
|
Dyer ML, Khouja JN, Jackson AR, Havill MA, Dockrell MJ, Munafo MR, Attwood AS. Effects of electronic cigarette e-liquid flavouring on cigarette craving. Tob Control 2023; 32:e3-e9. [PMID: 34789542 PMCID: PMC7614335 DOI: 10.1136/tobaccocontrol-2021-056769] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 11/03/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND E-liquid flavour restrictions may discourage electronic cigarette (e-cigarette) uptake among youth. However, possible unintended consequences may include reduced appeal and effectiveness of e-cigarettes for smoking cessation. Non-tobacco flavours appear to be important for smoking cessation, but how and why are currently unclear. METHODS We conducted an experimental study in a UK sample of adult daily smokers using an independent groups design (N=84). Participants were randomised to use an e-cigarette with nicotine-containing fruit/sweet-flavoured e-liquid (blackcurrant, strawberry, vanilla, caramel) or unflavoured e-liquid for 1 week. The primary outcomes were average, peak and cue-elicited cigarette craving (the latter was assessed using a cue exposure task). The secondary outcomes were smoking lapse occurrence, enjoyment of the e-cigarette, ease of transitioning from smoking to using an e-cigarette, intentions to continue using an e-cigarette, intentions and motivation to quit smoking, return to smoking, and continuation of e-cigarette use. RESULTS E-liquid flavouring did not appear to have an effect on average cigarette craving (b 0.18, 95% CI -0.44 to 0.79, p=0.57), peak cigarette craving (b -0.12, 95% CI -0.59 to 0.35, p=0.62) or cue-elicited cigarette craving (b -0.21, 95% CI -3.86 to 3.43, p=0.91). We did not find evidence of a difference in secondary outcomes. CONCLUSIONS We did not find evidence to suggest that nicotine-containing fruit/sweet-flavoured and unflavoured e-liquids have different effects on cigarette cravings after 1 week of use. Further research is needed to establish if differences emerge over longer periods of exposure and extend to smoking cessation outcomes.
Collapse
Affiliation(s)
- Maddy L Dyer
- School of Psychological Science, University of Bristol, Bristol, UK
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Jasmine N Khouja
- School of Psychological Science, University of Bristol, Bristol, UK
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Abigail R Jackson
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | | | | | - Marcus R Munafo
- School of Psychological Science, University of Bristol, Bristol, UK
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Angela S Attwood
- School of Psychological Science, University of Bristol, Bristol, UK
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| |
Collapse
|
32
|
Brouwer AF, Jeon J, Jimenez-Mendoza E, Land SR, Holford TR, Friedman AS, Tam J, Mistry R, Levy DT, Meza R. Changing patterns of cigarette and ENDS transitions in the USA: a multistate transition analysis of youth and adults in the PATH Study in 2015-2017 vs 2017-2019. Tob Control 2023:tc-2022-057905. [PMID: 36977570 PMCID: PMC10533746 DOI: 10.1136/tc-2022-057905] [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: 12/16/2022] [Accepted: 03/13/2023] [Indexed: 03/30/2023]
Abstract
INTRODUCTION It is unknown how recent changes in the tobacco product marketplace have impacted transitions in cigarette and electronic nicotine delivery system (ENDS) use. METHODS A multistate transition model was applied to 24 242 adults and 12 067 youth in waves 2-4 (2015-2017) and 28 061 adults and 12 538 youth in waves 4 and 5 (2017-2019) of the Population Assessment of Tobacco and Health Study. Transition rates for initiation, cessation and product transitions were estimated in multivariable models, accounting for gender, age group, race/ethnicity and daily versus non-daily product use. RESULTS Changes in ENDS initiation/relapse rates depended on age, including among adults. Among youth who had never established tobacco use, the 1-year probability of ENDS initiation increased after 2017 from 1.6% (95% CI 1.4% to 1.8%) to 3.8% (95% CI 3.4% to 4.2%). Persistence of ENDS-only use (ie, 1-year probability of continuing to use ENDS only) increased for youth from 40.7% (95% CI 34.4% to 46.9%) to 65.7% (95% CI 60.5% to 71.1%) and for adults from 57.8% (95% CI 54.4% to 61.3%) to 78.2% (95% CI 76.0% to 80.4%). Persistence of dual use similarly increased for youth from 48.3% (95% CI 37.4% to 59.2%) to 60.9% (95% CI 43.0% to 78.8%) and for adults from 40.1% (95% CI 37.0% to 43.2%) to 63.8% (95% CI 59.6% to 67.6%). Youth and young adults who used both products became more likely to transition to ENDS-only use, but middle-aged and older adults did not. CONCLUSIONS ENDS-only and dual use became more persistent. Middle-aged and older adults who used both products became less likely to transition to cigarette-only use but not more likely to discontinue cigarettes. Youth and young adults became more likely to transition to ENDS-only use.
Collapse
Affiliation(s)
| | - Jihyoun Jeon
- Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Stephanie R Land
- Tobacco Control Research Branch, National Cancer Institute Division of Cancer Control and Population Sciences, Rockville, Maryland, USA
| | - Theodore R Holford
- Biostatistics, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Abigail S Friedman
- Health Management and Policy, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Jamie Tam
- Health Management and Policy, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Ritesh Mistry
- Health Behavior Health Education, University of Michigan, Ann Arbor, Michigan, USA
| | - David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA
| | - Rafael Meza
- Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
- Integrative Oncology, BC Cancer Research Centre, Vancouver, British Columbia, Canada
| |
Collapse
|
33
|
Elling JM, Crutzen R, Talhout R, de Vries H. Effects of providing tailored information about e-cigarettes in a digital smoking cessation intervention: randomized controlled trial. HEALTH EDUCATION RESEARCH 2023; 38:150-162. [PMID: 36727168 PMCID: PMC10035064 DOI: 10.1093/her/cyad004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 09/09/2022] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
The effectiveness of e-cigarettes in smoking cessation is under debate. Informing smokers who are motivated to quit smoking about e-cigarettes may help them to make an informed decision about their use for smoking cessation, which, however, may also lead to unintended effects such as less quitting. This experimental study assessed the influence of providing tailored information about e-cigarettes in a web-based tailored smoking cessation intervention on participants' decision-making and smoking behavior. Adult smokers (N = 331) were randomized into a personalized eHealth intervention on (i) smoking cessation (control condition) or (ii) smoking cessation and information about e-cigarettes (intervention condition). Directly postintervention, participants in the intervention condition had more knowledge about e-cigarettes than participants in the control condition. Attitudes toward e-cigarettes were more positive among intervention participants than control participants, but the differences in attitude were less pronounced than the differences in knowledge and not consistent across items. At a 6-month follow-up, no between-condition differences were observed in the use of e-cigarettes as a smoking cessation method, the number of tobacco cigarettes smoked in the past 7 days, or other smoking outcomes.
Collapse
Affiliation(s)
- J M Elling
- *Correspondence to: J. M. Elling. E-mail:
| | - R Crutzen
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands
| | - R Talhout
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Postbus 1, Bilthoven, BA 3720, The Netherlands
| | - H de Vries
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands
| |
Collapse
|
34
|
Smith MJ, MacKintosh AM, Ford A, Hilton S. Youth's engagement and perceptions of disposable e-cigarettes: a UK focus group study. BMJ Open 2023; 13:e068466. [PMID: 36948552 PMCID: PMC10040067 DOI: 10.1136/bmjopen-2022-068466] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 03/03/2023] [Indexed: 03/24/2023] Open
Abstract
OBJECTIVES Evidence suggests that use of flavoured disposable electronic cigarettes (e-cigarettes) is increasing. Considering the growing popularity and rapid evolution of e-cigarettes, we explored youth's perceptions and engagement with disposable e-cigarettes. DESIGN Twenty focus groups were conducted between March and May 2022, with 82 youths aged 11-16 living in the Central belt of Scotland. METHODS Youths were asked about smoking and vaping behaviours and disposable e-cigarettes and were shown vaping-related images and videos from social media which were used to stimulate discussion about different messages, presentations and contextual features. Transcripts were imported into NVivo V.12, coded thematically, and analysed. RESULTS Youths described disposable e-cigarettes as 'cool', 'fashionable' and enticing and viewed as a modern lifestyle 'accessory'. Tank models were perceived as being used by older adults. Youths stated that disposable e-cigarettes were designed in a way to target youths and the brightly coloured devices and range of flavourings encouraged youths to want to try the products, particularly sweet flavourings. Participants perceived e-cigarettes to be less harmful compared with combustible cigarettes but noted the uncertainty of ingredients in disposable e-cigarettes. CONCLUSIONS Youths distinguish between e-cigarettes with varying characteristics and social perceptions of users. These findings provide evidence that disposable e-cigarettes are attractive to youths. Future research is needed to understand the factors that contribute to youth perceptions of disposable e-cigarettes. Policymakers should work together to design and implement policies and strategies to prevent youth uptake of vaping.
Collapse
Affiliation(s)
- Marissa J Smith
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | | | - Allison Ford
- Institute for Social Marketing, University of Stirling, Stirling, UK
| | - Shona Hilton
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| |
Collapse
|
35
|
Chen DTH. Dual and poly-use of novel and conventional nicotine and tobacco product use in Europe: Challenges for population health, regulatory policies, and the ways ahead. Front Public Health 2023; 11:1093771. [PMID: 36875352 PMCID: PMC9975263 DOI: 10.3389/fpubh.2023.1093771] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
Affiliation(s)
- Daniel Tzu-Hsuan Chen
- Primary Care Epidemiology, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
| |
Collapse
|
36
|
Krishnan N, Berg CJ, Le D, Ahluwalia J, Graham AL, Abroms LC. A pilot randomized controlled trial of automated and counselor-delivered text messages for e-cigarette cessation. Tob Prev Cessat 2023; 9:04. [PMID: 36816140 PMCID: PMC9926687 DOI: 10.18332/tpc/157598] [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: 09/16/2022] [Revised: 12/05/2022] [Accepted: 12/19/2022] [Indexed: 02/16/2023]
Abstract
INTRODUCTION Automated text messaging programs show promise for e-cigarette cessation. Adding live text counseling could make them more engaging. We developed Quit the Vape (QTV), an automated e-cigarette cessation text messaging program, designed to be delivered as stand-alone or with counselor-delivered messages (QTV-C), and evaluated the acceptability and preliminary efficacy of QTV and QTV-C. METHODS Between May and August 2021, we recruited 58 e-cigarette users, aged 20-43 years, 53.5% male, 63.8% non-Hispanic White, from an ongoing cohort study in the United States. Inclusion criteria were: using nicotine-containing e-cigarettes on ≥4 days per month; smartphone ownership; and not receiving tobacco cessation treatment. Motivation to quit did not impact eligibility. Participants were randomized to QTV (n=20), QTV-C (n=19), or control (link to e-cigarette cessation website, n=19). At end-of-treatment, we assessed program engagement and satisfaction, and self-reported quitting behaviors (e.g. point prevalence abstinence, PPA). RESULTS At baseline, average past-month e-cigarette use was 26.8 days (SD=6.2). At follow-up at 4 weeks, among QTV and QTV-C participants, ≥85% replied to ≥1 message, ≥35% set a quit date, and ≤15% opted out. More QTV and QTV-C participants (55.6%) versus control (17.7%) reported program satisfaction (p=0.034). QTV-C participants (vs QTV and control) trended more favorably on 7-day e-cigarette PPA [27.8% (95% CI: 11.5-53.3) vs 11.1% (95% CI: 2.6-37.0) and 5.9% (95% CI: 0.7-34.5)] and quit attempts [66.7% (95% CI: 41.6-84.9) vs 50.0% (95% CI: 27.4-72.6) and 52.9% (95% CI: 29.2-75.5)]. CONCLUSIONS Adding live text counseling to an automated text messaging program is acceptable and shows promise for e-cigarette cessation. A larger trial is warranted to assess its efficacy.
Collapse
Affiliation(s)
- Nandita Krishnan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, United States
| | - Carla J. Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, United States,George Washington Cancer Center, George Washington University, Washington, United States
| | - Daisy Le
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, United States,Department of Policy, Populations and Systems, George Washington University School of Nursing, Washington, United States
| | - Jasjit Ahluwalia
- Department of Behavioral and Social Sciences and Center for Alcohol and Addiction Studies, Brown University School of Public Health, Rhode Island, United States
| | - Amanda L. Graham
- Innovations Center, Truth Initiative, Washington, United States,Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, United States
| | - Lorien C. Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, United States,George Washington Cancer Center, George Washington University, Washington, United States
| |
Collapse
|
37
|
Hanewinkel R. Unsafe Lifestyle Product. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:58. [PMID: 36949641 DOI: 10.3238/arztebl.m2022.0264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
38
|
Kotz D. In Reply. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:58. [PMID: 36949642 DOI: 10.3238/arztebl.m2022.0265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
39
|
Notley C, Clark L, Belderson P, Ward E, Clark AB, Parrott S, Agrawal S, Bloom BM, Boyle AA, Morris G, Gray A, Coats T, Man MS, Bauld L, Holland R, Pope I. Cessation of smoking trial in the emergency department (CoSTED): protocol for a multicentre randomised controlled trial. BMJ Open 2023; 13:e064585. [PMID: 36657751 PMCID: PMC9853266 DOI: 10.1136/bmjopen-2022-064585] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Attendees of emergency departments (EDs) have a higher than expected prevalence of smoking. ED attendance may be a good opportunity to prompt positive behaviour change, even for smokers not currently motivated to quit. This study aims to determine whether an opportunist smoking cessation intervention delivered in the ED can help daily smokers attending the ED quit smoking and is cost-effective. METHODS AND ANALYSIS A two-arm pragmatic, multicentred, parallel-group, individually randomised, controlled superiority trial with an internal pilot, economic evaluation and mixed methods process evaluation. The trial will compare ED-based brief smoking cessation advice, including provision of an e-cigarette and referral to local stop smoking services (intervention) with the provision of contact details for local stop smoking services (control). Target sample size is 972, recruiting across 6 National Health Service EDs in England and Scotland. Outcomes will be collected at 1, 3 and 6 months. The primary outcome at 6 months is carbon monoxide verified continuous smoking abstinence. ETHICS AND DISSEMINATION The trial was approved by the South Central-Oxford B Research Committee (21/SC/0288). Dissemination will include the publication of outcomes, and the process and economic evaluations in peer-reviewed journals. The findings will also be appropriately disseminated to relevant practice, policy and patient representative groups. TRIAL REGISTRATION NUMBER NCT04854616; protocol V.4.2.
Collapse
Affiliation(s)
- Caitlin Notley
- Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Lucy Clark
- Norwich Clincial Trials Unit, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Pippa Belderson
- Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Emma Ward
- Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Allan B Clark
- Norwich Clincial Trials Unit, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | - Sanjay Agrawal
- Institute of Lung Health, University of Leicester, Leicester, UK
| | - Ben M Bloom
- Emergency Department, Barts Health NHS Trust, London, UK
| | - Adrian A Boyle
- Emergency Medicine, Addenbrooke's Hospital, Cambridge, UK
| | - Geraint Morris
- Department of Emergency Medicine, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Alasdair Gray
- Department of Emergency Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Tim Coats
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Mei-See Man
- Norwich Clincial Trials Unit, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Linda Bauld
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh Division of Medical and Radiological Sciences, Edinburgh, UK
| | | | - Ian Pope
- Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich, UK
- Department of Emergency Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| |
Collapse
|
40
|
Selya A, Wissmann R, Shiffman S, Chandra S, Sembower M, Joselow J, Kim S. Sales of Electronic Nicotine Delivery Systems (ENDS) and Cigarette Sales in the USA: A Trend Break Analysis. JOURNAL OF CONSUMER POLICY 2023; 46:79-93. [PMID: 36686374 PMCID: PMC9841499 DOI: 10.1007/s10603-022-09533-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
UNLABELLED Electronic nicotine delivery systems (ENDS) are a potentially lower-risk tobacco product which could help smokers switch completely away from cigarettes. However, the lack of strong evidence to date of a measurable, population-level effect on reducing smoking has generated skepticism about ENDS' potential benefits. This study examines whether increased US ENDS sales have been associated with reduced cigarette sales. Retail data on weekly per-capita cigarette and ENDS purchases in the USA during 2014-2019 were obtained from a national sample of brick-and-mortar retail outlets. Trends in cigarette sales were modeled before (2014-2016) ENDS had a substantial market share, and, after adjusting for macroeconomic factors, projected into the post-period (2017-2019). Actual cigarette sales were lower than projected sales (by up to 16% across the post-period), indicating a substantial "cigarette shortfall" in the post-period. To explore whether general (i.e., inclusive of potentially many mechanisms) substitution by ENDS can explain the cigarette shortfall, its association with per-capita ENDS volume sales was examined. Higher ENDS sales were significantly associated with a greater cigarette shortfall: for every additional per-capita ENDS unit, cigarette sales were 1.4 packs-per-capita lower than expected (B = 1.4, p < .0001). Error correction models which account for spurious correlation yielded similar results. These findings support ENDS serving as a substitute for cigarettes (through potentially many mechanisms including cigarette price), causing cigarette consumption to decline. Since ENDS potentially pose lower risk than cigarettes, this general substitution effect suggests that risk-proportionate tobacco regulation could mitigate the tobacco-related health burden. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s10603-022-09533-4.
Collapse
Affiliation(s)
- A. Selya
- PinneyAssociates, Inc, Pittsburgh, PA USA
| | | | | | - S. Chandra
- PinneyAssociates, Inc, Pittsburgh, PA USA
| | | | | | - S. Kim
- PinneyAssociates, Inc, Pittsburgh, PA USA
| |
Collapse
|
41
|
Ueng KC, Chiang CE, Chao TH, Wu YW, Lee WL, Li YH, Ting KH, Su CH, Lin HJ, Su TC, Liu TJ, Lin TH, Hsu PC, Wang YC, Chen ZC, Jen HL, Lin PL, Ko FY, Yen HW, Chen WJ, Hou CJY. 2023 Guidelines of the Taiwan Society of Cardiology on the Diagnosis and Management of Chronic Coronary Syndrome. ACTA CARDIOLOGICA SINICA 2023; 39:4-96. [PMID: 36685161 PMCID: PMC9829849 DOI: 10.6515/acs.202301_39(1).20221103a] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/03/2022] [Indexed: 01/24/2023]
Abstract
Coronary artery disease (CAD) covers a wide spectrum from persons who are asymptomatic to those presenting with acute coronary syndromes (ACS) and sudden cardiac death. Coronary atherosclerotic disease is a chronic, progressive process that leads to atherosclerotic plaque development and progression within the epicardial coronary arteries. Being a dynamic process, CAD generally presents with a prolonged stable phase, which may then suddenly become unstable and lead to an acute coronary event. Thus, the concept of "stable CAD" may be misleading, as the risk for acute events continues to exist, despite the use of pharmacological therapies and revascularization. Many advances in coronary care have been made, and guidelines from other international societies have been updated. The 2023 guidelines of the Taiwan Society of Cardiology for CAD introduce a new concept that categorizes the disease entity according to its clinical presentation into acute or chronic coronary syndromes (ACS and CCS, respectively). Previously defined as stable CAD, CCS include a heterogeneous population with or without chest pain, with or without prior ACS, and with or without previous coronary revascularization procedures. As cardiologists, we now face the complexity of CAD, which involves not only the epicardial but also the microcirculatory domains of the coronary circulation and the myocardium. New findings about the development and progression of coronary atherosclerosis have changed the clinical landscape. After a nearly 50-year ischemia-centric paradigm of coronary stenosis, growing evidence indicates that coronary atherosclerosis and its features are both diagnostic and therapeutic targets beyond obstructive CAD. Taken together, these factors have shifted the clinicians' focus from the functional evaluation of coronary ischemia to the anatomic burden of disease. Research over the past decades has strengthened the case for prevention and optimal medical therapy as central interventions in patients with CCS. Even though functional capacity has clear prognostic implications, it does not include the evaluation of non-obstructive lesions, plaque burden or additional risk-modifying factors beyond epicardial coronary stenosis-driven ischemia. The recommended first-line diagnostic tests for CCS now include coronary computed tomographic angiography, an increasingly used anatomic imaging modality capable of detecting not only obstructive but also non-obstructive coronary plaques that may be missed with stress testing. This non-invasive anatomical modality improves risk assessment and potentially allows for the appropriate allocation of preventive therapies. Initial invasive strategies cannot improve mortality or the risk of myocardial infarction. Emphasis should be placed on optimizing the control of risk factors through preventive measures, and invasive strategies should be reserved for highly selected patients with refractory symptoms, high ischemic burden, high-risk anatomies, and hemodynamically significant lesions. These guidelines provide current evidence-based diagnosis and treatment recommendations. However, the guidelines are not mandatory, and members of the Task Force fully realize that the treatment of CCS should be individualized to address each patient's circumstances. Ultimately, the decision of healthcare professionals is most important in clinical practice.
Collapse
Affiliation(s)
- Kwo-Chang Ueng
- Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital; School of Medicine, Chung Shan Medical University, Taichung
| | - Chern-En Chiang
- General Clinical Research Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei
- School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Ting-Hsing Chao
- Department of Internal Medicine, National Cheng Kung University Hospital; College of Medicine, National Cheng Kung University, Tainan
| | - Yen-Wen Wu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City
| | - Wen-Lieng Lee
- School of Medicine, National Yang Ming Chiao Tung University, Taipei
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
| | - Yi-Heng Li
- Department of Internal Medicine, National Cheng Kung University Hospital; College of Medicine, National Cheng Kung University, Tainan
| | - Ke-Hsin Ting
- Division of Cardiology, Department of Internal Medicine, Yunlin Christian Hospital, Yunlin
| | - Chun-Hung Su
- Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital; School of Medicine, Chung Shan Medical University, Taichung
| | - Hung-Ju Lin
- Cardiovascular Center, Department of Internal Medicine, National Taiwan University Hospital
| | - Ta-Chen Su
- Cardiovascular Center, Department of Internal Medicine, National Taiwan University Hospital
- Department of Environmental and Occupational Medicine, National Taiwan University College of Medicine, Taipei
| | - Tsun-Jui Liu
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
| | - Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
| | - Po-Chao Hsu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
| | - Yu-Chen Wang
- Division of Cardiology, Asia University Hospital, Department of Medical Laboratory Science and Biotechnology, Asia University, Taichung
| | - Zhih-Cherng Chen
- Division of Cardiology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan
| | - Hsu-Lung Jen
- Division of Cardiology, Cheng Hsin Rehabilitation Medical Center, Taipei
| | - Po-Lin Lin
- Division of Cardiology, Hsinchu MacKay Memorial Hospital, Hsinchu
| | - Feng-You Ko
- Cardiovascular Center, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Hsueh-Wei Yen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
| | - Wen-Jone Chen
- Division of Cardiology, Department of Internal Medicine, Min Sheng General Hospital, Taoyuan
| | - Charles Jia-Yin Hou
- Cardiovascular Center, Department of Internal Medicine, MacKay Memorial Hospital; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| |
Collapse
|
42
|
Delile JM. Tabac et précarité : l’enjeu central de l’accès aux soins. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2023; 35:69-80. [PMID: 38423965 DOI: 10.3917/spub.pr1.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
The prevalence and severity of smoking are particularly high in populations in precarious situations and make smoking an essential determinant of social inequalities in health, due to its particularly catastrophic impact on the health of these populations. The general reduction in smoking, less significant in disadvantaged populations, contributes to further increasing these inequalities, and smoking tends to be concentrated in the most vulnerable populations. The relationships between tobacco and precariousness are examined by identifying, based on a review of the literature, the main common factors of vulnerability: stress and social adversity, self-stigma, a low feeling of self-efficacy, the social function of tobacco use, the ambivalence of demands, associated addictions, the severity of tobacco dependence, distance from support and care systems, etc. Specific attention is paid to certain particular conditions: mental health disorders, addictions (other than tobacco), inadequate housing, detention, migration. On this basis, courses of action are proposed to improve access to care and its effectiveness for the people concerned. Emphasis is placed on the mobilization of professionals who often tend to neglect issues of smoking in view of the immediate severity of the problems at the origin of the demands of the people received. A support offer for harm reduction (vaping in particular) seems particularly suited to often-ambivalent demands. The importance of networking and the involvement of CSAPAs/CAARUDs is also underlined. At the systemic level, all of this must be accompanied by political advocacy to reduce these inequalities and social determinants of health..
Collapse
|
43
|
Sreeramareddy CT, Acharya K, Manoharan A. Electronic cigarettes use and 'dual use' among the youth in 75 countries: estimates from Global Youth Tobacco Surveys (2014-2019). Sci Rep 2022; 12:20967. [PMID: 36470977 PMCID: PMC9722706 DOI: 10.1038/s41598-022-25594-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 12/01/2022] [Indexed: 12/07/2022] Open
Abstract
We report the country-level prevalence of awareness about electronic cigarette use, and 'dual use' and its association with age, sex, country income, and e-cigarette regulatory status. We analyzed the most recent Global Youth Tobacco Surveys done on nationally representative samples of school-going youth aged 13-15 years in 75 countries/territories. The weighted prevalence of 'awareness' (heard about e-cigarettes), 'ever use' (even tried a few puffs), 'current use' (during the last 30 days), and 'dual use' (e-cigarette use and cigarette smoking during the last 30 days) were estimated. Awareness was > 80% in 13 countries mostly from Europe Poland being the highest at 95.8% (95% CI 94.8- 96.6). In seven countries, 30-50% of the youth had ever used an e-cigarette, Italy was the highest at 55.1% (95%CI 51-3,58.9). In 30 countries, current e-cigarette use was > 10%, the highest of 35.1% (95%CI 32.4-38.0) in Guam. Awareness and use were highest in the European region (74.6% and 34.5%) and HIC (83.6% and 39.4%). Youth from HIC (compared to lMIC) and countries having restrictive e-cigarette regulations (compared to NRP) had 2.4 times (aOR 2.2.4, 95% CI 2.2, 2.7) and 1.8 times (aOR 1.8, 95% CI 1.6, 2.0) higher odds of being current e-cigarette users respectively. Youth in countries with the most restrictive e-cigarette regulations (compared to NRP) had 0.6 times lower odds of being current e-cigarette users (aOR 0.6, 95% CI 0.6, 0.7). Awareness and e-cigarette use varied by sex, country income level, and region. Continued global surveillance of youth e-cigarette use is needed for the formulation of e-cigarette regulatory policy. Awareness and use of e-cigarettes were higher among boys, in countries in Europe and America regions, and among those with higher income and restrictive policies, whereas it was lower in countries having the most restrictive policies. Higher awareness is strongly correlated with a trial and current use of e-cigarettes. E-cigarette marketing should be restricted, and continued surveillance of e-cigarette use is needed. Most restrictive policies such as the ban on e-cigarettes appear to reduce e-cigarette use among the youth.
Collapse
Affiliation(s)
- Chandrashekhar T. Sreeramareddy
- grid.411729.80000 0000 8946 5787Department of Community Medicine, International Medical University, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Federal Territory of Kuala Lumpur, Malaysia
| | - Kiran Acharya
- New ERA, Rudramati Marga, Kalopul, Kathmandu, 44621 Nepal
| | - Anusha Manoharan
- grid.415759.b0000 0001 0690 5255Botanic Health Clinic, Ministry of Health, Selangor, Malaysia
| |
Collapse
|
44
|
Dyer ML, Sallis HM, Khouja JN, Dryhurst S, Munafò MR. Associations between COVID-19 Risk Perceptions and Mental Health, Wellbeing, and Risk Behaviours. JOURNAL OF RISK RESEARCH 2022; 25:1372-1394. [PMID: 37872962 PMCID: PMC7615237 DOI: 10.1080/13669877.2022.2127849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 06/16/2022] [Accepted: 09/02/2022] [Indexed: 10/25/2023]
Abstract
Background Mental health has worsened, and substance use has increased for some people during the coronavirus (COVID-19) pandemic. Some cross-sectional studies suggest that higher COVID-19 risk perceptions are related to poorer mental health and greater risk behaviours (e.g., substance use). However, longitudinal and genetic data are needed to help to reduce the likelihood of reverse causality. Methods We used cross-sectional, longitudinal, and polygenic risk score (PRS; for anxiety, depression, wellbeing) data from the Avon Longitudinal Study of Parents and Children (ALSPAC). We examined cross-sectional and prospective longitudinal associations between COVID-19 risk perceptions (i.e., cognitive, affective, self, other, and a combined 'holistic' measure) and mental health (i.e., anxiety, depression), wellbeing, and risk behaviours. Pandemic (April-July 2020) and pre-pandemic (2003-2017) data (ns = 233-5,115) were included. Results Higher COVID-19 risk perceptions (holistic) were associated with anxiety (OR 2.78, 95% confidence interval [CI] 2.20 to 3.52), depression (OR 1.65, 95% CI 1.24 to 2.18), low wellbeing (OR 1.76, 95% CI 1.45 to 2.13), and increased alcohol use (OR 1.46, 95% CI 1.24 to 1.72). Higher COVID-19 risk perceptions were also associated with self-isolating given a suspected COVID-19 infection (OR 1.74, 95% CI 1.13 to 2.68), and less face-to-face contact (OR 0.83, 95% CI 0.70 to 0.98) and physical contact (OR 0.83, 95% CI 0.68 to 1.00). Pre-pandemic anxiety (OR 1.64, 95% CI 1.29 to 2.09) and low wellbeing (OR 1.41, 95% CI 1.15 to 1.74) were associated with higher COVID-19 risk perceptions. The depression PRS (b 0.21, 95% CI 0.02 to 0.40) and wellbeing PRS (b -0.29, 95% CI -0.48 to -0.09) were associated with higher and lower COVID-19 risk perceptions, respectively. Conclusions Poorer mental health and wellbeing are associated with higher COVID-19 risk perceptions, and longitudinal and genetic data suggest that they may play a causal role in COVID-19 risk perceptions.
Collapse
Affiliation(s)
- Maddy L. Dyer
- School of Psychological Science, University of Bristol, Bristol, UK
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - Hannah M. Sallis
- School of Psychological Science, University of Bristol, Bristol, UK
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jasmine N. Khouja
- School of Psychological Science, University of Bristol, Bristol, UK
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - Sarah Dryhurst
- Winton Centre for Risk and Evidence Communication, University of Cambridge, Cambridge, UK
| | - Marcus R. Munafò
- School of Psychological Science, University of Bristol, Bristol, UK
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| |
Collapse
|
45
|
Varella MH, Andrade OA, Shaffer SM, Castro G, Rodriguez P, Barengo NC, Acuna JM. E-cigarette use and respiratory symptoms in residents of the United States: A BRFSS report. PLoS One 2022; 17:e0269760. [PMID: 36454742 PMCID: PMC9714717 DOI: 10.1371/journal.pone.0269760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/10/2022] [Indexed: 12/05/2022] Open
Abstract
PURPOSE E-cigarettes are the most common type of electronic nicotine delivery system in the United States. E-cigarettes contain numerous toxic compounds that has been shown to induce severe structural damage to the airways. The objective of this study is to assess if there is an association between e-cigarette use and respiratory symptoms in adults in the US as reported in the BRFSS. METHODS We analyzed data from 18,079 adults, 18-44 years, who participated at the Behavioral Risk Factor Surveillance System (BRFSS) in the year 2017. E-cigarette smoking status was categorized as current everyday user, current some days user, former smoker, and never smoker. The frequency of any respiratory symptoms (cough, phlegm, or shortness of breath) was compared. Unadjusted and adjusted logistic regression analysis were used to calculate odds ratios (OR) and 95% confidence intervals (CI). RESULTS The BRFSS reported prevalence of smoking e-cigarettes was 6%. About 28% of the participants reported any of the respiratory symptoms assessed. The frequency of reported respiratory symptoms was highest among current some days e-cigarette users (45%). After adjusting for selected participant's demographic, socio-economic, and behavioral characteristics, and asthma and COPD status, the odds of reporting respiratory symptoms increased by 49% among those who use e-cigarettes some days (OR 1.49; 95% CI: 1.06-2.11), and by 29% among those who were former users (OR 1.29; 95% CI: 1.07-1.55) compared with those who never used e-cigarettes. No statistically significant association was found for those who used e-cigarettes every day (OR 1.41; 95% CI 0.96-2.08). CONCLUSION E-cigarettes cannot be considered as a safe alternative to aid quitting use of combustible traditional cigarettes. Cohort studies may shed more evidence on the association between e-cigarette use and respiratory diseases.
Collapse
Affiliation(s)
- Marcia H. Varella
- Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States of America
| | - Olyn A. Andrade
- American University of Antigua College of Medicine, United States of America
| | - Sydney M. Shaffer
- American University of Antigua College of Medicine, United States of America
| | - Grettel Castro
- Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States of America
| | - Pura Rodriguez
- Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States of America
| | - Noël C. Barengo
- Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States of America
- Department of Health Policy and Management, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, United States of America
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Juan M. Acuna
- Department of Epidemiology and Aw 8474000331 R-DISC, Khalifa University, Abu Dhabi, United Arab Emirates
- CRUSADA, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, United States of America
- * E-mail:
| |
Collapse
|
46
|
AlShammeri O, AL Saif S, Al Shehri H, Alasng M, Qaddoura F, Al Shehri M, Turkistani Y, Tash A, Alharbi W, Al Qahtani F, Diaz R, Mahaimeed W, Al habeeb W, Alfaraidy K. Saudi Heart Association Guidelines on Best Practices in the Management of Chronic Coronary Syndromes. J Saudi Heart Assoc 2022; 34:182-211. [PMID: 36578770 PMCID: PMC9762239 DOI: 10.37616/2212-5043.1320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/05/2022] [Accepted: 10/09/2022] [Indexed: 12/12/2022] Open
Abstract
Background The prevalence of both chronic coronary syndrome (CCS) and its risk factors is alarming in Saudi Arabia and only a minority of patients achieve optimal medical management. Context-specific CCS guidelines outlining best clinical practices are therefore needed to address local gaps and challenges. Consensus panel A panel of experts representing the Saudi Heart Association (SHA) reviewed existing evidence and formulated guidance relevant to local clinical practice considering the characteristics of the Saudi population, the Saudi healthcare system, its resources and medical expertise. They were reviewed by external experts to ensure scientific and medical accuracy. Consensus findings Recommendations are provided on the clinical assessment and management of CCS, along with supporting evidence. Risk reduction through non-pharmacological therapy (lifestyle modifications) remains at the core of CCS management. Great emphasis should be placed on the use of available pharmacological options (anti-anginal therapy and event prevention) only as appropriate and necessary. Lifestyle counseling and pharmacological strategy must be optimized before considering revascularization, unless otherwise indicated. Revascularization strategies should be carefully considered by the Heart Team to ensure the appropriate choice is made in accordance to current guidelines and patient preference. Conclusion Conscientious, multidisciplinary, and personalized clinical management is necessary to navigate the complex landscape of CCS in Saudi Arabia considering its population and resource differences. The reconciliation of international evidence and local characteristics is critical for the improvement of healthcare outcomes among CCS patients in Saudi Arabia.
Collapse
Affiliation(s)
- Owayed AlShammeri
- Dr. Sulaiman Al-Habib Hospital, Riyadh,
Saudi Arabia,Corresponding author at: Dr. Sulaiman Alhabib Hospital, Ar Rayyan Hospital, Riyadh, 14212, Saudi Arabia. E-mail address: (O. AlShammeri)
| | | | - Halia Al Shehri
- King Salman Heart Centre, King Fahad Medical City, Riyadh,
Saudi Arabia
| | - Mirvat Alasng
- Cardiac Center, King Fahd Armed Forces Hospital, Jeddah,
Saudi Arabia
| | | | | | | | - Adel Tash
- National Heart Center, Saudi Health Council,
Saudi Arabia
| | - Walid Alharbi
- King Fahad Cardiac Center, King Saud University, Riyadh,
Saudi Arabia
| | - Fahad Al Qahtani
- King Salman Heart Centre, King Fahad Medical City, Riyadh,
Saudi Arabia
| | - Rafael Diaz
- ECLA (Estudios Clínicos Latino América), Instituto Cardiovascular de Rosario, Rosario,
Argentina
| | - Wael Mahaimeed
- Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi,
United Arab Emirates
| | - Waleed Al habeeb
- Saudi Heart Association, Department of Cardiac Sciences, King Saud University Riyadh,
Saudi Arabia
| | | |
Collapse
|
47
|
Hartmann-Boyce J, Lindson N, Butler AR, McRobbie H, Bullen C, Begh R, Theodoulou A, Notley C, Rigotti NA, Turner T, Fanshawe TR, Hajek P. Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev 2022; 11:CD010216. [PMID: 36384212 PMCID: PMC9668543 DOI: 10.1002/14651858.cd010216.pub7] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Electronic cigarettes (ECs) are handheld electronic vaping devices which produce an aerosol by heating an e-liquid. Some people who smoke use ECs to stop or reduce smoking, although some organizations, advocacy groups and policymakers have discouraged this, citing lack of evidence of efficacy and safety. People who smoke, healthcare providers and regulators want to know if ECs can help people quit smoking, and if they are safe to use for this purpose. This is a review update conducted as part of a living systematic review. OBJECTIVES To examine the effectiveness, tolerability, and safety of using electronic cigarettes (ECs) to help people who smoke tobacco achieve long-term smoking abstinence. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PsycINFO to 1 July 2022, and reference-checked and contacted study authors. SELECTION CRITERIA: We included randomized controlled trials (RCTs) and randomized cross-over trials, in which people who smoke were randomized to an EC or control condition. We also included uncontrolled intervention studies in which all participants received an EC intervention. Studies had to report abstinence from cigarettes at six months or longer or data on safety markers at one week or longer, or both. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods for screening and data extraction. Our primary outcome measures were abstinence from smoking after at least six months follow-up, adverse events (AEs), and serious adverse events (SAEs). Secondary outcomes included the proportion of people still using study product (EC or pharmacotherapy) at six or more months after randomization or starting EC use, changes in carbon monoxide (CO), blood pressure (BP), heart rate, arterial oxygen saturation, lung function, and levels of carcinogens or toxicants, or both. We used a fixed-effect Mantel-Haenszel model to calculate risk ratios (RRs) with a 95% confidence interval (CI) for dichotomous outcomes. For continuous outcomes, we calculated mean differences. Where appropriate, we pooled data in meta-analyses. MAIN RESULTS We included 78 completed studies, representing 22,052 participants, of which 40 were RCTs. Seventeen of the 78 included studies were new to this review update. Of the included studies, we rated ten (all but one contributing to our main comparisons) at low risk of bias overall, 50 at high risk overall (including all non-randomized studies), and the remainder at unclear risk. There was high certainty that quit rates were higher in people randomized to nicotine EC than in those randomized to nicotine replacement therapy (NRT) (RR 1.63, 95% CI 1.30 to 2.04; I2 = 10%; 6 studies, 2378 participants). In absolute terms, this might translate to an additional four quitters per 100 (95% CI 2 to 6). There was moderate-certainty evidence (limited by imprecision) that the rate of occurrence of AEs was similar between groups (RR 1.02, 95% CI 0.88 to 1.19; I2 = 0%; 4 studies, 1702 participants). SAEs were rare, but there was insufficient evidence to determine whether rates differed between groups due to very serious imprecision (RR 1.12, 95% CI 0.82 to 1.52; I2 = 34%; 5 studies, 2411 participants). There was moderate-certainty evidence, limited by imprecision, that quit rates were higher in people randomized to nicotine EC than to non-nicotine EC (RR 1.94, 95% CI 1.21 to 3.13; I2 = 0%; 5 studies, 1447 participants). In absolute terms, this might lead to an additional seven quitters per 100 (95% CI 2 to 16). There was moderate-certainty evidence of no difference in the rate of AEs between these groups (RR 1.01, 95% CI 0.91 to 1.11; I2 = 0%; 5 studies, 1840 participants). There was insufficient evidence to determine whether rates of SAEs differed between groups, due to very serious imprecision (RR 1.00, 95% CI 0.56 to 1.79; I2 = 0%; 8 studies, 1272 participants). Compared to behavioural support only/no support, quit rates were higher for participants randomized to nicotine EC (RR 2.66, 95% CI 1.52 to 4.65; I2 = 0%; 7 studies, 3126 participants). In absolute terms, this represents an additional two quitters per 100 (95% CI 1 to 3). However, this finding was of very low certainty, due to issues with imprecision and risk of bias. There was some evidence that (non-serious) AEs were more common in people randomized to nicotine EC (RR 1.22, 95% CI 1.12 to 1.32; I2 = 41%, low certainty; 4 studies, 765 participants) and, again, insufficient evidence to determine whether rates of SAEs differed between groups (RR 1.03, 95% CI 0.54 to 1.97; I2 = 38%; 9 studies, 1993 participants). Data from non-randomized studies were consistent with RCT data. The most commonly reported AEs were throat/mouth irritation, headache, cough, and nausea, which tended to dissipate with continued EC use. Very few studies reported data on other outcomes or comparisons, hence evidence for these is limited, with CIs often encompassing clinically significant harm and benefit. AUTHORS' CONCLUSIONS There is high-certainty evidence that ECs with nicotine increase quit rates compared to NRT and moderate-certainty evidence that they increase quit rates compared to ECs without nicotine. Evidence comparing nicotine EC with usual care/no treatment also suggests benefit, but is less certain. More studies are needed to confirm the effect size. Confidence intervals were for the most part wide for data on AEs, SAEs and other safety markers, with no difference in AEs between nicotine and non-nicotine ECs nor between nicotine ECs and NRT. Overall incidence of SAEs was low across all study arms. We did not detect evidence of serious harm from nicotine EC, but longest follow-up was two years and the number of studies was small. The main limitation of the evidence base remains imprecision due to the small number of RCTs, often with low event rates, but further RCTs are underway. To ensure the review continues to provide up-to-date information to decision-makers, this review is a living systematic review. We run searches monthly, with the review updated when relevant new evidence becomes available. Please refer to the Cochrane Database of Systematic Reviews for the review's current status.
Collapse
Affiliation(s)
- Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ailsa R Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Hayden McRobbie
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Chris Bullen
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Rachna Begh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Tari Turner
- Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Thomas R Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Peter Hajek
- Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| |
Collapse
|
48
|
Silva ALOD, Moreira JC. Sais de Nicotina e Nicotina Sintética: Novos Desafios para um Velho Problema. REVISTA BRASILEIRA DE CANCEROLOGIA 2022. [DOI: 10.32635/2176-9745.rbc.2022v68n4.2846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
O tabagismo é reconhecido como uma doença crônica causada pela dependência à nicotina, presente nos produtos à base de tabaco, e está ligado a uma série de doenças tabaco-relacionadas. Somando-se a isso, é considerada uma doença pediátrica. No Brasil, o tratamento para a cessação do tabagismo desde 2004 é oferecido em todos os níveis de complexidade pelo Sistema Único de Saúde (SUS), contudo, os protocolos internacionalmente utilizados parecem ter limitações significativas quando utilizados em populações tabagistas de crianças e adolescentes. Os sais de nicotina apresentam um menor grau de irritação e impacto na boca e na garganta causado pela nicotina, possibilitando o uso de concentrações maiores de nicotina. A nicotina sintética tem se mostrado a cada dia mais viável economicamente falando e já existem no mercado produtos que se utilizam dessa forma de nicotina, entretanto, poucos estudos foram conduzidos no sentido de avaliar seus impactos à saúde. As novas formas de nicotina e sua forma sintética, associadas com produtos com design atraente, especialmente para os mais jovens, trazem desafios técnicos consideráveis para os profissionais da saúde, pois desconhece-se, no momento, protocolos eficazes para tratar a dependência à nicotina originada dessas novas formas de consumo.
Collapse
|
49
|
Fekom M, Aarbaoui TE, Guignard R, Andler R, Quatremère G, Ducarroz S, Nguyen-Thanh V, Melchior M. Use of Tobacco Cessation Aids and Likelihood of Smoking Cessation: a French Population-Based Study. Prev Med Rep 2022; 30:102044. [DOI: 10.1016/j.pmedr.2022.102044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/02/2022] [Accepted: 11/05/2022] [Indexed: 11/14/2022] Open
|
50
|
Bold KW, Krishnan-Sarin S, O'Malley S, Morean ME. Examining associations of e-cigarette flavour restrictions with e-cigarette use and success quitting smoking among US adults. Tob Control 2022; 31:s184-s186. [PMID: 36328465 PMCID: PMC9664117 DOI: 10.1136/tobaccocontrol-2022-057458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/30/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Restricting available e-cigarette flavours to only tobacco and menthol may reduce appeal among youth; it is unknown how flavour restrictions impact adults using e-cigarettes to quit smoking cigarettes. METHODS Online US survey data were collected in summer 2021 from 857 adults who reported using e-cigarettes in a recent attempt to quit smoking. Survey items assessed e-cigarette flavours used during their quit attempt, whether e-cigarette flavour bans restricted access to flavours they like, and what impact the restrictions had on e-cigarette behaviour. Multivariable logistic regression models were used to examine the associations of flavour bans with success quitting smoking for 1 month or longer. RESULTS 30.2% (N=259) reported restricted access to e-cigarette flavours they like. During their quit attempt, 64.9% (N=168) used tobacco or menthol-flavoured e-cigarettes, and 90.7% (N=235) used another flavour that could be affected by restrictions, most commonly fruit, mint, and candy/dessert. Responses to flavour restrictions included switching devices to continue using preferred flavours (39.4%), using the same device only with available flavours (35.9%), buying preferred flavours elsewhere (eg, online) (19.3%), making flavours (3.5%) and 'other' (eg, no longer using e-cigarettes) (1.9%). The odds of quitting smoking for 1 month or longer were not significantly different between those experiencing flavour restrictions (vs not), preferring tobacco/menthol (vs restricted) flavour, or switching flavours in response to the bans (vs finding another way to obtain restricted flavours) (p>0.11). CONCLUSION Experiencing e-cigarette flavour restrictions was not associated with success quitting smoking among adults using e-cigarettes to try to quit.
Collapse
Affiliation(s)
- Krysten W Bold
- Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | - Meghan E Morean
- Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|