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Kim JS, Kim K. Electronic cigarette use and suicidal behaviors among adolescents. J Public Health (Oxf) 2021; 43:274-280. [PMID: 31334765 DOI: 10.1093/pubmed/fdz086] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 06/11/2019] [Accepted: 06/29/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the association of the use of e-cigarettes, which are regarded as alternatives to traditional cigarettes and are easy to purchase, with suicidal behaviors in adolescents. METHODS Data for 5405 middle and high school students aged 13-18 years who had used e-cigarettes were extracted from the 2016 Korean Youth Risk Behavior Web-Based Survey and analyzed using multiple logistic regression. RESULTS Among those who used e-cigarettes for 1-30 days in the past 30 days, suicidal ideation (odds ratio [OR] = 1.58, 95% CI, 1.31-1.89), suicidal plans (OR = 2.44, 95% CI, 1.94-3.08), suicidal attempts (OR = 2.44, 95% CI, 1.85-3.22) and serious attempts (OR = 3.09, 95% CI, 1.51-6.32) were higher compared to those who did not use an e-cigarette in the past 30 days. CONCLUSIONS Suicidal behaviors are significantly higher among current adolescent e-cigarette smokers than adolescents who have not used an e-cigarette in the past 30 days. Therefore, comprehensive intervention is needed to protect adolescents' mental health.
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Affiliation(s)
- J S Kim
- Department of Nursing, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul, Republic of Korea
| | - K Kim
- Department of Nursing, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul, Republic of Korea
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2
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Cao Y, Wu D, Ma Y, Ma X, Wang S, Li F, Li M, Zhang T. Toxicity of electronic cigarettes: A general review of the origins, health hazards, and toxicity mechanisms. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 772:145475. [PMID: 33770885 DOI: 10.1016/j.scitotenv.2021.145475] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/24/2021] [Accepted: 01/24/2021] [Indexed: 06/12/2023]
Abstract
Electronic cigarettes (E-cigarette) are an alternative for traditional cigarette smokers to quit smoking. Based on the current understanding, electronic cigarettes have rapidly become popular among existing smokers and former non-smokers. However, increasing research at different levels reveals that e-cigarettes are unsafe. This review provides an overview of the toxicology of e-cigarettes based on existing in vivo and in vitro studies and compares their toxicity with that of traditional cigarettes. Moreover, we describe the associated toxicity components in e-cigarettes, as well as the potential mechanism by which e-cigarettes exert toxic effects. As is known to all, the nicotine in traditional cigarettes and e-cigarettes has certain toxicity. Besides, a few studies have shown that propylene glycol and vegetable glycerin mixture and flavoring agents in e-cigarettes also are the key components causing adverse effects in animals or cells. There is insufficient scientific evidence on the toxicity of e-cigarettes due to the lack of standardized research methods, prompting the need to conduct a comprehensive toxicity assessment of e-cigarette toxicity to elucidate the safety issues of e-cigarettes. Eventually, a basis for decision-making on whether people use e-cigarettes will be obtained.
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Affiliation(s)
- Yuna Cao
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China
| | - Daming Wu
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China
| | - Ying Ma
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China
| | - Xinmo Ma
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China
| | - Shile Wang
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China
| | - Fuxian Li
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China
| | - Menghan Li
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China
| | - Ting Zhang
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China.
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3
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Driller G, Plasencia E, Apollonio DE. Retrospective review of nicotine exposures in California from 2012 to 2018 and analysis of the impacts of e-cigarette regulations. BMJ Open 2021; 11:e043133. [PMID: 33653751 PMCID: PMC7929887 DOI: 10.1136/bmjopen-2020-043133] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To review the association between US e-cigarette regulations and the number of reported nicotine exposures, and identify higher-risk products DESIGN: Retrospective review of de-identified medical records. SETTING California PARTICIPANTS: Cases reported to California Poison Control System in 2012-2018. PRIMARY AND SECONDARY OUTCOME MEASURES Suspected nicotine toxicity; route of exposure and product characteristics. RESULTS We examined 5277 exposures, of which 3033 involved combustible cigarettes, 1489 involved e-cigarettes and 818 involved other substances (ie, chewing tobacco, nicotine patches, nicotine lozenges, hookah, etc). Implementation of the Child Nicotine Poisoning Prevention Act of 2015 was not significantly associated with reduced exposures. Exposures for e-cigarettes increased significantly after the 2017 Food and Drug Administration Compliance Policy (p=0.003, coefficient (coeff)=0.61). Total exposures for all tobacco and nicotine products also increased significantly after the policy change (p=0.01, coeff=1.26). Nicotine exposure outcomes classified as being of minor and moderate severity increased significantly after implementation of the 2017 Compliance Policy (p=0.004, coeff=0.54 and p=0.002, coeff=0.56, respectively). Ingestion was the most common route of exposure (87.7%), followed by inhalation (8.1%), dermal (6.5%), ocular (2.1%) and other (intranasal, rectal, sublingual and unknown) routes (0.2%); some cases reported multiple routes of exposure. Exposure cases involving e-cigarettes fell into three problem categories: product design, labelling and the appeal of flavours. CONCLUSIONS Our analysis found that despite previous studies suggesting that the Child Nicotine Poisoning Prevention Act appeared to have reduced exposures for e-cigarettes, there was no significant change in exposures after its implementation. In contrast, there was a 30% increase in California e-cigarette exposures following the 2017 Compliance Policy. We conclude that current regulations are insufficient to reduce nicotine toxicities due to e-cigarette use.
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Affiliation(s)
- Gabrielle Driller
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Emily Plasencia
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Dorie E Apollonio
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
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Abstract
Objectives Intentional and unintentional exposures to electronic nicotine delivery system (ENDS) e-liquids can cause illness and death. In this study, we describe acute nicotine toxicity due to e-liquid exposure (ANTEE) information found on Twitter and contextualize ANTEE experiences to clarify conditions associated with exposure. Methods We obtained 20,180 ANTEE-relevant tweets from 2013-2018. We excluded retweets, suspected bots, non-English tweets, tweets not originating in the US, and advertisements. We coded relevant tweets qualitatively using domains for e-liquid exposure tweets and e-liquid-related non-exposure tweets (ie, posts reflecting hypothetical exposure, information about e-liquids). Results Content analyses were based on 1656 e-liquid exposure tweets and 1210 non-exposure tweets. More than half of exposure tweets (61.3%) were classified as accidental exposures; subjects were predominately young people, assumed to be under age 18 (40.5%), and self (27.7%). The most common exposure route was ingestion (61.1%). Of exposure tweets, 13.9% described health effects and 12.7% described seeking assistance. Most non-exposure tweets were classified as likely or hypothetical exposure (49.9%) or presentation of advice, information, or warnings (40.5%). Conclusions Tweets can serve as a novel and complementary data source for learning more about e-liquid exposures.
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5
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Sapru S, Vardhan M, Li Q, Guo Y, Li X, Saxena D. E-cigarettes use in the United States: reasons for use, perceptions, and effects on health. BMC Public Health 2020; 20:1518. [PMID: 33032554 PMCID: PMC7545933 DOI: 10.1186/s12889-020-09572-x] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/20/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Many researchers claim electronic cigarettes (e-cigarettes) to be a breakthrough invention for tobacco users that aspires to curb their addiction to conventional cigarettes. Claimed to be safer by their promoters, these smokeless devices have become increasingly popular since their arrival on the market among users of all ages, especially adolescents. This paper investigated the trends in e-cigarette usage since the time it arrived in the United States, highlighting the highest surge that has occurred in adolescent e-cigarette use. It also aimed to understand the reasons and perceptions behind the ever-increasing use of e-cigarettes by adolescents. MAIN BODY With the advent of e-cigarettes and common positive perceptions regarding their use, we are at risk of reversing the years of efforts regarding tobacco control and instead advance towards a new addiction with currently unknown long-term health hazards. There is substantial data showing a significant increase of e-cigarette users in the United States, especially among adolescents. The aim of this review was to explore the reasons behind this widespread increase in the use of e-cigarettes among the teenage population in the US and also to uncover the common perceptions about these new electronic delivery systems. In addition, this review attempted to summarize health benefits and hazards associated with e-cigarette use as it crucial to have the right information among its users regarding the health effects of e-cigarette use. CONCLUSION E-cigarettes are more appealing than c-cigarettes for a variety of reasons, including cost, choice of different flavors, ease of accessibility, and use and impact of social media. There are also different perceptions among e-cigarette users, including both adolescents and adults. The former group may use them because of the sense of fashion associated with this novel device, and the latter might intend to quit conventional/combustible cigarettes (c-cigarettes) by switching to e-cigarettes. However, it is important to note that e-cigarettes are a recent phenomenon; therefore, there is a lack of many long-term studies that can identify future health risks associated with e-cigarette use. We need more detailed studies that focus on the long-term health effects of e-cigarette use. Moreover, with the ever-increasing usage of e-cigarettes by adolescents (10 and 19 years), it is very important that e-cigarettes be incorporated into the current tobacco-free laws and ordinances. We conclude by stating that e-cigarettes need stronger regulations to prevent youth access and use.
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Affiliation(s)
- Sakshi Sapru
- Department of Molecular Pathobiology, New York University College of Dentistry, 345 E 24th St, Room 921B, New York, NY, 10010, USA
| | - Mridula Vardhan
- Department of Molecular Pathobiology, New York University College of Dentistry, 345 E 24th St, Room 921B, New York, NY, 10010, USA
| | - Qianhao Li
- Department of Molecular Pathobiology, New York University College of Dentistry, 345 E 24th St, Room 921B, New York, NY, 10010, USA
| | - Yuqi Guo
- Department of Molecular Pathobiology, New York University College of Dentistry, 345 E 24th St, Room 921B, New York, NY, 10010, USA
| | - Xin Li
- Department of Molecular Pathobiology, New York University College of Dentistry, 345 E 24th St, Room 921B, New York, NY, 10010, USA
- Departments of Urology, New York University School of Medicine, New York, NY, 10016, USA
| | - Deepak Saxena
- Department of Molecular Pathobiology, New York University College of Dentistry, 345 E 24th St, Room 921B, New York, NY, 10010, USA.
- Departments of Surgery, New York University School of Medicine, New York, NY, 10016, USA.
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Krishna A, Mathieu W, Mull E, Tobias JD. Perioperative Implications of Vaping. J Med Cases 2020; 11:129-134. [PMID: 34434382 PMCID: PMC8383562 DOI: 10.14740/jmc3451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 03/12/2020] [Indexed: 12/17/2022] Open
Abstract
Over the past 10 - 15 years, there has been a significant increase in the use of electronic cigarettes. These devices are generally used to deliver nicotine through inhalation by aerosolization. While the long-term risk of lung cancer is yet to be known, the chemicals and impurities in the solutions may have other acute and chronic effects on the respiratory system including respiratory failure from adult respiratory distress syndrome. Recent concerns have been raised regarding the potential for significant acute and chronic health care risks of these devices including pneumonitis, airway reactivity and respiratory failure. Given that many of the acute effects are related to the respiratory system, anesthetic care may be required during diagnostic procedures including bronchoscopy to investigate the etiology of acute respiratory symptomatology. We present an adolescent who presented to the operating room for bronchoscopy and bronchoalveolar lavage to investigate the etiology of respiratory involvement following an episode of vaping. The healthcare and end-organ effects of nicotine, tobacco smoke and vaping are discussed, and potential anesthetic implications are presented.
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Affiliation(s)
- Amogha Krishna
- Heritage College of Osteopathic Medicine, Dublin, OH, USA
| | - Wana Mathieu
- The Ohio State University School of Medicine, Columbus, OH, USA
| | - Eric Mull
- Division of Pediatric Pulmonology and Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA
| | - Joseph D Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
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7
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Ruszkiewicz JA, Zhang Z, Gonçalves FM, Tizabi Y, Zelikoff JT, Aschner M. Neurotoxicity of e-cigarettes. Food Chem Toxicol 2020; 138:111245. [PMID: 32145355 PMCID: PMC7089837 DOI: 10.1016/j.fct.2020.111245] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 02/29/2020] [Accepted: 03/03/2020] [Indexed: 02/07/2023]
Abstract
It appears that electronic cigarettes (EC) are a less harmful alternative to conventional cigarette (CC) smoking, as they generate substantially lower levels of harmful carcinogens and other toxic compounds. Thus, switching from CC to EC may be beneficial for smokers. However, recent accounts of EC- or vaping-associated lung injury (EVALI) has raised concerns regarding their adverse health effects. Additionally, the increasing popularity of EC among vulnerable populations, such as adolescents and pregnant women, calls for further EC safety evaluation. In this state-of-the-art review, we provide an update on recent findings regarding the neurological effects induced by EC exposure. Moreover, we discuss possible neurotoxic effects of nicotine and numerous other chemicals which are inherent both to e-liquids and EC aerosols. We conclude that in recognizing pertinent issues associated with EC usage, both government and scientific researchers must address this public health issue with utmost urgency.
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Affiliation(s)
- Joanna A Ruszkiewicz
- Molecular Toxicology Group, Department of Biology, University of Konstanz, Konstanz, Germany
| | - Ziyan Zhang
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Filipe Marques Gonçalves
- Biochemistry Graduate Program, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Yousef Tizabi
- Department of Pharmacology, Howard University College of Medicine, Washington DC, United States
| | - Judith T Zelikoff
- Department of Environmental Medicine, New York University School of Medicine, Manhattan, NY, United States
| | - Michael Aschner
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY, United States.
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8
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Tzortzi A, Kapetanstrataki M, Evangelopoulou V, Behrakis P. A Systematic Literature Review of E-Cigarette-Related Illness and Injury: Not Just for the Respirologist. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2248. [PMID: 32230711 PMCID: PMC7177608 DOI: 10.3390/ijerph17072248] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/20/2020] [Accepted: 03/25/2020] [Indexed: 12/13/2022]
Abstract
Following the recent electronic cigarette (e-cigarette) illness outbreak, the current review aimed to collect all related clinical cases for study and analysis and provide a critical synopsis of the proposed injury mechanism. Adhering to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines, e-cigarette-related clinical cases were identified via Google Scholar and PubMed databases. Additionally, references of published case reports and previous review papers were manually searched, revealing 159 publications presenting e-cigarette-related case reports and 19 reports by the Centers for Disease Control and Prevention. 238 individual cases were identified; 53% traumatic injuries due to e-cigarette explosion or self-combustion, 24% respiratory cases, and 12% poisonings. Additional cases pertained to oral, cardiovascular, immunologic, hematologic, allergic reactions, infant complications, and altered medication levels. Case reports were mainly published between 2016-2019 (78%). The oldest case, a lipoid pneumonia, was published in 2012. The current review showed that e-cigarette-related health effects extend beyond the acute lung injury syndrome, including traumatic, thermal injuries and acute intoxications. Physicians should be aware of the distinct clinical presentations and be trained to respond and treat effectively. Regulators and public health authorities should address the regulatory gap regarding electronic nicotine delivery systems (ENDS) and novel tobacco products.
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Affiliation(s)
- Anna Tzortzi
- George D. Behrakis Research Lab, Hellenic Cancer Society, 17B Ipitou Street, 10557 Athens, Greece; (V.E.); (P.B.)
- Institute of Public Health, The American College of Greece, 17B Ipitou Street, 10557 Athens, Greece
| | - Melpo Kapetanstrataki
- George D. Behrakis Research Lab, Hellenic Cancer Society, 17B Ipitou Street, 10557 Athens, Greece; (V.E.); (P.B.)
| | - Vaso Evangelopoulou
- George D. Behrakis Research Lab, Hellenic Cancer Society, 17B Ipitou Street, 10557 Athens, Greece; (V.E.); (P.B.)
| | - Panagiotis Behrakis
- George D. Behrakis Research Lab, Hellenic Cancer Society, 17B Ipitou Street, 10557 Athens, Greece; (V.E.); (P.B.)
- Institute of Public Health, The American College of Greece, 17B Ipitou Street, 10557 Athens, Greece
- Pulmonary Department, Athens Medical Center, Distomou 5-7, Marousi, 15125 Athens, Greece
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9
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Obertova N, Navratil T, Zak I, Zakharov S. Acute exposures to e-cigarettes and heat-not-burn products reported to the Czech Toxicological Information Centre over a 7-year period (2012-2018). Basic Clin Pharmacol Toxicol 2020; 127:39-46. [PMID: 32012431 DOI: 10.1111/bcpt.13393] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/13/2020] [Accepted: 01/19/2020] [Indexed: 11/29/2022]
Abstract
E-cigarettes and heat-not-burn cigarettes (HNBC) present new health risks due to their rising popularity, high content of nicotine and serious adverse effects. The objective of the study was to analyse the cases of acute exposure to e-cigarettes, e-liquids and HNBC products containing nicotine that led to toxicological consultations at our poisons control centre during a 7-year period (2012-2018) and identify the categories of special concern that require further investigation and intervention. The demographic, toxicological and clinical data were analysed by descriptive statistics. Poisoning severity score (PSS) was estimated. From 119 229 consultations, 148 cases concerned acute exposure to e-cigarettes. Children and adolescents were exposed in 91 (61%) cases, including exposure of neonates and infants in 54 (36%) cases. The main route of exposure was ingestion in 129 (87%), inhalation in nine (6%), ocular in six (4%) and intravenous administration in three (2%) cases. The source of exposure was the cartridge with e-liquid (107; 72%), refillable tank in 29 (20%) and HNBC refill in nine (6%) cases. The reason for exposure was accidental in 110 (74%), incorrect application of the device in 10 (7%), abuse in six (4%), suicide attempt in six (4%) and other/unknown in 16 (11%) cases. The dose estimation was severe/lethal in 6 (4%), toxic in 53 (36%), low-to-moderate in 35 (24%) and unknown in 54 (36%) cases. Vomiting was observed in 38 (26%) patients; 72% of patients were hospitalised. In symptomatic cases, 41 patient had PSS 1, 12 patients had PSS 2, and one patient had PSS 3. Activated charcoal was applied in 57 (39%) patients, and symptomatic treatment was recommended in 75 (51%) patients. Cases of unintentional exposure of children demonstrate the need for preventive risk reduction measures.
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Affiliation(s)
- Nikola Obertova
- Toxicological Information Centre, General University Hospital, Prague, Czech Republic.,Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Tomas Navratil
- Toxicological Information Centre, General University Hospital, Prague, Czech Republic.,Department of Electrochemistry at the Nanoscale, J. Heyrovsky Institute of Physical Chemistry of the Czech Academy of Sciences, Prague, Czech Republic
| | - Ivan Zak
- Toxicological Information Centre, General University Hospital, Prague, Czech Republic.,Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Sergey Zakharov
- Toxicological Information Centre, General University Hospital, Prague, Czech Republic.,Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
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Abstract
SIGNIFICANCE Prominent ocular surface dryness and poor tear film quality among electronic cigarette (e-cigarette) smokers (or vapers) indicate potential harm to the eyes from vaping. These findings may serve as precautionary signs for e-cigarette users and exposed bystanders. PURPOSE Little is known about the effect of e-cigarettes on the eyes except for reported eye irritation among individuals who were exposed to e-cigarette vapors and e-liquids. This study aims to investigate the effect of vaping on ocular surface health of long-term vapers. METHODS Twenty-one vapers and 21 healthy nonsmokers who are all male underwent measurements of the Ocular Surface Disease Index, noninvasive tear breakup time, fluorescein breakup time, ocular surface staining, tear meniscus height, and the Schirmer test. The effect of voltage used during vaping was also evaluated against the measurements. RESULTS Vapers experienced moderate-to-severe eye dryness (25.0 [interquartile range, 14.6 to 43.7]) as indicated by the Ocular Surface Disease Index. Significant reductions of noninvasive tear breakup time (3.13 ± 0.97 vs. 6.57 ± 2.31 seconds; P < .0001), fluorescein breakup time (2.68 [interquartile range, 2.33 to 3.18] vs. 4.12 [3.56 to 5.07] seconds; P < .0001), and tear meniscus height (203.0 [193.0 to 225.5] vs. 235.0 [210.0 to 253.50] μm; P = .002) were noted in vapers, but the Schirmer test showed higher results (14.5 [12.0 to 17.0] vs. 8.0 [7.0 to 11.0] mm; P = .001) compared with nonsmokers. Increase in vaping voltage aggravated the dry eye symptoms and tear instability (P < .05). Higher Schirmer test result was also noted as voltage increases. CONCLUSIONS Vapers showed moderate-to-severe symptomatic dry eye and poorer tear film quality compared with nonsmokers. High vaping voltage may have aggravated the dry eye syndrome because of hazardous by-products from pyrolysis of the e-liquid constituents. Investigation of the ocular surface health at cellular and molecular levels is warranted to gain a deeper understanding on the effect of e-cigarette to the eyes.
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11
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Kim JH, Mun YH, Park SY. Acute hypotension and bradycardia following ocular exposure to liquid nicotine. Clin Toxicol (Phila) 2019; 58:854-855. [PMID: 31760813 DOI: 10.1080/15563650.2019.1693046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Jung Ho Kim
- Department of Emergency Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - You Ho Mun
- Department of Emergency Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Sin-Youl Park
- Department of Emergency Medicine, Yeungnam University College of Medicine, Daegu, Korea
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12
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Robayo-González CX, Becerra N, Castro-Goyes DF. [Effects of electronic cigarettes on health. A literature review]. ACTA ACUST UNITED AC 2019; 21:115-121. [PMID: 33206918 DOI: 10.15446/rsap.v21n1.77032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 12/28/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To identify the most recent literature on electronic cigarettes (EC) available in the market, in order to characterize their composition, current use, health risks associated with their use, as well as their possible use as smoking cessation therapy. To generate a greater understanding of EC and their importance in the field of public health. MATERIALS AND METHODS A literature review was performed in indexed databases using MeSH and DeCS terms, finding 55 articles that met the inclusion criteria and five additional reviews of companies or governmental bodies. RESULTS The diversity of the types and components of electronic cigarettes has increased awareness of their use. So far, the increase in EC consumption worldwide has led many organizations to issue concepts and review different types of studies that show evidence of a discrepancy between what is offered and what is presented. Consequently, it is clear that a definitive concept of their use cannot be issued. CONCLUSIONS The increase in the use of electronic cigarettes worldwide has triggered alarms on the regulation of contents, presentations, effects on health, and possible recommendations for their use, making it necessary to better review the issue in order to give a clear concept to the public.
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Affiliation(s)
| | - Nelci Becerra
- NB. MD. Javesalud IPS. Clínica para dejar de fumar - Pontificia Universidad Javeriana. Bogotá, Colombia.
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13
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Hughes A, Hendrickson RG. An epidemiologic and clinical description of e-cigarette toxicity. Clin Toxicol (Phila) 2018; 57:287-293. [DOI: 10.1080/15563650.2018.1510503] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Adrienne Hughes
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA
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14
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Govindarajan P, Spiller HA, Casavant MJ, Chounthirath T, Smith GA. E-Cigarette and Liquid Nicotine Exposures Among Young Children. Pediatrics 2018; 141:peds.2017-3361. [PMID: 29686144 DOI: 10.1542/peds.2017-3361] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/21/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To investigate exposures to liquid nicotine (including electronic cigarette devices and liquids) among children <6 years old in the United States and evaluate the impact of legislation requiring child-resistant packaging for liquid nicotine containers. METHODS Liquid nicotine exposure data from the National Poison Data System for January 2012 through April 2017 were analyzed. RESULTS There were 8269 liquid nicotine exposures among children <6 years old reported to US poison control centers during the study period. Most (92.5%) children were exposed through ingestion and 83.9% were children <3 years old. Among children exposed to liquid nicotine, 35.1% were treated and released from a health care facility, and 1.4% were admitted. The annual exposure rate per 100 000 children increased by 1398.2% from 0.7 in 2012 to 10.4 in 2015, and subsequently decreased by 19.8% from 2015 to 8.3 in 2016. Among states without a preexisting law requiring child-resistant packaging for liquid nicotine containers, there was a significant decrease in the mean number of exposures during the 9 months before compared with the 9 months after the federal child-resistant packaging law went into effect, averaging 4.4 (95% confidence interval: -7.1 to -1.7) fewer exposures per state after implementation of the law. CONCLUSIONS Pediatric exposures to liquid nicotine have decreased since January 2015, which may, in part, be attributable to legislation requiring child-resistant packaging and greater public awareness of risks associated with electronic cigarette products. Liquid nicotine continues to pose a serious risk for young children. Additional regulation of these products is warranted.
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Affiliation(s)
- Preethi Govindarajan
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Rutgers New Jersey Medical School, Newark, New Jersey
| | - Henry A Spiller
- Central Ohio Poison Center, Columbus, Ohio.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio; and
| | - Marcel J Casavant
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Central Ohio Poison Center, Columbus, Ohio.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio; and
| | - Thitphalak Chounthirath
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Gary A Smith
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; .,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio; and.,Child Injury Prevention Alliance, Columbus, Ohio
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15
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Pérez A, Chien LC, Harrell MB, Pasch KE, Obinwa UC, Perry CL. Geospatial Associations Between Tobacco Retail Outlets and Current Use of Cigarettes and e-Cigarettes among Youths in Texas. ACTA ACUST UNITED AC 2017; 8. [PMID: 29214099 PMCID: PMC5713909 DOI: 10.4172/2155-6180.1000375] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction To identify the geospatial association between the presence of tobacco retail outlets (TRO) around schools’ neighborhoods, and current use of cigarettes and e-cigarettes among adolescents in four counties in Texas. Methods Students in grades 6, 8 and 10th were surveyed in their schools in 2014–2015. The schools’ addresses was geocoded to determine the presence of at least one TRO within half a mile of the school. Two outcomes were considered: past 30-day use of (a) cigarettes and (b) e-cigarettes. Bayesian structured additive regression models and Kriging methods were used to estimate the geospatial associations between the presence of TRO and use in three counties: Dallas/Tarrant, Harris, and Travis. Results We observed a geospatial association between the presence of TRO around the schools and current use of cigarettes in the eastern area of Dallas County and in the southeastern area of Harris County. Also, a geospatial association between the presence of TRO around the schools and current use of e-cigarettes was observed in the entire Tarrant County and in the northeastern area of Harris County. Conclusions There were geospatial associations between the presence of TRO around some schools and cigarette/e-cigarette use among students, but this association was not consistent across all the counties. More research is needed to determine why some areas are at higher risk for this association.
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Affiliation(s)
- Adriana Pérez
- Department of Biostatistics and Data Sciences, The University of Texas Health Science Center at Houston-UTHealth, School of Public Health, USA
| | - Lung-Chang Chien
- Department of Environmental and Occupational Health, University of Nevada, Las Vegas, School of Community Health Sciences, USA
| | - Melissa B Harrell
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston-UTHealth, School of Public Health, USA
| | - Keryn E Pasch
- Department of Kinesiology and Health Education, College of Education at The University of Texas at Austin, USA
| | - Udoka C Obinwa
- Research Assistant, The University of Texas Health Science Center at Houston-UTHealth, Michael & Susan Dell Center for Healthy Living, Austin, USA
| | - Cheryl L Perry
- Department of Health Promotion and Behavioral Sciences at UTHealth, University of Texas Health Science Center at Houston, School of Public Health, Austin Campus, USA
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16
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Breland A, Soule E, Lopez A, Ramôa C, El-Hellani A, Eissenberg T. Electronic cigarettes: what are they and what do they do? Ann N Y Acad Sci 2017; 1394:5-30. [PMID: 26774031 PMCID: PMC4947026 DOI: 10.1111/nyas.12977] [Citation(s) in RCA: 230] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Electronic cigarettes (ECIGs) use electricity to power a heating element that aerosolizes a liquid containing solvents, flavorants, and the dependence-producing drug nicotine for user inhalation. ECIGs have evolved rapidly in the past 8 years, and the changes in product design and liquid constituents affect the resulting toxicant yield in the aerosol and delivery to the user. This rapid evolution has been accompanied by dramatic increases in ECIG use prevalence in many countries among adults and, especially, adolescents in the United States. The increased prevalence of ECIGs that deliver nicotine and other toxicants to users' lungs drives a rapidly growing research effort. This review highlights the most recent information regarding the design of ECIGs and their liquid and aerosol constituents, the epidemiology of ECIG use among adolescents and adults (including correlates of ECIG use), and preclinical and clinical research regarding ECIG effects. The current literature suggests a strong rationale for an empirical regulatory approach toward ECIGs that balances any potential ECIG-mediated decreases in health risks for smokers who use them as substitutes for tobacco cigarettes against any increased risks for nonsmokers who may be attracted to them.
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Affiliation(s)
| | - Eric Soule
- Virginia Commonwealth University, Richmond, Virgina
| | - Alexa Lopez
- Virginia Commonwealth University, Richmond, Virgina
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17
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Glasser AM, Collins L, Pearson JL, Abudayyeh H, Niaura RS, Abrams DB, Villanti AC. Overview of Electronic Nicotine Delivery Systems: A Systematic Review. Am J Prev Med 2017; 52:e33-e66. [PMID: 27914771 PMCID: PMC5253272 DOI: 10.1016/j.amepre.2016.10.036] [Citation(s) in RCA: 320] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 10/07/2016] [Accepted: 10/26/2016] [Indexed: 12/20/2022]
Abstract
CONTEXT Rapid developments in e-cigarettes, or electronic nicotine delivery systems (ENDS), and the evolution of the overall tobacco product marketplace warrant frequent evaluation of the published literature. The purpose of this article is to report updated findings from a comprehensive review of the published scientific literature on ENDS. EVIDENCE ACQUISITION The authors conducted a systematic review of published empirical research literature on ENDS through May 31, 2016, using a detailed search strategy in the PubMed electronic database, expert review, and additional targeted searches. Included studies presented empirical findings and were coded to at least one of nine topics: (1) Product Features; (2) Health Effects; (3) Consumer Perceptions; (4) Patterns of Use; (5) Potential to Induce Dependence; (6) Smoking Cessation; (7) Marketing and Communication; (8) Sales; and (9) Policies; reviews and commentaries were excluded. Data from included studies were extracted by multiple coders (October 2015 to August 2016) into a standardized form and synthesized qualitatively by topic. EVIDENCE SYNTHESIS There were 687 articles included in this systematic review. The majority of studies assessed patterns of ENDS use and consumer perceptions of ENDS, followed by studies examining health effects of vaping and product features. CONCLUSIONS Studies indicate that ENDS are increasing in use, particularly among current smokers, pose substantially less harm to smokers than cigarettes, are being used to reduce/quit smoking, and are widely available. More longitudinal studies and controlled trials are needed to evaluate the impact of ENDS on population-level tobacco use and determine the health effects of longer-term vaping.
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Affiliation(s)
- Allison M Glasser
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia.
| | - Lauren Collins
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Jennifer L Pearson
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Haneen Abudayyeh
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Raymond S Niaura
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - David B Abrams
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - Andrea C Villanti
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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18
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Jo CL, Ambs A, Dresler CM, Backinger CL. Child-resistant and tamper-resistant packaging: A systematic review to inform tobacco packaging regulation. Prev Med 2017; 95:89-95. [PMID: 27939602 PMCID: PMC5299541 DOI: 10.1016/j.ypmed.2016.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 08/31/2016] [Accepted: 11/24/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We aimed to investigate the effects of special packaging (child-resistant, adult-friendly) and tamper-resistant packaging on health and behavioral outcomes in order to identify research gaps and implications for packaging standards for tobacco products. METHODS We searched seven databases for keywords related to special and tamper-resistant packaging, consulted experts, and reviewed citations of potentially relevant studies. 733 unique papers were identified. Two coders independently screened each title and abstract for eligibility. They then reviewed the full text of the remaining papers for a second round of eligibility screening. Included studies investigated a causal relationship between type of packaging or packaging regulation and behavioral or health outcomes and had a study population composed of consumers. Studies were excluded on the basis of publication type, if they were not peer-reviewed, and if they had low external validity. Two reviewers independently coded each paper for study and methodological characteristics and limitations. Discrepancies were discussed and resolved. RESULTS The review included eight studies: four assessing people's ability to access the contents of different packaging types and four evaluating the impact of packaging requirements on health-related outcomes. Child-resistant packaging was generally more difficult to open than non-child-resistant packaging. Child-resistant packaging requirements have been associated with reductions in child mortality. CONCLUSIONS Child-resistant packaging holds the expectation to reduce tobacco product poisonings among children under six.
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Affiliation(s)
- Catherine L Jo
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - Anita Ambs
- Office of Science, Center for Tobacco Products (CTP), Food and Drug Administration (FDA), Rockville, MD, United States.
| | - Carolyn M Dresler
- Office of Science, Center for Tobacco Products (CTP), Food and Drug Administration (FDA), Rockville, MD, United States
| | - Cathy L Backinger
- Office of Science, Center for Tobacco Products (CTP), Food and Drug Administration (FDA), Rockville, MD, United States
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19
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Affiliation(s)
- Chitra Dinakar
- From the Division of Allergy, Asthma, and Immunology, Children's Mercy Kansas City and the University of Missouri, Kansas City (C.D.); and the Division of Pulmonary, Allergy, Sleep, and Critical Care Medicine, Boston University School of Medicine, Boston (G.T.O.)
| | - George T O'Connor
- From the Division of Allergy, Asthma, and Immunology, Children's Mercy Kansas City and the University of Missouri, Kansas City (C.D.); and the Division of Pulmonary, Allergy, Sleep, and Critical Care Medicine, Boston University School of Medicine, Boston (G.T.O.)
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20
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Abstract
Electronic cigarettes (e-cigarettes) are often advertised as a healthier product when compared with traditional cigarettes. Currently, there are limited data to support this and only a threat of federal regulation from the US Food and Drug Administration. Calls to poison control centers about e-cigarette toxicity, especially in children, and case reports of toxic exposures have increased over the past 3 years. This research letter reports the frequency of hazardous exposures to e-cigarettes and characterizes the reported adverse health effects associated with e-cigarette toxicity.
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Affiliation(s)
- J Drew Payne
- 1 Texas Tech University Health Science Center, Lubbock, TX, USA
| | - David Michaels
- 1 Texas Tech University Health Science Center, Lubbock, TX, USA
| | | | - Kenneth Nugent
- 1 Texas Tech University Health Science Center, Lubbock, TX, USA
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21
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Kaisar MA, Prasad S, Liles T, Cucullo L. A decade of e-cigarettes: Limited research & unresolved safety concerns. Toxicology 2016; 365:67-75. [PMID: 27477296 DOI: 10.1016/j.tox.2016.07.020] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/07/2016] [Accepted: 07/26/2016] [Indexed: 01/21/2023]
Abstract
It is well known that tobacco consumption is a leading cause of preventable deaths worldwide and has been linked to major diseases ranging from cancer to chronic obstructive pulmonary disease, atherosclerosis, stroke and a host of neurological/neurodegenerative disorders. In the past decade a number of alternative vaping products have hit the market, rapidly gaining consumers especially among the younger population. Electronic nicotine delivery systems or e-cigarettes have become the sought-after product due to the belief that they are much safer than traditional cigarettes. However, inadequate research and lack of regulatory guidelines for both the manufacturing process and the content of the vaping solution of the e-cigarette has become a major concern. Highly debated and unresolved questions such as whether e-cigarettes may help smokers quit and whether e-cigarettes will promote the use of nicotine among non-smokers add to the confusion of the safety of e-cigarettes. In this review article, we summarize the current understanding (and lack thereof) of the potential health impacts of e-cigarettes. We will also highlight the most recent studies (in vivo/in vitro) which seem to conflict with the broad safety claims put forward by the manufacturers. Finally, we provide potential solutions to overcome the research gap of the short and long-term health impact of e-cigarettes.
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Affiliation(s)
- Mohammad Abul Kaisar
- Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA
| | - Shikha Prasad
- Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA
| | - Tylor Liles
- Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA
| | - Luca Cucullo
- Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA; Center for Blood Brain Barrier Research, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA.
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22
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A Practitioner's Guide to Electronic Cigarettes in the Adolescent Population. J Adolesc Health 2015; 57:574-9. [PMID: 26422289 DOI: 10.1016/j.jadohealth.2015.07.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 07/10/2015] [Accepted: 07/12/2015] [Indexed: 11/22/2022]
Abstract
We present guidance on electronic nicotine delivery systems (ENDS) for health care professionals who care for adolescents. ENDS provide users with inhaled nicotine in an aerosolized mist. Popular forms of ENDS include e-cigarettes and vape-pens. ENDS range in disposability, customization, and price. Growth of ENDS usage has been particularly rapid in the adolescent population, surpassing that of conventional cigarettes in 2014. Despite surging use throughout the United States, little is known about the health risks posed by ENDS, especially in the vulnerable adolescent population. These products may potentiate nicotine addiction in adolescents and have been found to contain potentially harmful chemicals. The growth in these products may be driven by relaxed purchasing restrictions for minors, lack of advertising regulations, and youth friendly flavors. Taken together, ENDS represent a new and growing health risk to the adolescent population, one that health care professionals should address with their patients. We suggest a patient centered strategy to incorporate ENDS use into routine substance counseling.
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23
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Alawsi F, Nour R, Prabhu S. Are e-cigarettes a gateway to smoking or a pathway to quitting? Br Dent J 2015; 219:111-5. [DOI: 10.1038/sj.bdj.2015.591] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2015] [Indexed: 01/04/2023]
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24
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Fagerstrom K, Etter JF, Unger JB. E-cigarettes: a disruptive technology that revolutionizes our field? Nicotine Tob Res 2015; 17:125-6. [PMID: 25609846 DOI: 10.1093/ntr/ntu240] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
| | | | - Jennifer B Unger
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
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25
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Electronic Cigarettes—A Narrative Review for Clinicians. Am J Med 2015; 128:674-81. [PMID: 25731134 DOI: 10.1016/j.amjmed.2015.01.033] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 12/31/2014] [Accepted: 01/07/2015] [Indexed: 12/21/2022]
Abstract
Electronic cigarettes (e-cigarettes) were introduced into the US market in 2007 and have quickly become a popular source of nicotine for many patients. They are designed to simulate smoking by heating a nicotine-containing solution producing an aerosol that the user inhales. The short- and long-term effects of e-cigarette use are still unclear, but their use is increasing. Some acute effects of e-cigarettes on heart rate, blood pressure, and airway resistance are reported. Although there are some reports of improved cessation in a subset of users, there are also studies reporting decreased cessation in dual users of regular and e-cigarettes. Additionally, there is no current regulation of these devices, and this allows virtually anyone with a form of online payment to obtain them.
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