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Zamora Goicoechea J, Boughner A, Cirion Lee JJ, Mahajan A, Yeo K, Sproga M, Patel T, Saitta C, Russell C, Coughlan M, Caponnetto P, Polosa R. A Global Health Survey of People Who Vape but Never Smoked: Protocol for the VERITAS (Vaping Effects: Real-World International Surveillance) Study. JMIR Res Protoc 2024; 13:e54236. [PMID: 38546715 PMCID: PMC11009848 DOI: 10.2196/54236] [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: 11/02/2023] [Revised: 12/19/2023] [Accepted: 01/31/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND There is only limited information about the health effects of regular vaping. Research on the health status of people who used to smoke faces the challenge that previous smoking may have caused unknown health effects. Only studies of people who vape but have never smoked combustible cigarettes can enable the detection of harms attributable to vaping. Large prospective studies of well-characterized electronic cigarette users with and without a history of combustible cigarette smoking are warranted to establish the long-term effects of regular vaping on respiratory health. OBJECTIVE We will conduct a global cross-sectional survey of individuals from 6 world regions. Respiratory symptoms will be assessed using a validated questionnaire-the Respiratory Symptom Experience Scale (RSES). Current vapers who are nonusers of other tobacco or nicotine products will be compared with matched controls who are nonusers of vapes and other tobacco or nicotine products. METHODS This will be a multicountry, cross-sectional internet-based survey of 750 adults aged ≥18 years who satisfy the criteria for inclusion in either a cohort of people who exclusively vape and who are nonusers of other tobacco or nicotine products ("vapers cohort"; target N=500) or a cohort of nonvapers who are also nonusers of other tobacco or nicotine products ("controls cohort"; target N=250). The primary end point of the study is the RSES score. RSES scores of people in the "vapers cohort" will be compared with those of people in the "controls cohort." Additionally, the study will collect data to characterize patterns of vaping product use among the vapers cohort. Data collection will include information about the age initiation of using vape products, reasons for starting and continuing the use of vape products, specific types of products used, flavors and nicotine strengths of recently used products, as well as the frequency and intensity of product use in the past 30 days. RESULTS Participant recruitment started in April 2023, and enrollment was completed by November 2023 with 748 participants. Results will be reported in 2024. CONCLUSIONS This will be the first study providing key insights into respiratory health effects associated with using electronic cigarettes in people who vape with no established use of combustible cigarettes or other tobacco or nicotine products. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/54236.
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Affiliation(s)
- Jeffrey Zamora Goicoechea
- International Network of Nicotine Consumer Organisations, Vejle, Denmark
- Asociación de Reducción de Daños del Tabaquismo, Bogota, Colombia
- Asociación de usuarios de vaporizadores y métodos de reducción de daños por tabaquismo de Costa Rica, San José, Costa Rica
| | - Allison Boughner
- American Vapor Manufacturers, Prescott, AZ, United States
- South Carolina Vapor Association, Charleston, SC, United States
| | | | | | - Kurt Yeo
- Vaping Saved My Life, Benoni, Gauteng, South Africa
- World Vapers Alliance, Miami, FL, United States
| | | | - Tasmin Patel
- Confidosoft Ltd, Leatherhead, London, United Kingdom
| | | | | | | | - Pasquale Caponnetto
- Section of Psychology, Department of Science of Education, University of Catania, Catania, Italy
- Center of Excellence for the Acceleration of Harm Reduction, University of Catania, Catana, Italy
| | - Riccardo Polosa
- Center of Excellence for the Acceleration of Harm Reduction, University of Catania, Catana, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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Tao X, Zhang J, Meng Q, Chu J, Zhao R, Liu Y, Dong Y, Xu H, Tian T, Cui J, Zhang L, Chu M. The potential health effects associated with electronic-cigarette. ENVIRONMENTAL RESEARCH 2024; 245:118056. [PMID: 38157958 DOI: 10.1016/j.envres.2023.118056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 12/17/2023] [Accepted: 12/25/2023] [Indexed: 01/03/2024]
Abstract
A good old gateway theory that electronic-cigarettes (e-cigarettes) are widely recognized as safer tobacco substitutes. In actuality, demographics also show that vaping cannibalizes smoking, the best explanation of the data is the "common liability". However, the utilization of e-cigarette products remains a controversial topic at present. Currently, there has been a widespread and substantial growth in e-cigarette use worldwide owing to their endless new flavors and customizable characteristics. Furthermore, e-cigarette has grown widespread among smokers as well as non-smokers, including adolescents and young adults. And some studies have shown that e-cigarette users are at greater risk to start using combustible cigarettes while e-cigarettes use was also observed the potential benefits to people who want to quit smoking or not. Although it is true that e-cigarettes generally contain fewer toxic substances than combustible cigarettes, this does not mean that the chemical composition in e-cigarettes aerosols poses absolutely no risks. While concerns about toxic substances in e-cigarettes and their widespread use in the population are reasonable, it is also crucial to consider that e-cigarettes have been associated with the potential for promoting smoking cessation and the clinically relevant improvements in users with smoking-related pathologies. Meanwhile, there is still short of understanding of the health impacts associated with e-cigarette use. Therefore, in this review, we discussed the health impacts of e-cigarette exposure on oral, nasal, pulmonary, cardiovascular systems and brain. We aspire for this review to change people's previous perceptions of e-cigarettes and provide them with a more balanced perspective. Additionally, we suggest appropriate adjustments on regulation and policy for e-cigarette to gain greater public health benefits.
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Affiliation(s)
- Xiaobo Tao
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Jiale Zhang
- The Second People's Hospital of Nantong, Nantong, Jiangsu, China
| | - Qianyao Meng
- Department of Global Health and Population, School of Public Health, Harvard University, Boston, USA
| | - Junfeng Chu
- Department of Oncology, Jiangdu People's Hospital of Yangzhou, Yangzhou, Jiangsu, China
| | - Rongrong Zhao
- Department of Oncology, Jiangdu People's Hospital of Yangzhou, Yangzhou, Jiangsu, China
| | - Yiran Liu
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Yang Dong
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Huiwen Xu
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Tian Tian
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Jiahua Cui
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Lei Zhang
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu, China.
| | - Minjie Chu
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu, China.
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Wölkart G, Kollau A, Russwurm M, Koesling D, Schrammel A, Mayer B. Varied effects of tobacco smoke and e-cigarette vapor suggest that nicotine does not affect endothelium-dependent relaxation and nitric oxide signaling. Sci Rep 2023; 13:15833. [PMID: 37739972 PMCID: PMC10517138 DOI: 10.1038/s41598-023-42750-6] [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: 06/27/2023] [Accepted: 09/14/2023] [Indexed: 09/24/2023] Open
Abstract
Chronic smoking causes dysfunction of vascular endothelial cells, evident as a reduction of flow-mediated dilation in smokers, but the role of nicotine is still controversial. Given the increasing use of e-cigarettes and other nicotine products, it appears essential to clarify this issue. We studied extracts from cigarette smoke (CSE) and vapor from e-cigarettes (EVE) and heated tobacco (HTE) for their effects on vascular relaxation, endothelial nitric oxide signaling, and the activity of soluble guanylyl cyclase. The average nicotine concentrations of CSE, EVE, and HTE were 164, 800, and 85 µM, respectively. At a dilution of 1:3, CSE almost entirely inhibited the relaxation of rat aortas and porcine coronary arteries to acetylcholine and bradykinin, respectively, while undiluted EVE, with a 15-fold higher nicotine concentration, had no significant effect. With about 50% inhibition at 1:2 dilution, the effect of HTE was between CSE and EVE. Neither extract affected endothelium-independent relaxation to an NO donor. At the dilutions tested, CSE was not toxic to cultured endothelial cells but, in contrast to EVE, impaired NO signaling and inhibited NO stimulation of soluble guanylyl cyclase. Our results demonstrate that nicotine does not mediate the impaired endothelium-dependent vascular relaxation caused by smoking.
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Affiliation(s)
- Gerald Wölkart
- Department of Pharmacology and Toxicology, Institute of Pharmaceutical Sciences, Universität Graz, Humboldtstraße 46, 8010, Graz, Austria
| | - Alexander Kollau
- Department of Pharmacology and Toxicology, Institute of Pharmaceutical Sciences, Universität Graz, Humboldtstraße 46, 8010, Graz, Austria
| | - Michael Russwurm
- Department of Pharmacology and Toxicology, Ruhr-Universität Bochum, MA N1-39, 44780, Bochum, Germany
| | - Doris Koesling
- Department of Pharmacology and Toxicology, Ruhr-Universität Bochum, MA N1-39, 44780, Bochum, Germany
| | - Astrid Schrammel
- Department of Pharmacology and Toxicology, Institute of Pharmaceutical Sciences, Universität Graz, Humboldtstraße 46, 8010, Graz, Austria
| | - Bernd Mayer
- Department of Pharmacology and Toxicology, Institute of Pharmaceutical Sciences, Universität Graz, Humboldtstraße 46, 8010, Graz, Austria.
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O'Leary R, La Rosa GRM, Vernooij R, Polosa R. Identifying spin bias of nonsignificant findings in biomedical studies. BMC Res Notes 2023; 16:50. [PMID: 37131244 PMCID: PMC10155298 DOI: 10.1186/s13104-023-06321-2] [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: 02/01/2023] [Accepted: 03/30/2023] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVE The purpose of this research note is to share a technique for the identification of spin bias that we developed as part of a living systematic review on the cardiovascular testing of e-cigarette substitution for cigarette smoking. While some researchers have remarked on the subjective nature of ascertaining spin bias, our technique objectively documents forms of spin bias arising from the misrepresentation of nonsignificant findings and from the omission of data. RESULTS We offer a two-step process for the identification of spin bias consisting of tracking data and findings and recording of data discrepancies by describing how the spin bias was produced in the text. In this research note, we give an example of the documentation of spin bias from our systematic review. Our experience was that nonsignificant results were presented as causal or even as significant in the Discussion of studies. Spin bias distorts scientific research and misleads readers; therefore it behooves peer reviewers and journal editors to make the effort to detect and correct it.
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Affiliation(s)
- Renée O'Leary
- Center of Excellence for the Acceleration of Harm Reduction, University of Catania, Via Santa Sofia, 89 Torre Biologica 11 piano, 95123, Catania, Italy.
| | | | - Robin Vernooij
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Riccardo Polosa
- Center of Excellence for the Acceleration of Harm Reduction, University of Catania, Via Santa Sofia, 89 Torre Biologica 11 piano, 95123, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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Daiber A, Kuntic M, Oelze M, Hahad O, Münzel T. E-cigarette effects on vascular function in animals and humans. Pflugers Arch 2023:10.1007/s00424-023-02813-z. [PMID: 37084087 DOI: 10.1007/s00424-023-02813-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 04/22/2023]
Abstract
Smoking tobacco cigarettes is a significant (cardiovascular) health risk factor. Although the number of tobacco cigarette users declined over the last decades, shisha smoking and e-cigarette vaping partially compensated for this health benefit. E-cigarettes may create highly addicted dual users (vaping and smoking). E-cigarettes seem not to represent a healthier alternative to tobacco smoking, although they may be less harmful. E-cigarette vaping causes oxidative stress, inflammation, endothelial dysfunction, and associated cardiovascular sequelae. This is primarily due to a significant overlap of toxic compounds in the vapor compared to tobacco smoke and, accordingly, a substantial overlap of pathomechanistic features between vaping and smoking. Whereas the main toxins in vapor are reactive aldehydes such as formaldehyde and acrolein, the toxic mixture in smoke is more complex, comprising particulate matter, reactive gases, transition metals, volatile organic compounds, and N-nitrosamines. However, it seems that both lifestyle drugs impair endothelial function to a quite similar extent, which may be due to the role of oxidative stress as the central pathomechanism to mediate endothelial dysfunction and vascular damage. Finally, the main selling argument for e-cigarette use that they help to quit smoking and get rid of nicotine addiction may be false because it seems that e-cigarettes instead trigger the opposite-younger entrance age and more frequent use. With our review, we summarize the adverse health impact of tobacco cigarettes and e-cigarettes, emphasizing the detrimental effects on endothelial function and cardiovascular health.
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Affiliation(s)
- Andreas Daiber
- Department of Cardiology 1, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany.
- German Center for Cardiovascular Research (DZHK), Partnersite Rhine-Main, Mainz, Germany.
| | - Marin Kuntic
- Department of Cardiology 1, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partnersite Rhine-Main, Mainz, Germany
| | - Matthias Oelze
- Department of Cardiology 1, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Omar Hahad
- Department of Cardiology 1, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partnersite Rhine-Main, Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology 1, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany.
- German Center for Cardiovascular Research (DZHK), Partnersite Rhine-Main, Mainz, Germany.
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