Health effects of electronic cigarettes

Misconceptions About E-cigarettes Among Healthcare Workers at Primary Health Care Centers in Riyadh, Saudi Arabia

BACKGROUND

As e-cigarettes become increasingly popular, especially among youth, addressing the misinformation surrounding their use is crucial. This study aims to enhance healthcare workers' knowledge of the risks associated with e-cigarettes, ultimately improving patient education and public health outcomes.

AIMS AND OBJECTIVES

To assess health workers' awareness of misconceptions surrounding e-cigarette use and the implications of this awareness on their personal use and professional practices  Methods: A cross-sectional study was conducted at the primary healthcare centers of Prince Sultan Military Medical City (PSMMC) in Riyadh, Saudi Arabia, to assess healthcare professionals' awareness of e-cigarette misconceptions. Utilizing a convenience sampling technique, the target sample size was 246 participants, and the actual participants were 208, ensuring robust representation. Eligible participants include PSMMC healthcare providers currently working in PHC settings, while those from other departments or institutions will be excluded. Data was collected through a structured online questionnaire covering demographic information, personal e-cigarette usage, awareness of health impacts, addictive potential, and regulations related to e-cigarettes.

RESULTS

The study included a total of 208 participants, with the majority (150 participants, 72.1%) aged between 25 and 35 years. The group was predominantly male (108 participants, 51.9%) and Saudi nationals (147 participants, 70.7%). Additionally, 108 participants (51.9%) were married, and half were specializing in family medicine. While only 35 (16.8%) personally use e-cigarettes, 124 (59.6%) know someone who does, and social media is the primary information source for 127 (61.06%) participants. A strong majority (185,88.9%) believe e-cigarettes are harmful, and 164 (78.8%) recognize the potential harm to bystanders from e-cigarette aerosol. The views on e-cigarettes being less harmful than traditional cigarettes are mixed, with 64 (30.8%) in agreement, while 136 (65.4%) acknowledge their addictive nature. There is widespread support for regulating e-cigarettes like tobacco products (150, 72.1%) and prohibiting their use for individuals under 18 (164, 78.8%). Statistical analysis shows a significant association between the specialty of family medicine and the belief in the health risks of e-cigarettes (p=0.029), indicating the need for targeted education and policy measures.

CONCLUSION

Despite participants' relatively good knowledge of e-cigarettes and their health implications, a significant number of misconceptions persist. This highlights the need for ongoing education and training programs tailored for healthcare professionals to address gaps in understanding and ensure they are equipped with accurate information.

An integrated dual process model in predicting e-cigarette use in undergraduate students

The use of e-cigarette or vape devices is a growing concern on an international scale, given the devices' addictive nature and questions regarding their short- and long-term health impacts. Their use is especially an issue in young people, many of whom have little or no previous nicotine use experience. This study tested an integrated dual process model in 363 young Australian undergraduates where prospectively measured e-cigarette use was predicted by the psychological constructs of the theory of planned behavior, supplemented with risk perception, e-cigarette dependence, habit, and implicit attitude. Intention to use an e-cigarette was predicted by affective attitude, subjective norm, and e-cigarette dependance, but not instrumental attitude, perceived behavioral control, or risk perception. E-cigarette use was predicted by e-cigarette dependance, intention, habit, implicit attitude, and previous nicotine use, although perceived behavioral control did not directly predict behavior nor moderate the intention-behavior relationship. Current findings provide evidence for important psychological predictors of e-cigarette use, signposting potential intervention targets. Specifically, interventions may benefit from using strategies that tap affective or normative beliefs alongside automatic constructs and dependence, while focusing less on beliefs about the health impacts of e-cigarettes or control over using.

Social Media Exposure and Other Correlates of Increased e-Cigarette Use Among Adolescents During Remote Schooling: Cross-Sectional Study

Background

Little is known about the role of exposure to e-cigarette-related digital content, behavioral and mental health factors, and social environment on the change in adolescent e-cigarette use during COVID-19 shelter-in-place orders and remote schooling.

Objective

The aim of the study was to examine changes in adolescent e-cigarette use during shelter-in-place and remote schooling in association with exposure to e-cigarette-related digital content and other correlates: stronger e-cigarette dependence, feeling lonely, inability to socialize, e-cigarette use to cope with shelter-in-place, and the number of family members aware of participants' e-cigarette use.

Methods

A cross-sectional survey conducted between August 2020 and March 2021 included 85 California adolescents (mean age 16.7, SD 1.2 years; 39/85, 46% identified as female and 37/85, 44% as Hispanic) who reported e-cigarette use in the past 30 days. Multivariable penalized logistic regressions determined associations adjusted for age, race and ethnicity, and mother's education. The outcome of increased e-cigarette use was defined as more frequent use of e-cigarettes of the same or stronger nicotine or tetrahydrocannabinol concentration.

Results

Almost all respondents (83/85, 98%) reported using social media more since shelter-in-place, and 74% (63/85) reported seeing e-cigarette digital content. More than half (46/85, 54%) reported increased e-cigarette use during shelter-in-place. Most individuals who increased use were exposed to e-cigarette digital content (38/46, 83%) compared to those who did not increase e-cigarette use (25/39, 64%), but the association was nonsignificant after adjusting for demographics (adjusted odds ratio [AOR] 2.34, 95% CI 0.71-8.46). Respondents who felt lonely (AOR 3.33, 95% CI 1.27-9.42), used e-cigarettes to cope with shelter-in-place (AOR 4.06, 95% CI 1.39-13.41), or had ≥2 family members aware of participants' e-cigarette use (AOR 6.42, 95% CI 1.29-39.49) were more likely to report increased e-cigarette use.

Conclusions

Almost all participants reported using social media more during shelter-in-place, with many respondents reporting increased e-cigarette use, and significant associations with loneliness and use to cope with shelter-in-place. Future interventions should consider leveraging digital platforms for e-cigarette use prevention and cessation and address the mental health consequences of the COVID-19 pandemic.

What are the health impacts of nicotine and tobacco products on young people?

DESIGN

Narrative review.

REVIEW QUESTION

What are the implications of new nicotine and tobacco products on adolescent health?

PRODUCTS

E-cigarettes and oral nicotine products such as pouches, lozenges, tablets, gum, and gummies.

RESULTS

These products can be addictive and can cause respiratory, cardiovascular and oral potential health problems. They also have effects on brain development. Products are attractive to adolescents, with more than 1:10 American adolescents uses them.

CONCLUSIONS

The use of nicotine and tobacco products by adolescents puts their health at risk and may, in some instances, lead to nicotine addiction. Those providing healthcare for adolescents have an opportunity to provide advice and signpost people to resources to help them stop using such products. There is also a need for legislation to restrict the sale of e-cigarettes and tobacco products.

Electronic Cigarette Harms: Aggregate Evidence Shows Damage to Biological Systems

Evidence of the harms of e-cigarettes has been unfolding slowly and has been documented in many reviews and reports worldwide. A narrative review of new evidence is presented since, as research has continued, newly aggregated evidence of the dangers of electronic cigarettes on the brain, heart, and lungs is vital to inform decisions on restricting the use of e-cigarettes. Several biomedical research databases were searched for electronic cigarette health effects, emphasizing reviews, systematic reviews, and meta-analyses. Over 50 review studies, primarily in 2022 and 2023, illustrate some of the latest information on e-cigarette harms. Results show studies of respiratory, neurological, and cardiovascular effects. Researchers call for expanding studies through new methods to elaborate on initial findings of multiple harms emerging in clinical investigations. Since the use of electronic cigarettes for adult cessation is not sanctioned in most countries, it is clear that health authorities see significant costs to the health of the general population if the promotion and use of electronic cigarettes occur worldwide. Regulatory action to control electronic cigarettes should consider the substantial evidence of electronic cigarette harm.

The nicotine and tobacco epidemic among adolescents: new products are addicting our youth

PURPOSE OF REVIEW

New nicotine and tobacco products such as electronic cigarettes and oral nicotine products have increased in use and threaten to addict a new generation of youth. This review summarizes current literature on nicotine and tobacco products used by youth, epidemiology, health effects, prevention and treatment of nicotine dependence, and current policies and regulations.

RECENT FINDINGS

Electronic cigarettes and oral nicotine products are popular among youth, attracting adolescents through exposure to deceptive marketing and fruit, candy and dessert flavors. Electronic cigarettes and oral nicotine product use can lead to nicotine addiction and is associated with respiratory, cardiovascular, and oral health problems, although long-term health effects are not fully known. The Food and Drug Administration (FDA) has authority to regulate nicotine and tobacco products; however, thousands of unregulated and unauthorized products remain on the market.

SUMMARY

Millions of adolescents continue to use nicotine and tobacco products, which puts them at risk for health problems, including nicotine addiction. Pediatric providers can provide prevention messages, screen youth for tobacco and nicotine use, and offer appropriate treatment options. Regulation of tobacco and nicotine products by the FDA is critical to reverse this public health epidemic of youth nicotine and tobacco use.

The Association of Global and Disease-Related Stress With Susceptibility to and Use of E-Cigarettes and Marijuana Among Adolescents With Congenital Heart Disease

OBJECTIVE

Adolescents with congenital heart disease (CHD) are exposed to disease-related stressors and have elevated risk for cardiovascular and cognitive complications that are exacerbated by e-cigarettes and marijuana. The aims of this cross-sectional study are to: (1) identify the association between perceived global and disease-related stress and susceptibility to e-cigarettes and marijuana, (2) determine if the association between stress and susceptibility differs by gender, and (3) explore the association between stress and ever use of e-cigarettes and marijuana among adolescents with CHD.

METHODS

Adolescents with CHD (N = 98; aged 12-18 years) completed self-report measures of susceptibility to/ever use of e-cigarettes and marijuana and global and disease-related stress.

RESULTS

Susceptibility to e-cigarettes and marijuana was reported by 31.3% and 40.2% of adolescents, respectively. Ever use of e-cigarettes and marijuana was reported by 15.3% and 14.3% of adolescents, respectively. Global stress was associated with susceptibility to and ever use of e-cigarettes and marijuana. Disease-related stress was associated with susceptibility to marijuana. Females reported more global and disease-related stress than males, but the association of stress with susceptibility to e-cigarettes and marijuana did not differ by gender.

CONCLUSIONS

Susceptibility to e-cigarettes and marijuana is common among adolescents with CHD and is associated with stress. Future work to examine the longitudinal associations between susceptibility, stress, and use of e-cigarettes and marijuana is warranted. Global stress may be an important consideration in the development of strategies to prevent these risky health behaviors among adolescents with CHD.

E-Cigarettes Reexamined: Product Toxicity

The introduction of e-cigarettes, or electronic nicotine delivery systems (ENDS), has been accompanied by controversy regarding their safety and effectiveness as a cessation aid and by an explosion in their use by youth. Their use does not involve the combustion of tobacco and the creation of harmful combustion products; they have been seen as a "harm reduction" tool that may be of assistance in promoting smoking cessation. Recognition that ENDS can deliver an array of chemicals and materials with known adverse consequences has spurred more careful examination of these products. Nicotine, nitrosamines, carbonyl compounds, heavy metals, free radicals, reactive oxygen species, particulate matter, and "emerging chemicals of concern" are among the constituents of the heated chemical aerosol that is inhaled when ENDS are used. They raise concerns for cardiovascular and respiratory health that merit the attention of clinicians and regulatory agencies. Frequently cited concerns include evidence of disordered respiratory function, altered hemodynamics, endothelial dysfunction, vascular reactivity, and enhanced thrombogenesis. The absence of evidence of the consequences of their long-term use is of additional concern. Their effectiveness as cessation aids and beneficial impact on health outcomes continue to be examined. It is important to ensure that their production and availability are thoughtfully regulated to optimise their safety and permit their use as harm reduction devices and potentially as smoking-cessation aids. It is equally vital to effectively prevent them from becoming ubiquitous consumer products with the potential to rapidly induce nicotine addiction among large numbers of youth. Clinicians should understand the nature of these products and the implications of their use.