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Askwith Z, Grignon J, Ismail M, Martin G, McEachern LW, Seabrook JA, Gilliland JA. Environmental influences on E-cigarette use among young people: A systematic review. Health Place 2024; 87:103212. [PMID: 38493658 DOI: 10.1016/j.healthplace.2024.103212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/12/2024] [Accepted: 02/13/2024] [Indexed: 03/19/2024]
Abstract
E-cigarettes are a popular mode of delivery for nicotine, tobacco and cannabis. The prevalence of vaping among youth is increasing and this review aims to identify features of the neighbourhood environment, e.g., retailers, advertisements, and policies, that are associated with youth vaping. We included 48 studies. Of these, approximately 40% and 60% reported that presence of e-cigarette retailers, and advertisements, was associated with statistically higher odds of e-cigarette use in youth, respectively. Approximately 30% of studies reported that policies affecting e-cigarette availability were associated with statistically lower odds of vaping. Identifying these influential features of the neighbourhood environment will help formulate appropriate policies to reduce e-cigarette use among youth.
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Affiliation(s)
- Zoe Askwith
- Department of Geography and Environment, Western University, Canada
| | - Josh Grignon
- Department of Geography and Environment, Western University, Canada
| | - Mariam Ismail
- Department of Geography and Environment, Western University, Canada
| | - Gina Martin
- Department of Geography and Environment, Western University, Canada; Faculty of Health Disciplines, Athabasca University, Canada
| | - Louise W McEachern
- Department of Geography and Environment, Western University, Canada; Children's Health Research Institute, London, Ontario, Canada
| | - Jamie A Seabrook
- Children's Health Research Institute, London, Ontario, Canada; School of Food and Nutritional Sciences, Brescia University College, Canada; Department of Epidemiology and Biostatistics, Western University, Canada; Department of Pediatrics, Western University, Canada; Lawson Health Research Institute, London, Ontario, Canada
| | - Jason A Gilliland
- Department of Geography and Environment, Western University, Canada; Children's Health Research Institute, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, Canada; Department of Pediatrics, Western University, Canada; Lawson Health Research Institute, London, Ontario, Canada.
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Aherrera A, Lin JJ, Chen R, Tehrani M, Schultze A, Borole A, Tanda S, Goessler W, Rule AM. Metal Concentrations in E-Cigarette Aerosol Samples: A Comparison by Device Type and Flavor. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:127004. [PMID: 38048100 PMCID: PMC10695266 DOI: 10.1289/ehp11921] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/18/2023] [Accepted: 11/06/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND The rapid evolution of electronic cigarette (e-cigarette) products warrants surveillance of the differences in exposure across device types-modifiable devices (MODs), cartridge ("pod")-containing devices (PODs), disposable PODs (d-PODs)-and flavors of the products available on the market. OBJECTIVE This study aimed to measure and compare metal aerosol concentrations by device type and common flavors. METHODS We collected aerosol from 104 MODs, 67 PODs (four brands: JUUL, Bo, Suorin, PHIX), and 23 d-PODs (three brands: ZPOD, Bidi, Stig) via droplet deposition in a series of conical pipette tips. Metals and metalloids [aluminum (Al), arsenic (As), cobalt (Co), chromium (Cr), copper (Cu), iron (Fe), manganese (Mn), nickel (Ni), lead (Pb), antimony (Sb), tin (Sn), and zinc (Zn)] were measured using inductively coupled plasma mass spectrometry (ICP-MS), results were log-transformed for statistical analysis, and concentrations are reported in aerosol units (mg / m 3 ). RESULTS Of the 12 elements analyzed, concentrations were statistically significantly higher in MOD devices, except for Co and Ni, which were higher in PODs and d-PODs. Of the POD brands analyzed, PHIX had the highest median concentrations among four metals (Al, Ni, Pb, and Sn) compared to the rest of the POD brands. According to POD flavor, seven metals were three to seven orders of magnitude higher in tobacco-flavored aerosol compared to those in mint and mango flavors. Among the d-POD brands, concentrations of four metals (Al, Cu, Ni, and Pb) were higher in the ZPOD brand than in Bidi Stick and Stig devices. According to d-POD flavor, only Cr concentrations were found to be statistically significantly higher in mint than tobacco-flavored d-PODs. DISCUSSION We observed wide variability in aerosol metal concentrations within and between the different e-cigarette device types, brands, and flavors. Overall, MOD devices generated aerosols with higher metal concentrations than PODs and d-PODs, and tobacco-flavored aerosols contained the highest metal concentrations. Continued research is needed to evaluate additional factors (i.e., nicotine type) that contribute to metal exposure from new and emerging e-cigarette devices in order to inform policy. https://doi.org/10.1289/EHP11921.
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Affiliation(s)
- Angela Aherrera
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Division of Pediatric Pulmonary Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joyce Jy Lin
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rui Chen
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mina Tehrani
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andrew Schultze
- Department of Biochemistry, Ithaca College School of Humanities and Sciences, Ithaca, New York, USA
| | - Aryan Borole
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Stefan Tanda
- Institute of Chemistry, University of Graz, Graz, Austria
| | | | - Ana M. Rule
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Liu J, Vázquez-Otero C, Berman ML, Stevens EM. Youth-appealing features in popular e-cigarette brand advertising in the USA after heightened scrutiny in 2018. Tob Control 2023; 32:497-500. [PMID: 34675113 PMCID: PMC9021318 DOI: 10.1136/tobaccocontrol-2021-056720] [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] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 09/28/2021] [Indexed: 11/04/2022]
Abstract
PURPOSE Youth electronic cigarette (e-cigarette) use remains high in the USA, and advertising is a contributor. The purpose of this study was to identify themes and characteristics of popular e-cigarette companies' advertising after e-cigarette companies became more highly scrutinised in 2018. METHODS Using a systematic, quantitative content analysis, three trained coders coded e-cigarette advertisements from JUUL, Puff Bar, Vuse and Blu from 2019 and 2020. Based on previous work, they coded for: type of advertisement, flavours, promotions, product cues, descriptors, claims, imagery, youth-oriented themes and sensational appeals. RESULTS Of the 401 e-cigarette advertisements, the majority were emails (38.2%) and Instagram posts (30.9%). Over half (53.6%) showed flavours other than tobacco, with Puff Bar leading the brands (70.2%; p<0.001). The most frequently used product cues were showing the product (51.4%) or packaging (42.4%). The most common claim was being an alternative to smoking (14.2%). The most frequently used imagery was fruit (14.0%), employed most by Puff Bar (p<0.001). The only youth-oriented theme present was humour (4.2%). Positive sensations (eg, good taste, good smell or satisfying; 17.1%) was the most common form of appeal, with Puff Bar using it at the highest frequency (p<0.001). CONCLUSION Even with heightened scrutiny of e-cigarette brands, advertisements still included youth-appealing content such as flavours, fruit imagery and positive sensations. Puff Bar led in all these categories, and it rapidly gained market share after market leader JUUL limited the sales of its flavoured products. Research should continue to monitor the characteristics of e-cigarette advertisements and consider their impact on youth.
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Affiliation(s)
- Jessica Liu
- Department of Social and Behavioral Sciences, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Coralia Vázquez-Otero
- Department of Public Health, College for Health, Community and Policy, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Micah L Berman
- College of Public Health & Moritz College of Law, Ohio State University, Columbus, Ohio, USA
| | - Elise M Stevens
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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Felicione NJ, Kaiser L, Leigh NJ, Page MK, Block AC, Schurr BE, O’Connor RJ, Goniewicz ML. Comparing POD and MOD ENDS Users' Product Characteristics, Use Behaviors, and Nicotine Exposure. Nicotine Tob Res 2023; 25:498-504. [PMID: 36073762 PMCID: PMC9910144 DOI: 10.1093/ntr/ntac211] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/24/2022] [Accepted: 09/06/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION POD electronic nicotine delivery systems (ENDS), often containing high concentrations of nicotine salts, have replaced MODs (ie, open/modifiable devices) as the most popular devices. The purpose of this study was to compare device/liquid characteristics, use behavior, and nicotine exposure between POD and MOD users. METHODS Data from the initial visit of a prospective observational study of exclusive ENDS users compared MOD (n = 48) and POD (n = 37) users. Participants completed questionnaires on demographic characteristics, patterns of ENDS use, and ENDS features. A urine sample was collected to test for cotinine and an ENDS liquid sample was collected to test for nicotine and salts. Puff topography was captured during an ad libitum bout at the end of the session. RESULTS MOD and POD users did not differ on demographic characteristics. MOD users reported purchasing more liquid in the past month than POD users (180.4 ± 28.0 vs. 50.9 ± 9.0 ml, p < .001). Differences in characteristics of devices used by MOD and POD users included flavor type (p = .029), nicotine concentration (liquids used by MOD users contained less nicotine than those used by POD users: 8.9 ± 2.0 vs. 41.6 ± 3.2 mg/ml, p < .001), and presence of the nicotine salt (fewer MOD liquids had salts present than POD liquids: 11.9% vs. 77.4%, p < .001). User groups did not differ on urinary cotinine levels or puff topography (ps > .05). CONCLUSIONS Despite different characteristics of MOD and POD ENDS, users of those products are exposed to similar amounts of nicotine, likely due to using more liquid among MOD users. IMPLICATIONS This study directly compares ENDS product characteristics, user behavior, and nicotine exposure between MOD and POD ENDS users. Although POD products contained higher nicotine concentrations compared to MOD products, users of PODs reported consuming less liquid than MOD users. Ultimately, MOD and POD users were exposed to similar levels of nicotine, suggesting users behaviorally compensate for differences in product characteristics.
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Affiliation(s)
- Nicholas J Felicione
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Lisa Kaiser
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Noel J Leigh
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Michelle K Page
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Ashleigh C Block
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Bradley E Schurr
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Richard J O’Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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Silver NA, Bertrand A, Kucherlapaty P, Schillo BA. Examining influencer compliance with advertising regulations in branded vaping content on Instagram. Front Public Health 2023; 10:1001115. [PMID: 36699883 PMCID: PMC9869128 DOI: 10.3389/fpubh.2022.1001115] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023] Open
Abstract
Background Youth and young adults are exposed to vaping advertisements on social media sites, despite regulations and guidelines intended to reduce the prevalence of such content on these platforms. This research uses replicable criteria to identify vaping influencers who have worked with vaping brands to promote vaping products on Instagram and documents the extent to which posts by these users comply with existing advertising regulations. Methodology We conducted three google searches collecting eight different vaping influencer lists, with a total of 575 unique influencers. We limited our sample to public accounts with 100,000 followers or more (n = 54). An initial sample of 360 Instagram posts was used to identify an analytic sample of 262 vape-related posts from 2021. We conducted a conceptual content analysis to first identify unambiguous vaping advertisements (branded content), and then code ads for compliance with existing regulations. Results On average, the 54 Instagram accounts had 265,851.9 followers (sd = 383,349.8) and 4,158 posts (sd = 7,302.1). Most posts featured vaping products 239 (91.2%), with 186 (76.2%) posts being unambiguously branded vape advertisements and 31 (14.3%) even including purchase links in the post itself. However, one post complied with FTC disclosure guidelines. Although 50 (20.9%) had warning labels, only 8 (15.1%) were fully compliant with FDA warning label guidelines. Discussion Findings demonstrate minimal compliance with existing regulations among influencers known to have financial relationships with vaping brands. Most influencer posts are unambiguous, branded, vaping advertisements. Implications for barriers to regulating influencer content and the need for greater enforcement resources are discussed.
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Gades MS, Alcheva A, Riegelman AL, Hatsukami DK. The Role of Nicotine and Flavor in the Abuse Potential and Appeal of Electronic Cigarettes for Adult Current and Former Cigarette and Electronic Cigarette Users: A Systematic Review. Nicotine Tob Res 2022; 24:1332-1343. [PMID: 35305014 PMCID: PMC9356694 DOI: 10.1093/ntr/ntac073] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 01/31/2022] [Accepted: 03/16/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Many adult cigarette smokers use electronic cigarettes (e-cigarettes) to cut down on or quit smoking cigarettes. E-cigarettes with higher abuse potential and appeal might facilitate complete switching. E-liquid nicotine concentration and flavor are two of the characteristics that may affect the abuse potential and appeal of e-cigarettes. The objective of this systematic review was to compile results from survey, animal, human laboratory, and clinical studies to understand the possible effects of nicotine concentration and flavor on abuse potential and appeal of e-cigarettes in adult current and former cigarette and e-cigarette users. AIMS AND METHODS A comprehensive literature search was conducted in Ovid Medline and PsycINFO followed by citation tracking in Web of Science Core Collection. Peer-reviewed studies published in English between 2007 and August 2020 were selected that analyzed differences between e-liquid nicotine concentration and/or flavors, had outcome measures related to abuse potential and/or appeal, and included adult humans (18+) or animals. A total of 1624 studies were identified and screened. A qualitative synthesis of results was performed. RESULTS Results from 104 studies included in this review suggest that higher nicotine concentration and access to a variety of flavors are likely to be associated with higher abuse potential and appeal of e-cigarettes for adult current and former cigarette and e-cigarette users. CONCLUSIONS Higher nicotine concentrations and the availability of a variety of flavors in e-cigarettes might facilitate complete substitution for cigarettes. Future e-cigarette regulations should take into account their impact on smokers, for whom e-cigarettes may be a cessation tool or reduced-harm alternative. IMPLICATIONS E-cigarettes may provide a reduced-harm alternative to cigarettes for smokers unwilling/unable to quit or serve as a path for quitting all nicotine products. Higher nicotine concentrations and flavor variety are associated with higher abuse potential and appeal of e-cigarettes. Higher abuse potential and appeal products may help facilitate complete switching from cigarettes to e-cigarettes. Regulation of nicotine concentration and flavors aimed at decreasing naïve uptake may inadvertently decrease uptake and complete switching among smokers, reducing the harm reduction potential of e-cigarettes. Evidence-based effects of regulating nicotine concentration and flavors must be considered for the population as a whole, including smokers.
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Affiliation(s)
- Mari S Gades
- Department of Psychology, University of Minnesota, 75 E. River Road, Minneapolis, MN, 55454, USA
| | - Aleksandra Alcheva
- Division of Environmental Health Sciences, School of Public Health and Masonic Cancer Center, University of Minnesota, 2231 6th Street SE, Minneapolis, MN 55455, USA
| | - Amy L Riegelman
- Social Sciences Department, University of Minnesota Libraries, 309 19 Avenue S., Minneapolis, MN, 55455, USA
| | - Dorothy K Hatsukami
- Masonic Cancer Center and Department of Psychiatry and Behavioral Sciences, University of Minnesota, 717 Delaware St. SE, Minneapolis, MN, 55414, USA
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Sánchez-Romero LM, Yuan Z, Li Y, Levy DT. The Kentucky SimSmoke Tobacco Control Policy Model of Smokeless Tobacco and Cigarette Use. Int J Health Policy Manag 2022; 11:592-609. [PMID: 33131221 PMCID: PMC9309926 DOI: 10.34172/ijhpm.2020.187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 09/26/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Smokeless tobacco (SLT) prevalence was decreasing in Kentucky before 2007, but has since increased. This study examines the impact of policies on cigarette and SLT use by applying the SimSmoke tobacco control policy simulation model. METHODS Using data from the large-scale Tobacco Use Supplement of the Current Population Survey (TUS-CPS) and information on state-specific tobacco policies, Kentucky SimSmoke is updated and extended to incorporate exclusive SLT and dual cigarette and SLT use. The model is validated using survey data through 2017. The model was used to estimate the impact on smoking and SLT prevalence and attributable deaths of policies implemented between 1993 and 2018 and the impact of stronger future policies implemented in 2018 and maintained through 2060. RESULTS SimSmoke generally reflects trends in exclusive cigarette use from the TUS-CPS and the Behavioral Risk Factor Surveillance System (BRFSS), but underestimated the increase in SLT prevalence in recent years. SimSmoke projects that policies implemented between 1993 and 2018 reduced male and female cigarette use by 23.7% and 23.0%, and male and female SLT use by 4.9% by 2018, averting 9018 tobacco-attributable deaths by 2018, increasing to 89 547 by 2060. The largest reductions in cigarette and SLT use were attributed to cigarette price increases. Strengthening tobacco control policies could reduce smoking prevalence by 41% and 40%, and reduce SLT prevalence by 33% and 25% for males and females by 2060. CONCLUSION Our results suggest that cigarette-oriented policies were effective in reducing SLT use but have been less successful in recent years. Future use rates can be further reduced through more restrictive statewide policies, which also target non-combustible nicotine products.
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Affiliation(s)
| | - Zhe Yuan
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Yameng Li
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - David T. Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
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Morphett K, Fraser D, Borland R, Hall W, Walker N, Bullen C, Gartner C. A pragmatic randomised comparative trial of e-cigarettes and other nicotine products for quitting or long-term substitution in smokers. Nicotine Tob Res 2021; 24:1079-1088. [PMID: 34929031 DOI: 10.1093/ntr/ntab266] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 11/30/2021] [Accepted: 12/16/2021] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Tobacco harm reduction has potential to improve individual and population health. However, little research exists on low-intensity interventions, such as encouraging longer-term NRT or e-cigarette use. We aimed to determine whether: 1) encouraging use of nicotine products as long-term tobacco substitutes is more effective for smoking abstinence than standard treatment, and 2) offering e-cigarettes is more effective than NRT. METHODS An open-label, parallel group randomised trial was conducted in Australia between 2014 and 2015, with 1563 adult daily smokers, randomised to: A) Standard cessation advice and NRT: advice to use NRT short-term B) Quit or substitute advice and NRT: advice to use NRT as a longer-term substitute for smoking if required to maintain smoking cessation or C) Quit or substitute advice and NRT and/or e-cigarettes. Participants were offered an initial supply of products they could then purchase for up to 7 months. The primary outcome was self-reported continuous smoking abstinence at 7 months. Point prevalence, dual use, and cigarette reduction were secondary outcomes. RESULTS At 7 months, 2.8% (N=9) of group A (N=324) were abstinent, compared with 1.8% (N=11) in B (N=620) and 1.3% (N=8) in C (N=619) (Adjusted ORs: B vs A 0.66, 95% CI: 0.27-1.63; C vs A 0.46, 95% CI: 0.17-1.21; C vs B 0.69, 95% CI 0.27-1.73). There were no suspected unexpected serious adverse reactions associated with trial products. CONCLUSION A free trial of NRT and first generation e-cigarettes and advice on long-term substitution was no better for smoking abstinence than usual care. IMPLICATIONS This pragmatic trial allowed the comparison of existing and alternative policy options under semi-realistic conditions, such as product choice and financial cost. All trial arms had low rates of smoking cessation. The findings suggest that providing unflavoured cigalike e-cigarettes without additional support may not increase quitting compared with advice to use standard NRT in a general population of Australians who smoke. More intensive support and education, and/or opportunity to try a range of e-cigarette products, may be required to motivate quit attempts using e-cigarettes.
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Affiliation(s)
| | - Doug Fraser
- The University of Queensland, School of Public Health
| | - Ron Borland
- The University of Melbourne, School of Psychological Sciences.,Cancer Council Victoria
| | - Wayne Hall
- The University of Queensland, National Centre for Youth Substance Use Research
| | - Natalie Walker
- The University of Auckland, School of Population Health, National Institute for Health Innovation
| | - Chris Bullen
- The University of Auckland, School of Population Health, National Institute for Health Innovation
| | - Coral Gartner
- The University of Queensland, School of Public Health.,The University of Queensland, Queensland Alliance for Environmental Health Sciences
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Olmedo P, Rodrigo L, Grau-Pérez M, Hilpert M, Navas-Acién A, Téllez-Plaza M, Pla A, Gil F. Metal exposure and biomarker levels among e-cigarette users in Spain. ENVIRONMENTAL RESEARCH 2021; 202:111667. [PMID: 34256077 DOI: 10.1016/j.envres.2021.111667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/29/2021] [Accepted: 07/05/2021] [Indexed: 05/11/2023]
Abstract
The use of electronic cigarettes (e-cigarettes) has increased due to the belief that they are healthier than tobacco cigarettes. E-cigarettes contain a metallic heating coil (composed of Ni, Cr, Al and other metals) to heat a solution (commonly called e-liquid) and convert it into an aerosol. This aerosol is inhaled (vaped) by the users who can be potentially exposed to a wide variety of metals. We investigated the possible transfer of metals from the coil to the e-liquid and the generated aerosol, and how the exposure to this aerosol can increase metal body burden in e-cigarette users. We recruited 75 e-cigarette users (50 who only vaped and 25 dual users who vaped and smoked) and 25 controls who neither vaped nor smoked. E-liquid samples before (dispenser e-liquid) and after (tank e-liquid) being added to their devices were collected. Aerosol samples were collected using a condensation method. All participants provided urine and hair samples. All samples were analyzed for metals by ICP-MS. We observed higher metal concentrations in the aerosol and tank e-liquid (in contact with the coil) compared to the dispenser e-liquid (before contact with the coil). The median concentrations for some of the metals with the most remarkable increases in aerosol and tank e-liquid vs. dispenser e-liquid were 36.90 and 62.73 vs. 18.29 μg/kg for Al; 6.71 and 28.97 vs. 0.98 μg/kg for Cr; 91.39 and 414.47 vs. 1.64 μg/kg for Ni; 738.99 and 744.24 vs. 16.56 μg/kg for Zn; and 10.17 and 22.31 vs. 0.88 μg/kg for Pb. We also found detectable and potentially high concentrations of other metals such as Mn, Cu, Sb and Sn. In urine, increases in the median levels (μg/g creatinine) in vapers/duals vs. controls were observed for some metals, including Cr (0.34/0.28 vs. 0.20), Cu (1.72/2.36 vs. 1.46), Sn (0.26/0.31 vs. 0.18) and Pb (0.39/0.44 vs. 0.22). In hair, there were no differences in metal concentrations among the three groups. In conclusion, e-cigarettes are likely a source of metals such as Cr, Cu, Ni, Pb or Sn. These metals come from the device, likely the heating resistance, as their concentrations were low in the dispenser e-liquid and higher in the aerosol and the e-liquid left in the tank. Although the exposure to e-cigarette aerosol can have an influence in the body burden of metals, aerosol metal levels were not clearly associated with metal levels in biological samples such as urine or hair in e-cigarette users in this study.
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Affiliation(s)
- Pablo Olmedo
- Department of Legal Medicine and Toxicology. School of Medicine, University of Granada, Granada, Spain
| | - Lourdes Rodrigo
- Department of Legal Medicine and Toxicology. School of Medicine, University of Granada, Granada, Spain
| | - María Grau-Pérez
- Area of Cardiometabolic and Renal Risk, Biomedical Research Institute Hospital Clinic de Valencia (INCLIVA), Valencia, Spain
| | - Markus Hilpert
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Ana Navas-Acién
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - María Téllez-Plaza
- Department of Chronic Disease Epidemiology. Carlos III Health Institute, Madrid, Spain
| | - Antonio Pla
- Department of Legal Medicine and Toxicology. School of Medicine, University of Granada, Granada, Spain
| | - Fernando Gil
- Department of Legal Medicine and Toxicology. School of Medicine, University of Granada, Granada, Spain.
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Hair EC, Kreslake JM, Mowery P, Pitzer L, Schillo B, Vallone DM. A longitudinal analysis of e-cigarette use and cigar, little cigar or cigarillo initiation among youth and youth adults: 2017-2019. Drug Alcohol Depend 2021; 226:108821. [PMID: 34218009 DOI: 10.1016/j.drugalcdep.2021.108821] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/02/2021] [Accepted: 05/03/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To examine whether youth and young adult e-cigarette use is associated with initiation of cigars, little cigars, or cigarillos (CLCCs) and current use of flavored CLCCs. BASIC PROCEDURES The sample is drawn from the Truth Longitudinal Cohort, a probability-based longitudinal cohort of youth and young adults recruited at ages 15-21 and surveyed every six months. The sample for this study was CLCC-naïve defined as those who had never used CLCCs as of 2017 (N = 5586). The outcomes were the odds of (1) initiating any CLCC use and (2) reporting current (past 30-day) use of flavored CLCCs from 2018 to late 2019. The main predictor was use of e-cigarettes by 2018. RESULTS The odds of initiating a CLCC was greater for those who had used ever used JUUL (OR: 3.30, p < 0.001) or were current users of another type of e-cigarette by 2018 (OR: 3.57, p < 0.001). Odds of CLCC initiation was also greater for those who had ever used combustible cigarettes (OR: 1.62, p < 0.05), were current smokers (OR: 3.12, p < 0.001) or had used marijuana (OR: 1.92, p < 0.001) by 2018. E-cigarette use that occurred by 2018 was associated with greater odds of current use of flavored CLCCs compared to non-flavored CLCCs (ever users of JUUL: OR: 2.57, p < 0.01; current users of some other e-cigarette: OR: 3.06, p < 0.05). CONCLUSION AND RELEVANCE This study raises new concerns about the effects of e-cigarette use on subsequent combustible tobacco use. Restrictions on CLCCs should be considered in conjunction with current policies designed to reduce the youth vaping epidemic.
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Affiliation(s)
- Elizabeth C Hair
- Schroeder Institute at Truth Initiative, Washington, DC, USA; School of Global Public Health, New York University, New York, NY, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Jennifer M Kreslake
- Schroeder Institute at Truth Initiative, Washington, DC, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Lindsay Pitzer
- Schroeder Institute at Truth Initiative, Washington, DC, USA
| | - Barbara Schillo
- Schroeder Institute at Truth Initiative, Washington, DC, USA
| | - Donna M Vallone
- Schroeder Institute at Truth Initiative, Washington, DC, USA; School of Global Public Health, New York University, New York, NY, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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11
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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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12
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Li Y, Burns AE, Tran LN, Abellar KA, Poindexter M, Li X, Madl AK, Pinkerton KE, Nguyen TB. Impact of e-Liquid Composition, Coil Temperature, and Puff Topography on the Aerosol Chemistry of Electronic Cigarettes. Chem Res Toxicol 2021; 34:1640-1654. [PMID: 33949191 DOI: 10.1021/acs.chemrestox.1c00070] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
E-cigarette aerosol is a complex mixture of gases and particles with a composition that is dependent on the e-liquid formulation, puffing regimen, and device operational parameters. This work investigated mainstream aerosols from a third generation device, as a function of coil temperature (315-510 °F, or 157-266 °C), puff duration (2-4 s), and the ratio of propylene glycol (PG) to vegetable glycerin (VG) in e-liquid (100:0-0:100). Targeted and untargeted analyses using liquid chromatography high-resolution mass spectrometry, gas chromatography, in situ chemical ionization mass spectrometry, and gravimetry were used for chemical characterizations. PG and VG were found to be the major constituents (>99%) in both phases of the aerosol. Most e-cigarette components were observed to be volatile or semivolatile under the conditions tested. PG was found almost entirely in the gas phase, while VG had a sizable particle component. Nicotine was only observed in the particle phase. The production of aerosol mass and carbonyl degradation products dramatically increased with higher coil temperature and puff duration, but decreased with increasing VG fraction in the e-liquid. An exception is acrolein, which increased with increasing VG. The formation of carbonyls was dominated by the heat-induced dehydration mechanism in the temperature range studied, yet radical reactions also played an important role. The findings from this study identified open questions regarding both pathways. The vaping process consumed PG significantly faster than VG under all tested conditions, suggesting that e-liquids become more enriched in VG and the exposure to acrolein significantly increases as vaping continues. It can be estimated that a 30:70 initial ratio of PG:VG in the e-liquid becomes almost entirely VG when 60-70% of e-liquid remains during the vaping process at 375 °F (191 °C). This work underscores the need for further research on the puffing lifecycle of e-cigarettes.
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Affiliation(s)
- Yichen Li
- Department of Environmental Toxicology, University of California at Davis, Davis, California 95616, United States
| | - Amanda E Burns
- Department of Environmental Toxicology, University of California at Davis, Davis, California 95616, United States
| | - Lillian N Tran
- Department of Environmental Toxicology, University of California at Davis, Davis, California 95616, United States
| | - Karizza A Abellar
- Department of Chemistry, University of California at Davis, Davis, California 95616, United States
| | - Morgan Poindexter
- Center for Health and the Environment, University of California at Davis, Davis, California 95616, United States
| | - Xiaohan Li
- Center for Health and the Environment, University of California at Davis, Davis, California 95616, United States
| | - Amy K Madl
- Center for Health and the Environment, University of California at Davis, Davis, California 95616, United States
| | - Kent E Pinkerton
- Center for Health and the Environment, University of California at Davis, Davis, California 95616, United States
| | - Tran B Nguyen
- Department of Environmental Toxicology, University of California at Davis, Davis, California 95616, United States
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13
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Chatterjee N, Gupte HA, Mandal G. A Qualitative Study of Perceptions and Practices Related to Areca Nut Use Among Adolescents in Mumbai, India. Nicotine Tob Res 2021; 23:1793-1800. [PMID: 33831182 DOI: 10.1093/ntr/ntab067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 04/06/2021] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Areca nut, commonly known as supari, is widely used in India. In addition to tobacco and alcohol, it has been identified as one of the contributory factors for high rates of oral cancer in the country. METHODS This qualitative study explored perceptions and practices around the use of areca nut by conducting in-depth interviews and focus group discussions with 61 school-going adolescents in the city of Mumbai, India. RESULTS Respondents used low-priced sachets of sweetened, flavored areca nut called supari. They perceived supari as harmless because it was sweet, it had a fresh after-taste as compared to bitter-tasting smokeless tobacco products. How can something sweet be harmful was a common argument offered by respondents. Respondents invariably compared and contrasted areca nut to more harmful and addictive tobacco products; perceiving supari to have milder or inconsequential health effects. Supari use was initiated with friends, a sibling, or a cousin. It was almost always used with friends. Respondents also reported difficulty in refusal to use when offered supari by friends. Parental response to finding out about the child's supari use was often muted in comparison to extreme reactions associated with the child's tobacco use. CONCLUSIONS Perceptions of low risk or relative harmlessness of the product, social influence, and the features of the product itself influence adolescents' use of areca nut. Although more research on perceptions of risk, with larger samples, is required, these findings are useful for school-based tobacco prevention and cessation programs and health policy-makers. IMPLICATIONS The study findings have implications for prevention and cessation programs, and policymakers. School-based health education programs should allocate special sessions on areca nut use. Focused mass media communication campaigns describing its harms and association with oral cancer are required for the larger community. As was done for tobacco, Indian policymakers will have to evaluate the marketing, commerce, and distribution of areca nut and create appropriate laws. More research, with larger nationwide samples, is required to examine perceptions of areca nut.
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14
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D'Angelo H, Patel M, Rose SW. Convenience Store Access and E-cigarette Advertising Exposure Is Associated With Future E-cigarette Initiation Among Tobacco-Naïve Youth in the PATH Study (2013-2016). J Adolesc Health 2021; 68:794-800. [PMID: 33039271 PMCID: PMC8317228 DOI: 10.1016/j.jadohealth.2020.08.030] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 08/04/2020] [Accepted: 08/28/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE The association between e-cigarette marketing exposure and youth e-cigarette initiation is not well understood. This study examines whether convenience store access, exposure to retail e-cigarette marketing, and having a favorite e-cigarette ad before e-cigarette use is associated with susceptibility to use and future e-cigarette initiation in a national longitudinal study of youth. METHODS A nationally representative longitudinal cohort of youth in the Population Assessment of Tobacco and Health study (12-17 years) was followed up over three waves of annual data collection (2013-2016). Tobacco-naïve (wave 1) and e-cigarette-naïve (wave 2) youth (n = 6,470) were included. Marketing exposure at wave 2 was examined in association with e-cigarette susceptibility (wave 2) and e-cigarette initiation (wave 3) using adjusted logistic regression models. Analysis occurred in 2019. RESULTS Youth visiting convenience stores at least weekly (vs. never) had 1.51 times the odds of e-cigarette susceptibility (95% confidence interval [CI]: 1.25, 1.81) and 1.79 times the odds of e-cigarette initiation (95% CI: 1.29, 2.48). Noticing a retail e-cigarette ad (vs. not noticing) was associated with e-cigarette susceptibility (adjusted odds ratio [AOR] 1.36, 95% CI: 1.18, 1.57), but not initiation. Youth reporting a favorite branded e-cigarette ad had greater odds of both susceptibility (AOR 1.31, 95% CI, 1.10, 1.56) and e-cigarette initiation (AOR 1.60, 95% CI: 1.18, 2.17) compared to youth without a favorite ad. CONCLUSIONS Tobacco-naïve youth with frequent convenience store access and exposure to e-cigarette marketing were at greater risk of e-cigarette susceptibility and progression to e-cigarette initiation over a 2-year period. Policies to restrict retailer locations and e-cigarette marketing could enhance youth e-cigarette use prevention efforts.
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Affiliation(s)
- Heather D'Angelo
- School of Medicine and Public Health, Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin. heather.d'
| | - Minal Patel
- Truth Initiative Schroeder Institute, Washington, District of Columbia
| | - Shyanika W Rose
- College of Medicine, Department of Behavioral Science, and Center for Health Equity Transformation, University of Kentucky, Lexington, Kentucky; Markey Cancer Center, Lexington, Kentucky
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15
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Felicione NJ, Fix BV, McNeill A, Cummings KM, Goniewicz ML, Hammond D, Borland R, Heckman BW, Bansal-Travers M, Gravely S, Hitchman SC, Levy DT, Fong GT, O'Connor R. Characteristics and changes over time of nicotine vaping products used by vapers in the 2016 and 2018 ITC Four Country Smoking and Vaping Surveys. Tob Control 2021; 31:e66-e73. [PMID: 33753550 PMCID: PMC8455705 DOI: 10.1136/tobaccocontrol-2020-056239] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/28/2021] [Accepted: 02/23/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Regulation of nicotine vaping products (NVPs) varies between countries, impacting the availability and use of these products. This study updated the analyses of O'Connor et al on types of NVPs used and examined changes in NVP features used over 18 months in four countries with differing regulatory environments. DESIGN Data are from 4734 adult current vapers in Australia, Canada, England and the USA from Waves 1 (2016) and 2 (2018) of the International Tobacco Control Four Country Smoking and Vaping Survey. NVP characteristics included device description, adjustable voltage, nicotine content and tank size. Longitudinal analyses (n=1058) assessed movement towards or away from more complex/modifiable NVPs. A logistic regression was used to examine factors associated with changes in device description from 2016 to 2018. RESULTS Like 2016, box-tanks were the most popular NVP (37.3%) in all four countries in 2018. Over 80% of vapers continued using the same NVP and nicotine content between waves, though movement tended towards more complex/modifiable devices (14.4% of vapers). Box-tank users, exclusive daily vapers and older vapers were most likely to continue using the same device description. Certain NVPs and features differed by country, such as higher nicotine contents in the USA (11.5% use 21+ mg/mL) and greater device stability over time in Australia (90.8% stability). CONCLUSIONS Most vapers continued using the same vaping device and features over 18 months. Differences in NVP types and features were observed between countries, suggesting that differing NVP regulations affect consumer choices regarding the type of vaping device to use.
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Affiliation(s)
- Nicholas J Felicione
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Brian Vincent Fix
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Ann McNeill
- Department of Addictions, King's College London, London, UK.,Shaping Public Health Policies to Reduce Inequalities and Harm (SPECTRUM), Nottingham, UK
| | - K Michael Cummings
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Maciej Lukasz Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Ron Borland
- School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Bryan W Heckman
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Maansi Bansal-Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | | | - David T Levy
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada.,Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Richard O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
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16
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Pearson JL, Zhou Y, Smiley SL, Rubin LF, Harvey E, Koch B, Niaura R, Abrams DB. Intensive Longitudinal Study of the Relationship Between Cigalike E-cigarette Use and Cigarette Smoking Among Adult Cigarette Smokers Without Immediate Plans to Quit Smoking. Nicotine Tob Res 2021; 23:527-534. [PMID: 32421191 PMCID: PMC7885790 DOI: 10.1093/ntr/ntaa086] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 05/12/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION This study examined the association between the introduction of an e-cigarette and subsequent change in cigarette smoking among smokers who were not immediately interested in quitting. AIMS AND METHODS The Moment Study was a 21-day intensive longitudinal study with an online follow-up survey at 30 days. After observing baseline cigarette smoking for 1 week, participants received 10 cigalike e-cigarettes on study days 6 and 13. Participants reported cigarettes per day, e-cigarette puffs per day, and e-cigarette satisfaction using text-message-based surveys. RESULTS The sample of 96 daily smokers was majority female (53.1%), African American (67.7%), and non-Hispanic (95.8%). When e-cigarettes were provided (day 6), average cigarettes per day dropped by 1.82 cigarettes (p < .0001). The within-person e-cigarette puff effect on daily cigarette smoking was significantly negative (β = -0.023; p = .005); a participant who consumed 100 more e-cigarette puffs in a day than usual for that person was expected to smoke 2.3 fewer cigarettes that day, but this was only true for non-menthol smokers (p = .006). Smokers older than 45 and those who started smoking at a younger age rated e-cigarettes as less satisfying (ps < .05). Participants with greater than the median reported satisfaction were 6.5 times more likely to use an e-cigarette at follow-up. CONCLUSIONS Giving e-cigarettes to smokers who did not intend to quit reduced their cigarette smoking on days when they used e-cigarette more frequently, but this relationship did not hold for menthol smokers. Satisfaction with e-cigarette use was predictive of continued use 30 days later. IMPLICATIONS A greater amount of cigalike e-cigarette use resulted in less smoking among adult daily smokers without immediate plans to quit, but a lack of nicotine delivery and satisfaction for these devices may have limited their utility as a replacement for cigarette smoking, especially among menthol smokers. The global concept of "satisfaction" may be an important driver of e-cigarette use among adult smokers.
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Affiliation(s)
- Jennifer L Pearson
- Division of Social and Behavioral Health/Health Administration and Policy, University of Nevada, Reno, NV
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Yitong Zhou
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC
| | - Sabrina L Smiley
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Leslie F Rubin
- Counseling and Psychological Services, Northwestern University, Evanston, IL
| | - Emily Harvey
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Contractor—Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Brandon Koch
- Division of Epidemiology, Biostatistics, and Environmental Health, University of Nevada, Reno, NV
| | - Raymond Niaura
- Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York, NY
| | - David B Abrams
- Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York, NY
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17
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Karasneh R, Al-Azzam S, Nusair M, Hawamdeh S. Perceptions, symptoms, and practices of electronic cigarette users: Descriptive analysis and validation of Arabic short form vaping consequences questionnaire. PLoS One 2021; 16:e0245443. [PMID: 33481827 PMCID: PMC7822314 DOI: 10.1371/journal.pone.0245443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 12/31/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND E-cigarette (EC) use is increasing worldwide. Understanding the practices and perceptions of e-cigarette users and profiling the symptoms they experience is essential for regulating the use of such products. This study aims to investigate the practices and perceptions of e-cigarette users in Jordan and examine the symptoms (e.g. respiratory) they associate with e-cigarette use. METHODS A cross-sectional online survey was conducted to assess EC use and tobacco smoking behaviors and the corresponding health symptoms among EC users in Jordan. EC use expectancies were also assessed using the Short Form Vaping Consequences Questionnaire, which was first translated into Arabic and tested for validity and reliability. RESULTS Out of the 400 EC users surveyed, 95.5% were male, 76.2% used nicotine-containing juice, and 56.8% were concurrent tobacco smokers. Further, the participants had a mean age of 28.9 years (±10.2). Among dual EC/cigarette users, 88.6% reported that they tried to quit cigarette smoking, with e-cigarette use being the most commonly tried method of smoking cessation. The smoking-related symptoms reported by regular cigarette smokers mainly included sputum production (77.5%). The participants reported that using e-cigarettes instead of tobacco cigarettes had led to improvements in their sputum production (60.8%), breathing (59%), and general wellbeing (52%). Pleasant taste, enjoyable taste sensation, and flavor were significantly stronger (P-value < 0.05) among e-cigarette users compared to dual users. Dual EC/cigarette users reported stronger perceptions in the negative consequences scale, particularly with regards to the hazardous effects of smoking on health (P-value < 0.05). CONCLUSION Dual daily use of e-cigarettes and regular cigarettes is a common practice among EC users. We recommend that further research is conducted on dual EC/cigarette use and the potential health risks this may have (e.g. higher nicotine intake as compared to the single use of either products).
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Affiliation(s)
- Reema Karasneh
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Sayer Al-Azzam
- Clinical Pharmacy Department, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad Nusair
- Department of Pharmacy Practice, Faculty of Pharmacy, Yarmouk University, Irbid, Jordan
| | - Sahar Hawamdeh
- Clinical Pharmacy Department, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
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18
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Cantrell J, Huang J, Greenberg M, Willett J, Hair E, Vallone D. History and Current Trends in the Electronic Cigarette Retail Marketplace in the United States: 2010-2016. Nicotine Tob Res 2020; 22:843-847. [PMID: 30312465 DOI: 10.1093/ntr/nty214] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 10/04/2018] [Indexed: 11/14/2022]
Abstract
INTRODUCTION The US market for electronic nicotine delivery systems (ENDS) has grown rapidly in the last decade. There is limited published evidence examining changes in the ENDS marketplace prior to the US Food and Drug Administration's (FDA) deeming rule in 2016. This study describes US ENDS retail market trends from 2010 to 2016. METHODS National data were obtained from Nielsen retail scanners for five product types: (1) disposables, (2) rechargeables, (3) cartridge replacements, (4) e-liquid bottle refills, and (5) specialty vapor products. We examined dollar sales, volume, price, brand, and flavor. RESULTS Adjusted national sales increased from $11.6 million in 2010 to $751.2 million in 2016. The annual rate of sales growth rapidly increased before slowing through 2015. The rate of growth spiked in 2016. Market share for menthol products and other assorted flavors increased from 20% in 2010 to 52.1% by 2016. NJOY's early market dominance shifted as tobacco industry brands entered the market and eventually captured 87.8% of share by 2016. Rechargeables and accompanying products comprised an increased proportion of total volume sold over time while disposable volume declined. Specialty vapor products appeared at retail in 2015. CONCLUSIONS Findings show strong early growth in the ENDS retail market followed by considerable slowing over time, despite a slight uptick in 2016. Trends reflect shifts to flavored products, newer generation "open-system" devices, lower prices, and tobacco industry brands. This study provides a baseline against which to compare the impact of FDA's 2016 deeming rule and future actions on the ENDS marketplace. IMPLICATIONS This study uses market scanner data from US retail outlets to describe trends in the ENDS retail market from 2010 to 2016, providing a baseline against which to compare the impact of FDA's 2016 deeming rule and future actions on the ENDS marketplace. Understanding historical market trends is valuable in assessing how future regulatory efforts and advances in ENDS technology may impact industry response and consumer uptake and use.
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Affiliation(s)
- Jennifer Cantrell
- Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York, NY.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jidong Huang
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA
| | | | | | - Elizabeth Hair
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Schroeder Institute, Truth Initiative, Washington, DC
| | - Donna Vallone
- Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York, NY.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Schroeder Institute, Truth Initiative, Washington, DC
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19
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Czaplicki L, Simpson R, Zhou Y, Patel M, Cuccia AF, Vallone DM, Schillo BA. Public Support for E-Cigarette-related Policies among a Nationally Representative Sample of US Adults. Tob Use Insights 2020; 13:1179173X20959700. [PMID: 33100830 PMCID: PMC7549073 DOI: 10.1177/1179173x20959700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 08/21/2020] [Indexed: 12/28/2022] Open
Abstract
Background: The wide availability of flavored e-cigarettes and broad use of e-cigarettes
in public places may contribute to the rapidly increasing rates of use among
youth and young adults in the U.S. However, policies at the federal, state
and local levels can address these factors. Objective: Assess public support for 5 e-cigarette-related policies and evaluate
response patterns by demographics, tobacco use, e-cigarette harm
perceptions, geographic region, and strength of state-level clean indoor air
policies. Methods: Data were collected Oct-Dec 2018 from a nationally representative online
panel of U.S. adults (n = 3211). We measured support for 5 policies: (1) a
ban on the sale flavored e-cigarettes; (2) requiring tobacco products, like
e-cigarettes, be kept out of view in stores where adolescents shop; and
prohibiting e-cigarette use in (3) all public places; (4) restaurants; and
(5) bars. Weighted, adjusted logistic regressions modeled variation in
policy support. Results: A majority of respondents (63.3%) supported a flavor ban, with no differences
in support by smoking status. Most respondents supported keeping tobacco
products out of view (78.0%) and prohibiting e-cigarette use in indoor
public places (82.9%), restaurants (86.5%), and bars (76.1%). In the
adjusted models, current e-cigarette users had significantly lower odds of
policy support compared to never users. We observed no differences in
support by geographic region or strength of state-level clean indoor air
policies. Conclusion: Results suggest high levels of public support to regulate e-cigarette
flavors, marketing, and use in public places. Targeted messaging may be
needed to increase support among current e-cigarette users.
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Affiliation(s)
| | - Randall Simpson
- Schroeder Institute at Truth Initiative, Washington, DC, USA
| | - Yitong Zhou
- Schroeder Institute at Truth Initiative, Washington, DC, USA
| | - Minal Patel
- Schroeder Institute at Truth Initiative, Washington, DC, USA
| | - Alison F Cuccia
- Schroeder Institute at Truth Initiative, Washington, DC, USA
| | - Donna M Vallone
- Schroeder Institute at Truth Initiative, Washington, DC, USA.,College of Global Public Health, New York University, New York, NY, USA.,Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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20
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Odani S, Armour B, Agaku IT. Flavored Tobacco Product Use and Its Association With Indicators of Tobacco Dependence Among US Adults, 2014-2015. Nicotine Tob Res 2020; 22:1004-1015. [PMID: 31180498 DOI: 10.1093/ntr/ntz092] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 06/07/2019] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Widely marketed flavored tobacco products might appeal to nonusers and could be contributing to recent increases in tobacco product use. We assessed flavored product use among current tobacco users; and measured associations between flavored product use and dependence among US adults. METHODS Data were from the 2014-2015 Tobacco Use Supplement to the Current Population Survey, a cross-sectional household-based survey of US adults ≥18 years (n = 163 920). Current users of cigarettes, cigars, pipes, hookahs, smokeless tobacco, and electronic cigarettes (e-cigarettes) were asked whether their usual product was menthol or came in any characterizing flavors. Proportions of flavored product users were computed nationally and by state and demographic characteristics. Tobacco dependence was assessed with two proxy measures: daily use and use ≤30 minutes after waking. Associations between flavored product use and tobacco dependence were examined using logistic regression adjusted for sex, age, race/ethnicity, and multi tobacco product use. RESULTS An estimated 41.0% of current users of any tobacco product usually used a flavored product during 2014-2015. The proportion ranged from 22.5% (Maine) to 62.1% (District of Columbia). By product, the proportion ranged from 28.3% (cigars) to 87.2% (hookah). Flavored product use was associated with: daily tobacco product use among current e-cigarette users (adjusted odds ratio [AOR] = 1.71), cigar smokers (AOR = 1.42), and cigarette smokers (AOR = 1.13); and tobacco product use ≤30 minutes after waking among current cigar smokers (AOR = 1.80), and cigarette smokers (AOR = 1.11). CONCLUSIONS Restricting sales of flavored tobacco products and implementation of proven population-level tobacco control interventions could help reduce tobacco product use among US adults. IMPLICATIONS During 2014-2015, flavored tobacco products were widely used by US adults with variations across states and demographic characteristics. Use of flavored e-cigarettes, flavored cigars, and menthol cigarettes were associated with daily tobacco use: use of flavored cigars and menthol cigarettes were associated with tobacco use within 30 minutes after waking. These findings suggest associations between flavor use and increased tobacco dependence. Prohibiting sale of flavored products can reduce access to those products, and could help reduce tobacco dependence and promote cessation behaviors among current tobacco product users.
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Affiliation(s)
- Satomi Odani
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Brian Armour
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Israel T Agaku
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
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21
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D'Angelo H, Rose SW, Golden SD, Queen T, Ribisl KM. E-cigarette availability, price promotions and marketing at the point-of sale in the contiguous United States (2014-2015): National estimates and multilevel correlates. Prev Med Rep 2020; 19:101152. [PMID: 32670780 PMCID: PMC7338777 DOI: 10.1016/j.pmedr.2020.101152] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 05/18/2020] [Accepted: 06/20/2020] [Indexed: 01/04/2023] Open
Abstract
Electronic cigarette (e-cigarette) sales and use have increased rapidly, yet point-of-sale e-cigarette availability and marketing is understudied. We estimated changes in e-cigarette availability and marketing among tobacco retailers in the U.S., and associations with neighborhood characteristics. A national sample of tobacco retailers in the Contiguous U.S. was audited in 2014 and 2015 (n = 1,905 and n = 2,126, respectively) to observe e-cigarette availability and marketing (signs, ads, displays and promotions) and generate national prevalence estimates. Store, neighborhood and state level correlates of 2015 e-cigarette availability, price promotions and exterior advertising were analyzed using multilevel mixed-effects generalized linear models. E-cigarettes were sold at 72.0% of retailers in 2014 and at 79.2% in 2015. Price promotions increased from 11.9% to 20.2% of retailers. Among retailers that did not previously sell e-cigarettes in 2012, availability in 2015 was greater for retailers in neighborhoods with the highest proportion of Black residents (vs. lowest). E-cigarette price promotions were more prevalent in neighborhoods with more Hispanic residents, while exterior e-cigarette marketing was more prevalent in neighborhoods with more Black residents. State smoking prevalence was positively associated with e-cigarette availability, promotions and advertising. E-cigarette point-of-sale availability and marketing increased between 2014 and 2015 and expanded to neighborhoods with a higher proportion of Black residents between 2012 and 2015. Retailers located within states with high smoking prevalence appear to be targeted by e-cigarette marketing. As e-cigarettes become the target of more regulations, understanding changes in the e-cigarette retail environment is critical to inform potential policies regulating their sale and marketing.
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Affiliation(s)
- Heather D'Angelo
- School of Medicine and Public Health, Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Shyanika W. Rose
- College of Medicine, Department of Behavioral Science, and Center for Health Equity Transformation, University of Kentucky, Lexington, KY, USA
- Truth Initiative Schroeder Institute, Washington, DC, USA
| | - Shelley D. Golden
- Gillings School of Global Public Health, Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Tara Queen
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Kurt M. Ribisl
- Gillings School of Global Public Health, Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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22
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Hwang J, Lee C, Mastrolonardo E, Frasso R. Where there's smoke, there's fire: what current and future providers do and do not know about electronic cigarettes. BMC Public Health 2020; 20:1145. [PMID: 32689998 PMCID: PMC7372802 DOI: 10.1186/s12889-020-09265-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 07/14/2020] [Indexed: 02/08/2023] Open
Abstract
Background Health care providers play a pivotal role as educators on health-related matters ranging from vaccination to smoking cessation. With the rising popularity of electronic cigarettes (e-cigarettes), providers face a new challenge. To date, studies have identified a general lack of knowledge among providers regarding e-cigarettes and discomfort with counseling patients on e-cigarette use. This study aims to systematically explore the perspectives of different health care providers on e-cigarettes and their health implications. With a growing availability of research on the health consequences of e-cigarette use, our study also aims to assess the familiarity of our participants with this literature. Methods From July to October 2018, a sample of attendings (n = 15), residents (n = 15), medical students (n = 33), and nursing students (n = 28) from Thomas Jefferson University participated in a freelisting interview and survey. Results Our study found that perceptions of e-cigarettes vary across different participant groups, as evidenced by the range of responses when asked to think about e-cigarettes and their health implications. We identified gaps in knowledge among students regarding FDA regulation of e-cigarettes and found that attending physicians are less aware than junior trainees of the prevalence of use. Familiarity with evidence-based health consequences was variable and low across all groups. Finally, participants most commonly reported learning about e-cigarettes from news outlets and social media rather than professional platforms. Conclusion This study highlights the need for curricular development in nursing and medical schools, residency training, and continuing medical education regarding e-cigarette use and their impact on human health.
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Affiliation(s)
- Josephine Hwang
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Crystal Lee
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - Eric Mastrolonardo
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Rosemary Frasso
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA.
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23
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Corcoran A, Carl JC, Rezaee F. The importance of anti-vaping vigilance-EVALI in seven adolescent pediatric patients in Northeast Ohio. Pediatr Pulmonol 2020; 55:1719-1724. [PMID: 32462762 PMCID: PMC7384027 DOI: 10.1002/ppul.24872] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 05/25/2020] [Indexed: 11/10/2022]
Abstract
As of 18 February 2020, the e-cigarette or vaping product use-associated lung injury (EVALI) epidemic has claimed the lives of 68 patients in the USA with the total number of reported cases standing at 2807 to date. We present the clinical and radiologic findings, course of illness, and treatment of EVALI in seven adolescent patients in Northeast Ohio. Five of our patients required supplemental oxygen with four requiring intensive care unit care for respiratory support during admission. Three patients were treated with systemic steroids while inpatient. Bilateral opacities were seen on radiographic imaging of all seven of our patients. All patients were discharged alive on room air. However, impaired diffusing capacity of the lungs for carbon monoxide (DLCO) with nonobstructive spirometry was seen in patients that were tested postdischarge. This suggests that although recovery from the acute illness process of EVALI is achieved, there may be long-term impact on lung function in these patients. We recommend close follow-up with a pediatric pulmonologist where spirometry and DLCO can be performed.
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Affiliation(s)
- Aoife Corcoran
- Department of Pediatrics, Cleveland Clinic Children's, Cleveland, Ohio
| | - John C Carl
- Centre for Pediatric Pulmonary Medicine, Cleveland Clinic Children's, Cleveland, Ohio
| | - Fariba Rezaee
- Centre for Pediatric Pulmonary Medicine, Cleveland Clinic Children's, Cleveland, Ohio.,Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio
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24
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Li Y, Burns AE, Burke GJP, Poindexter ME, Madl AK, Pinkerton KE, Nguyen TB. Application of High-Resolution Mass Spectrometry and a Theoretical Model to the Quantification of Multifunctional Carbonyls and Organic Acids in e-Cigarette Aerosol. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2020; 54:5640-5650. [PMID: 32271013 DOI: 10.1021/acs.est.9b07387] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Electronic (e-) cigarette aerosol (particle and gas) is a complex mixture of chemicals, of which the profile is highly dependent on device operating parameters and e-liquid flavor formulation. The thermal degradation of the e-liquid solvents propylene glycol and glycerol often generates multifunctional carbonyls that are challenging to quantify because of unavailability of standards. We developed a theoretical method to calculate the relative electrospray ionization sensitivities of hydrazones of organic acids and carbonyls with 2,4-dinitrophenylhydrazine based on their gas-phase basicities (ΔGdeprotonation). This method enabled quantification by high-performance liquid chromatography-high-resolution mass spectrometry HPLC-HRMS in the absence of chemical standards. Accurate mass and tandem multistage MS (MSn) were used for structure identification of vaping products. We quantified five simple carbonyls, six hydroxycarbonyls, four dicarbonyls, three acids, and one phenolic carbonyl in the e-cigarette aerosol with Classic Tobacco flavor. Our results suggest that hydroxycarbonyls, such as hydroxyacetone, lactaldehyde, and dihydroxyacetone can be significant components in e-cigarette aerosols but have received less attention in the literature and have poorly understood health effects. The data support the radical-mediated e-liquid thermal degradation scheme that has been previously proposed and emphasize the need for more research on the chemistry and toxicology of the complex product formation in e-cigarette aerosols.
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Affiliation(s)
- Yichen Li
- Department of Environmental Toxicology, University of California Davis, Davis, California 95616, United States
| | - Amanda E Burns
- Department of Environmental Toxicology, University of California Davis, Davis, California 95616, United States
| | - Guy J P Burke
- Department of Environmental Toxicology, University of California Davis, Davis, California 95616, United States
| | - Morgan E Poindexter
- Center for Health and the Environment, University of California Davis, Davis, California 95616, United States
| | - Amy K Madl
- Center for Health and the Environment, University of California Davis, Davis, California 95616, United States
| | - Kent E Pinkerton
- Center for Health and the Environment, University of California Davis, Davis, California 95616, United States
| | - Tran B Nguyen
- Department of Environmental Toxicology, University of California Davis, Davis, California 95616, United States
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25
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Briganti M, Wackowski OA, Delnevo CD, Brown L, Hastings SE, Singh B, Steinberg MB. Content Analysis of Electronic Nicotine Delivery System Publications in Core Clinical Journals from 2012 to 2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2201. [PMID: 32218306 PMCID: PMC7177383 DOI: 10.3390/ijerph17072201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/11/2020] [Accepted: 03/21/2020] [Indexed: 02/07/2023]
Abstract
There is no consensus if electronic nicotine delivery systems (ENDS) should be used to reduce harm among the smoking population. Physicians, who represent a trusted source of health communication, are exposed to a range of often conflicting ENDS information and this information may be relayed to patients looking to quit smoking. Previous studies have examined ENDS content of various sources of media but there is a lack of knowledge about ENDS content in medical journals. We analyzed 421 ENDS publications printed between 2012 and 2018 from PubMed's Core Clinical Journal list. Publications were analyzed based on publication type, journal type, study design, geographic focus, theme, terminology, outcomes, and positive/negative statements. The number of ENDS publications grew since 2012, and peaked in 2015. Across all years, negative statements about ENDS outnumbered positive statements, though this difference decreased over time. Over time, negative statements about "toxins and carcinogens" were made less frequently, while negative statements about "gateway effects" and "youth appeal" became more prevalent. UK journals had fewer negative statements relative to US journals. Only 12.6% of publications included guidance for healthcare professionals about ENDS. As published ENDS topics change over time, physicians' communications with patients may be impacted.
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Affiliation(s)
- Michael Briganti
- Rutgers Center for Tobacco Studies, New Brunswick, NJ 08901, USA; (M.B.); (O.A.W.); (C.D.D.); (B.S.)
| | - Olivia A. Wackowski
- Rutgers Center for Tobacco Studies, New Brunswick, NJ 08901, USA; (M.B.); (O.A.W.); (C.D.D.); (B.S.)
| | - Cristine D. Delnevo
- Rutgers Center for Tobacco Studies, New Brunswick, NJ 08901, USA; (M.B.); (O.A.W.); (C.D.D.); (B.S.)
| | - Leanne Brown
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA; (L.B.); (S.E.H.)
| | - Shirin E. Hastings
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA; (L.B.); (S.E.H.)
| | - Binu Singh
- Rutgers Center for Tobacco Studies, New Brunswick, NJ 08901, USA; (M.B.); (O.A.W.); (C.D.D.); (B.S.)
| | - Michael B. Steinberg
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA; (L.B.); (S.E.H.)
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26
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Haw S, Currie D, Eadie D, Pearce J, MacGregor A, Stead M, Amos A, Best C, Wilson M, Cherrie M, Purves R, Ozakinci G, MacKintosh AM. The impact of the point-of-sale tobacco display ban on young people in Scotland: before-and-after study. PUBLIC HEALTH RESEARCH 2020. [DOI: 10.3310/phr08010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background
Tobacco displays at point of sale have been shown to increase young people’s pro-smoking attitudes, susceptibility to smoking and smoking initiation. In Scotland, legislation that prohibited tobacco point-of-sale displays was implemented in large stores (i.e. those > 280 m2) in April 2013 and in small retailers in April 2015.
Objective
To assess the impact of the point-of-sale tobacco display ban on young people’s exposure to tobacco advertising, their attitudes to smoking and smoking susceptibility, and their risk of smoking initiation.
Design
Multimodal before-and-after study design using mixed methods to collect data at baseline (2013) and then longitudinally for 4 years.
Setting
Four main study communities in the central belt of mainland Scotland, UK, purposively selected to reflect two levels of urbanity (urban vs. small town) and two levels of deprivation (high vs. medium/low). Four matched communities.
Participants
In the main study communities, 94 tobacco retail outlets. All Secondary 2 (aged 13 years) and Secondary 4 (aged 15 years) pupils in 2013 and 2014 together with all Secondary 1 to Secondary 6 (aged 12–17 years) pupils in 2015–17. This included 6612 pupils who completed 14,344 questionnaires over 5 years. Three hundred and eighty-two participants in 80 focus groups who were recruited from Secondary 2 and Secondary 4 in 2013–17. In matched communities, 24 retail panel members in 2013–17.
Main outcome measures
Tobacco product and tobacco storage visibility, density of retail outlets (the number of retailers in a pre-defined area such as a residential neighbourhood), tobacco product exposure, brand awareness, perceived accessibility of tobacco, pro-smoking attitudes, pro-smoking norms, smoking susceptibility and smoking initiation.
Data platform and methods
The study had four components – a mapping and spatial analysis of retail outlets; a tobacco marketing audit, including retail panel interviews in matched communities; school surveys; and focus group discussions with secondary school pupils.
Limitations
The study was based on a small number of communities and did not include communities in remote areas.
Results
Compliance with the point-of-sale legislation in Scotland was high. This led to a large reduction in the visibility of tobacco products in retail outlets. However, when the results were stratified by socioeconomic status, declines in retailer density, weighted by total product visibility, were restricted to the least disadvantaged tertile of participants. Nevertheless, the implementation of the legislation was associated with a reduction in risk of both smoking susceptibility and smoking initiation in young people, as well as a reduction in the perceived accessibility of tobacco and in pro-smoking attitudes after both the partial and the comprehensive bans were introduced.
Conclusions
The Scottish point-of-sale legislation has been successful in reducing the overall visibility of tobacco products and is associated with improvements in attitudinal and behavioural outcomes in young people. However, cues that tobacco is for sale are still highly visible, particularly in retail outlets in areas of deprivation. In addition, the increase in retailer density that was observed after 2015 increased inequalities in product visibility. There was also evidence that the emergence of e-cigarettes may have disrupted the full impact of the legislation.
Future work
Our research indicates that further research is needed to examine the longitudinal relationships between tobacco outlet availability and product visibility inequalities; and the impact of e-cigarettes and standardised packaging on smoking initiation and prevalence.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 1. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Sally Haw
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Dorothy Currie
- Centre for Adolescent and Child Health Research, School of Medicine, University of St Andrews, St Andrews, UK
| | - Douglas Eadie
- Institute for Social Marketing, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Jamie Pearce
- Institute of Geography, School of GeoSciences, University of Edinburgh, Edinburgh, UK
| | | | - Martine Stead
- Institute for Social Marketing, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Amanda Amos
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Catherine Best
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Michael Wilson
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Mark Cherrie
- Institute of Geography, School of GeoSciences, University of Edinburgh, Edinburgh, UK
| | - Richard Purves
- Institute for Social Marketing, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Gozde Ozakinci
- School of Medicine, Medical & Biological Sciences, University of St Andrews, St Andrews, UK
| | - Anne Marie MacKintosh
- Institute for Social Marketing, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
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27
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Havermans A, Krüsemann EJZ, Pennings J, de Graaf K, Boesveldt S, Talhout R. Nearly 20 000 e-liquids and 250 unique flavour descriptions: an overview of the Dutch market based on information from manufacturers. Tob Control 2019. [PMID: 31685584 DOI: 10.1136/tobaccocontrol‐2019‐055303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Flavours increase attractiveness of electronic cigarettes and stimulate use among vulnerable groups such as non-smoking adolescents. It is important for regulators to monitor the market to gain insight in, and regulate the range of e-liquid flavours that is available to consumers. E-liquid manufacturers are required to report key product information to authorities in the European Member States in which they plan to market their products. This information was used to provide an overview of e-liquid flavour descriptions marketed in the Netherlands in 2017. METHODS Two researchers classified 19 266 e-liquids into the 16 main categories of the e-liquid flavour wheel, based on information from four variables in the European Common Entry Gate system. Flavour descriptions were further specified in subcategories. RESULTS For 16 300 e-liquids (85%), sufficient information was available for classification. The categories containing the highest number of e-liquids were fruit (34%), tobacco (16%) and dessert (10%). For all e-liquids, excluding unflavoured ones, 245 subcategories were defined within the main categories. In addition to previously reported subcategories, various miscellaneous flavours such as sandwich, buttermilk and lavender were identified. CONCLUSIONS In 2017, ~20 000 e-liquids were reported to be marketed in the Netherlands, in 245 unique flavour descriptions. The variety of marketed flavour descriptions reflects flavour preference of e-cigarette users as described in literature. Our systematic classification of e-liquids by flavour description provides a tool for organising the huge variety in market supply, serves as an example for other countries to generate similar overviews and can support regulators in developing flavour regulations.
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Affiliation(s)
- Anne Havermans
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Erna J Z Krüsemann
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.,Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Jeroen Pennings
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Kees de Graaf
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Sanne Boesveldt
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Reinskje Talhout
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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28
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Havermans A, Krüsemann EJZ, Pennings J, de Graaf K, Boesveldt S, Talhout R. Nearly 20 000 e-liquids and 250 unique flavour descriptions: an overview of the Dutch market based on information from manufacturers. Tob Control 2019; 30:57-62. [PMID: 31685584 PMCID: PMC7803909 DOI: 10.1136/tobaccocontrol-2019-055303] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/25/2019] [Accepted: 09/30/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Flavours increase attractiveness of electronic cigarettes and stimulate use among vulnerable groups such as non-smoking adolescents. It is important for regulators to monitor the market to gain insight in, and regulate the range of e-liquid flavours that is available to consumers. E-liquid manufacturers are required to report key product information to authorities in the European Member States in which they plan to market their products. This information was used to provide an overview of e-liquid flavour descriptions marketed in the Netherlands in 2017. METHODS Two researchers classified 19 266 e-liquids into the 16 main categories of the e-liquid flavour wheel, based on information from four variables in the European Common Entry Gate system. Flavour descriptions were further specified in subcategories. RESULTS For 16 300 e-liquids (85%), sufficient information was available for classification. The categories containing the highest number of e-liquids were fruit (34%), tobacco (16%) and dessert (10%). For all e-liquids, excluding unflavoured ones, 245 subcategories were defined within the main categories. In addition to previously reported subcategories, various miscellaneous flavours such as sandwich, buttermilk and lavender were identified. CONCLUSIONS In 2017, ~20 000 e-liquids were reported to be marketed in the Netherlands, in 245 unique flavour descriptions. The variety of marketed flavour descriptions reflects flavour preference of e-cigarette users as described in literature. Our systematic classification of e-liquids by flavour description provides a tool for organising the huge variety in market supply, serves as an example for other countries to generate similar overviews and can support regulators in developing flavour regulations.
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Affiliation(s)
- Anne Havermans
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Erna J Z Krüsemann
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.,Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Jeroen Pennings
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Kees de Graaf
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Sanne Boesveldt
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Reinskje Talhout
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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29
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Tobore TO. On the potential harmful effects of E-Cigarettes (EC) on the developing brain: The relationship between vaping-induced oxidative stress and adolescent/young adults social maladjustment. J Adolesc 2019; 76:202-209. [DOI: 10.1016/j.adolescence.2019.09.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 09/07/2019] [Accepted: 09/22/2019] [Indexed: 12/20/2022]
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30
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Rose SW, Johnson AL, Glasser AM, Villanti AC, Ambrose BK, Conway K, Cummings KM, Stanton CA, Delnevo C, Wackowski OA, Edwards KC, Feirman SP, Bansal-Travers M, Bernat J, Holder-Hayes E, Green V, Silveira ML, Zhou Y, Abudayyeh H, Hyland A. Flavour types used by youth and adult tobacco users in wave 2 of the Population Assessment of Tobacco and Health (PATH) Study 2014-2015. Tob Control 2019; 29:432-446. [PMID: 31542778 DOI: 10.1136/tobaccocontrol-2018-054852] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 05/18/2019] [Accepted: 05/28/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Most youth and young adult (YA) tobacco users use flavoured products; however, little is known about specific flavours used. METHODS We report flavour types among US tobacco users from the Population Assessment of Tobacco and Health Study, wave 2, 2014-2015. At wave 2, we examined (1) flavour use and type at past 30-day use; (2) new flavoured tobacco product use and type; (3) product-specific flavour patterns across youth (ages 12-17) (n=920), YA (18-24) (n=3726) and adult (25+) (n=10 346) past 30-day and new tobacco users and (4) concordance between self-coded and expert-coded brand flavour type among all adults (18+). RESULTS Prevalence of flavoured tobacco product use was highest among youth, followed by YA and adult 25+ any tobacco users. Within each age group, flavoured use was greatest among hookah, e-cigarette and snus users. Overall, menthol/mint, fruit and candy/sweet were the most prevalent flavour types at first and past 30-day use across age groups. For past 30-day use, all flavour types except menthol/mint exhibited an inverse age gradient, with more prevalent use among youth and YAs, followed by adults 25+. Prevalence of menthol/mint use was high (over 50% youth, YAs; 76% adults 25+) and exhibited a positive age gradient overall, though the reverse for cigarettes. Brand-categorised and self-reported flavour use measures among adults 18+ were moderately to substantially concordant across most products. CONCLUSIONS Common flavours like menthol/mint, fruit and candy/sweet enhance appeal to young tobacco users. Information on flavour types used by product and age can inform tobacco flavour regulations to addess flavour appeal especially among youth.
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Affiliation(s)
| | - Amanda L Johnson
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland, USA
| | | | - Andrea C Villanti
- Truth Initiative Schroeder Institute, Washington, DC, USA.,Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, Vermont, USA
| | - Bridget K Ambrose
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Kevin Conway
- Division of Epidemiology, Services, and Prevention Branch, National Institute on Drug Abuse, Bethesda, Maryland, USA
| | - K Michael Cummings
- Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Cassandra A Stanton
- Westat Inc, Rockville, Maryland, USA.,Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, United States
| | - Cristine Delnevo
- Center for Tobacco Studies, School of Public Health, Rutgers University, Piscataway, New Jersey, USA
| | - Olivia A Wackowski
- Center for Tobacco Studies, School of Public Health, Rutgers University, Piscataway, New Jersey, USA
| | | | - Shari P Feirman
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland, USA
| | | | - Jennifer Bernat
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Enver Holder-Hayes
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Victoria Green
- Division of Epidemiology, Services, and Prevention Branch, National Institute on Drug Abuse, Bethesda, Maryland, USA.,Kelly Government Solutions, Rockville, Maryland, USA
| | - Marushka L Silveira
- Division of Epidemiology, Services, and Prevention Branch, National Institute on Drug Abuse, Bethesda, Maryland, USA.,Kelly Government Solutions, Rockville, Maryland, USA
| | - Yitong Zhou
- Truth Initiative Schroeder Institute, Washington, DC, USA
| | | | - Andrew Hyland
- Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA
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Kuiper NM, Gammon D, Loomis B, Falvey K, Wang TW, King BA, Rogers T. Trends in Sales of Flavored and Menthol Tobacco Products in the United States During 2011-2015. Nicotine Tob Res 2019; 20:698-706. [PMID: 28575408 DOI: 10.1093/ntr/ntx123] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 05/26/2017] [Indexed: 11/14/2022]
Abstract
Introduction Flavors can mask the harshness of tobacco and make it appealing to young people. This study assessed flavored and menthol tobacco product sales at the national and state levels. Methods Universal Product Code tobacco sales data collected by Nielsen were combined for convenience stores and all-outlets-combined during October 22, 2011-January 9, 2016. Products were characterized as flavored, menthol, or non-flavored/non-menthol. Total unit sales, and the proportion of flavored and menthol unit sales, were assessed nationally and by state for seven tobacco products. Joinpoint regression was used to assess trends in average monthly percentage change. Results Nationally, the proportion of flavored and menthol sales in 2015 was as follows: cigarettes (32.5% menthol), large cigars (26.1% flavored), cigarillos (47.5% flavored, 0.2% menthol), little cigars (21.8% flavored, 19.4% menthol), chewing tobacco (1.4% flavored, 0.7% menthol), moist snuff (3.0% flavored, 57.0% menthol), and snus (88.5% menthol). From 2011 to 2015, sales increased for flavored cigarillos and chewing tobacco, as well as for menthol cigarettes, little cigars, moist snuff, and snus. Sales decreased for flavored large cigars, moist snuff, and snus, and for menthol chewing tobacco. State-level variations were observed by product; for example, flavored little cigar sales ranged from 4.4% (Maine) to 69.3% (Utah) and flavored cigarillo sales ranged from 26.6% (Maine) to 63.0% (Maryland). Conclusions Menthol and flavored sales have increased since 2011, particularly for the products with the highest number of units sold, and significant state variation exists. Efforts to restrict flavored tobacco product sales could reduce overall U.S. tobacco consumption. Implications Flavors in tobacco products can mask the harshness of tobacco and make these products more appealing to young people. This is the first study to assess national and state-level trends in flavored and menthol tobacco product sales. These findings underscore the importance of population-based interventions to address flavored tobacco product use at the national, state, and local levels. Additionally, further monitoring of flavored and menthol tobacco product sales can inform potential future regulatory efforts at the national, state, and local levels.
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Affiliation(s)
- Nicole M Kuiper
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Doris Gammon
- Public Health Research Division, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC
| | - Brett Loomis
- Public Health Research Division, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC
| | - Kyle Falvey
- Public Health Research Division, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC
| | - Teresa W Wang
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA
| | - Brian A King
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Todd Rogers
- Public Health Research Division, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC
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Lanza HI, Pittman PS. A Peek Past the Vape Clouds: Vape Shop Decline in Long Beach, California during 2015-2018. TOB REGUL SCI 2019; 5:447-455. [PMID: 32879896 PMCID: PMC7462366 DOI: 10.18001/trs.5.5.5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The current study adds to the literature on vape shops by evaluating vape shop growth in an urban community over a 3-year period, assessing similarities and differences across the vape shop context, and addressing whether socialization spaces within vape shops are associated with a vape shop's ultimate success - remaining operational. As e-cigarette/vaping use enters its second decade in the US market, its regulation and status as a novel form of substance use is evolving; accordingly, it is unknown whether the presence of vape shops has changed as well. METHODS In this study, we tracked and observed 19 vape shops over a 3-year period in Long Beach, California. RESULTS Vape shop presence declined by 53% between September 2015 and September 2018. A comparison of vape shops remaining open versus those closing in the 3-year period indicated that shops with designated socialization spaces (lounges/tasting bars) were more likely to remain operational. CONCLUSIONS The substantial decline in vape shop presence in this community may reflect an entrepreneurial response to increased regulation, as well as a dynamic market for e-cigarette/vape products. Findings suggest vape users support Electronic Nicotine Delivery Systems (ENDS) retailers that promote community-building or recreational activity.
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Affiliation(s)
- H Isabella Lanza
- H. Isabella Lanza, Associate Professor, Department of Human Development, California State University, Long Beach, CA. Patricia S. Pittman, Department of Human Development and Family Science, The Ohio State University, Columbus, OH
| | - Patricia S Pittman
- H. Isabella Lanza, Associate Professor, Department of Human Development, California State University, Long Beach, CA. Patricia S. Pittman, Department of Human Development and Family Science, The Ohio State University, Columbus, OH
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33
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Giovenco DP, Spillane TE, Merizier JM. Neighborhood Differences in Alternative Tobacco Product Availability and Advertising in New York City: Implications for Health Disparities. Nicotine Tob Res 2019; 21:896-902. [PMID: 30452712 PMCID: PMC6588385 DOI: 10.1093/ntr/nty244] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 11/09/2018] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Alternative tobacco products (ATPs), such as cigars, smokeless tobacco, and electronic nicotine delivery systems (ENDS), have a strong presence in the US retail environment amid declining cigarette consumption. This study documented the promotion of ATPs in tobacco retailers in New York City and examined associations with neighborhood demographics. METHODS Data on product availability and advertising were collected from a stratified, random sample of tobacco retailers in 2017 (n = 796). Multilevel models estimated adjusted prevalence ratios (aPRs) for each outcome by neighborhood racial/ethnic composition and median household income. RESULTS Nearly half (49.8%) of retailers carried 99-cent cigarillos, but availability was significantly greater in neighborhoods in the highest (vs. lowest) quartile for the percentage of Black residents [68.2%, aPR: 1.59 (1.19, 2.11)] and in the lowest (vs. highest) income quartile [67.3%, aPR: 1.56 (1.04, 2.35)]. Conversely, retailers in neighborhoods with the highest percentage of White residents were significantly more likely to carry ENDS [66.4%, aPR: 1.71 (1.11, 2.62)]. Advertisements for ENDS were less common in neighborhoods in the highest (vs. lowest) quartiles for the percentage of Black and Hispanic residents [20.3%, aPR: 0.64 (0.41, 0.99); 22.9%, aPR: 0.62 (0.40, 0.98)]. CONCLUSIONS The marketing of inexpensive, combusted tobacco products disproportionately saturates low-income, minority communities, while potentially lower risk, noncombusted products are more accessible in largely White and higher income neighborhoods. This pattern may exacerbate tobacco-related inequities. Public health policies should prioritize reducing the appeal and affordability of the most harmful tobacco products to help reduce health disparities. IMPLICATIONS Although cigarette promotion at the point-of-sale is well documented in the literature, questions remain about the ways in which alternative tobacco products (ATPs) are marketed in communities. Importantly, these products fall on a continuum of harm, with combusted tobacco overwhelmingly responsible for tobacco-related death and disease. We found that retailers in minority and low-income communities were more likely to carry and advertise inexpensive ATPs such as cigarillos, while potentially less risky, noncombusted products such as smokeless tobacco and e-cigarettes were more accessible in higher income and predominantly White neighborhoods. Policies aligned with product risk may help reduce health disparities.
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Affiliation(s)
- Daniel P Giovenco
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY
| | - Torra E Spillane
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY
| | - July M Merizier
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY
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Son Y, Mishin V, Laskin JD, Mainelis G, Wackowski OA, Delnevo C, Schwander S, Khlystov A, Samburova V, Meng Q. Hydroxyl Radicals in E-Cigarette Vapor and E-Vapor Oxidative Potentials under Different Vaping Patterns. Chem Res Toxicol 2019; 32:1087-1095. [PMID: 30977360 PMCID: PMC6579624 DOI: 10.1021/acs.chemrestox.8b00400] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Available studies, while limited in number, suggest that e-cigarette vaping induces oxidative stress, with one potential mechanism being the direct formation of reactive oxygen species (ROS) in e-vapor. In the present studies, we measured the formation of hydroxyl radical (•OH), the most destructive ROS, in e-vapor under a range of vaping patterns (i.e., power settings, solvent concentrations, flavorings). Study results show that increased power output and puff volume correspond with the formation of significantly higher amounts of •OH in e-vapor because of elevated coil temperature and oxygen supply. Vegetable glycerin (VG) e-liquids generated higher •OH levels than propylene glycol (PG) e-liquids, as did flavored e-liquids relative to nonflavored e-liquids. E-vapor in combination with ascorbic acid, which is an abundant biological molecule in human epithelial lining fluid, can also induce •OH formation. The dose of radical per puff associated with e-cigarette vaping was 10-1000 times lower than the reported dose generated by cigarette smoking. However, the daily average •OH dose can be comparable to that from cigarette smoking depending on vaping patterns. Overall, e-cigarette users who use VG-based flavored e-cigarettes at higher power output settings may be at increased risk for •OH exposures and related health consequences such as asthma and chronic obstructive pulmonary disease.
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Affiliation(s)
- Yeongkwon Son
- Department of Environmental and Occupational Health, School of Public Health, Rutgers University, Piscataway, New Jersey 08854, United States
- Division of Atmospheric Sciences, Desert Research Institute, Reno, Nevada 89512, United States
| | - Vladimir Mishin
- # Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, New Jersey 08854, United States
| | - Jeffrey D. Laskin
- # Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, New Jersey 08854, United States
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey 08854, United States
| | - Gediminas Mainelis
- Department of Environmental Sciences, Rutgers University, New Brunswick, New Jersey 08901, United States
| | - Olivia A. Wackowski
- Center for Tobacco Studies, School of Public Health, Rutgers University, Piscataway, New Jersey, United States
- Cancer Prevention & Control Program, Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey 08854, United States
| | - Cristine Delnevo
- Center for Tobacco Studies, School of Public Health, Rutgers University, Piscataway, New Jersey, United States
- Cancer Prevention & Control Program, Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey 08854, United States
| | - Stephan Schwander
- Department of Environmental and Occupational Health, School of Public Health, Rutgers University, Piscataway, New Jersey 08854, United States
- # Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, New Jersey 08854, United States
- Center for Tobacco Studies, School of Public Health, Rutgers University, Piscataway, New Jersey, United States
- Department of Urban-Global Public Health, School of Public Health, Rutgers University, Newark, New Jersey 07102, United States
| | - Andrey Khlystov
- Division of Atmospheric Sciences, Desert Research Institute, Reno, Nevada 89512, United States
| | - Vera Samburova
- Division of Atmospheric Sciences, Desert Research Institute, Reno, Nevada 89512, United States
| | - Qingyu Meng
- Department of Environmental and Occupational Health, School of Public Health, Rutgers University, Piscataway, New Jersey 08854, United States
- # Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, New Jersey 08854, United States
- Center for Tobacco Studies, School of Public Health, Rutgers University, Piscataway, New Jersey, United States
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35
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Schroth KRJ. Increasing Price and Reducing Access to Tobacco in New York City. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2019; 47:87-90. [PMID: 31298140 DOI: 10.1177/1073110519857326] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This paper describes novel tobacco control laws passed in New York City in 2017. These laws are designed to improve the city's strategy of using price to decrease tobacco consumption, and over time, change the city's landscape by making tobacco less accessible.
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Affiliation(s)
- Kevin R J Schroth
- Kevin R.J. Schroth, J.D., is an Associate Professor in the Rutgers University's School of Public Health, where he's a member of the Center for Tobacco Studies. His research centers on the intersection of tobacco control law and regulatory science. He previously served at the New York City Department of Health and Mental Hygiene as the Senior Legal Counsel with the Bureau of Chronic Disease Prevention and Tobacco Control, where he played a principal role in drafting and advancing more than a dozen laws designed to reduce tobacco use, and policies designed to reduce sodium and sugary beverage consumption. He also worked as a commercial litigator in private practice and clerked for federal and state judges in New Jersey. He earned his J.D. from Rutgers Law School and B.A. from Bucknell University
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Barrientos-Gutierrez I, Lozano P, Arillo-Santillan E, Morello P, Mejia R, Thrasher JF. "Technophilia": A new risk factor for electronic cigarette use among early adolescents? Addict Behav 2019; 91:193-200. [PMID: 30224154 PMCID: PMC6358480 DOI: 10.1016/j.addbeh.2018.09.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 08/11/2018] [Accepted: 09/04/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE Develop and validate a scale that measures Technophilia (positive orientation toward new technology) and use it to address orientation toward new technologies to explain e-cigarette trial and adoption, especially in relatively low risk adolescents. METHODS Survey data were obtained from students of the three largest cities in Mexico (n = 8123). We developed eight questions involving access, use and pleasure from different electronic media to measure technophilia. Exploratory factor analysis (EFA) was conducted. Linear GEE models were used when regressing technophilia on covariates. When regressing e-cigarette and conventional cigarette trial and use, logistic GEE models were used. Finally, we used multinomial logistic regression to evaluate the associations between technophilia and e-cigarettes as the first tobacco product. RESULTS Technophilia were correlated with theoretically-related variables. Unadjusted and adjusted models regressing e-cigarette trial and use indicated that students in the highest quartile for technophilia were more likely to have tried e-cigarettes compared with the lowest quartile (AORQ4 vs Q1 = 1.36, 95% CI 1.14-1.62). Technophilia was not independently associated with current e-cigarette use in adjusted models. Students with higher technophilia were more likely to have first tried e-cigarettes in both crude and adjusted models (AORQ4vQ1 = 1.66, 95% CI 1.20-2.31; AORQ3vQ1 = 1.43, 95% CI 1.02-2.01). Technophilia did not have a statistically significant, independent association with first use of other tobacco products. CONCLUSION This study suggests that technophilia is associated with trial of e-cigarettes among youth. The measure we developed appears useful for understanding why some youth are open to trying novel, technologically oriented ways to consume nicotine.
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Affiliation(s)
- Inti Barrientos-Gutierrez
- National Institute of Public Health, Mexico Universidad, No. 655, Col. Santa María Ahuacatitlán, Cuernavaca, Morelos, Mexico, CP.62100.
| | - Paula Lozano
- University of South Carolina, Arnold School of Public Health. Discovery I,915 Greene Street, Columbia, SC 29208, United States
| | - Edna Arillo-Santillan
- National Institute of Public Health, Mexico Universidad, No. 655, Col. Santa María Ahuacatitlán, Cuernavaca, Morelos, Mexico, CP.62100
| | - Paola Morello
- Centro de Estudios de Estado y Sociedad (CEDES), Sánchez de Bustamante 27, C1173AAA CABA, Argentina
| | - Raul Mejia
- Centro de Estudios de Estado y Sociedad (CEDES), Sánchez de Bustamante 27, C1173AAA CABA, Argentina
| | - James F Thrasher
- National Institute of Public Health, Mexico Universidad, No. 655, Col. Santa María Ahuacatitlán, Cuernavaca, Morelos, Mexico, CP.62100; University of South Carolina, Arnold School of Public Health. Discovery I,915 Greene Street, Columbia, SC 29208, United States
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37
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Mead EL, Duffy V, Oncken C, Litt MD. E-cigarette palatability in smokers as a function of flavorings, nicotine content and propylthiouracil (PROP) taster phenotype. Addict Behav 2019; 91:37-44. [PMID: 30470456 PMCID: PMC6358501 DOI: 10.1016/j.addbeh.2018.11.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 10/01/2018] [Accepted: 11/13/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND The popularity of E-cigarettes is due in part to their flavorings. The purpose of this study was to determine the effect on smokers' sensory perceptions and liking of various e-cigarette flavorings, and the degree to which those perceptions are influenced by nicotine level, sex, and PROP bitter taster phenotype. METHODS We recruited 132 non-treatment-seeking, daily cigarette smokers. In repeated trials in one laboratory session participants vaped the Joyetech eGo-C e-cigarette with each of the following flavorings (in random order): unflavored, tobacco, cherry, chocolate, and menthol. Participants vaped the e-juice first without nicotine and then with high nicotine (18 mg/ml), and provided sensory (bitterness/sourness, irritation, sweetness) and liking ratings. Perceived intensity of 6-n-propylthiouracil (PROP) was used to classify the participants as non-tasters (n = 28), medium-tasters (n = 74), or supertasters (n = 28). Mixed-effects linear models and generalized estimating equations were used to evaluate ratings as a function of flavor interacting with nicotine content, sex and taster phenotype, adjusting for age, race/ethnicity, menthol use, and nicotine dependence. RESULTS Regardless of nicotine level, cherry (β = 1.76, p < .001) and chocolate (β = 0.69, p < .001) were rated as sweeter, but were not better liked, than unflavored e-juice. Menthol elicited the highest liking rating, especially for women (β = 12.23, p < .05) and supertasters (β = 20.52, p < .05). Regardless of flavor, high nicotine was rated as more irritating (OR = 1.43, 95% CI = 1.02-2.01) than the no-nicotine e-juice. Irritation (β = -13.65, p < .001), bitterness/sourness (β = -11.38, p < .001), and sweetness (β = 4.79, p < .001) were associated with liking. CONCLUSION Menthol may enhance e-cigarette palatability for some smokers, which may increase e-cigarette utility in smoking cessation.
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Affiliation(s)
- Erin L Mead
- Department of Medicine, MC3229, University of Connecticut School of Medicine, Farmington, CT 06030, USA.
| | - Valerie Duffy
- Department of Allied Health Science, College of Agricultural, Health & Natural Resources, University of Connecticut, Storrs, CT 06269, USA.
| | - Cheryl Oncken
- Department of Medicine, MC3229, University of Connecticut School of Medicine, Farmington, CT 06030, USA.
| | - Mark D Litt
- Division of Behavioral Sciences and Community Health, MC3910, UConn Health, Farmington, CT 06030, USA.
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Lee MS, Allen JG, Christiani DC. Endotoxin and [Formula: see text] Contamination in Electronic Cigarette Products Sold in the United States. ENVIRONMENTAL HEALTH PERSPECTIVES 2019; 127:047008. [PMID: 31017484 PMCID: PMC6785222 DOI: 10.1289/ehp3469] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/13/2019] [Accepted: 03/19/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Cigarette smoke contains microbes and microbial toxins, such as endotoxin and [Formula: see text], that may have adverse respiratory effects. To our knowledge, the potential for contamination of electronic cigarette (EC) products sold in the United States has not been investigated. OBJECTIVES We aimed to determine whether popular cartridge and e-liquid EC products were contaminated with endotoxin or glucan and to examine differences according to the type and flavor of products. METHODS We selected 37 cartridges and 38 e-liquid products with the highest nicotine content from the ten top-selling U.S. brands. Flavors were classified into four groups: tobacco, menthol, fruit, and other. Endotoxin and glucan were measured using an endotoxin-specific kinetic turbidimetric assay and a Glucatell® Kinetic Assay (Associates of Cape Cod, Inc.), respectively. RESULTS Endotoxin concentrations were over the limit of detection (LOD) in 17 of 75 products tested (23%), and glucan concentrations were greater than LOD in 61 of 75 products (81%). After adjusting for brand and flavor, the mean glucan concentration was 3.2 times higher [95% confidence interval (CI): [Formula: see text], 18.4] in cartridge vs. e-liquid samples. After adjusting for brand and type of product, glucan concentrations in tobacco- and menthol-flavored ECs were 10.4 (95% CI: 1.8, 44.9) and 3.5 (95% CI: 0.1, 17.3) times higher than concentrations found in fruit-flavored products. CONCLUSIONS EC products may be contaminated with microbial toxins. Further studies with large representative samples of products are needed to confirm our findings, identify sources and routes of contamination, and evaluate health effects associated with the use of contaminated products. https://doi.org/10.1289/EHP3469.
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Affiliation(s)
- Mi-Sun Lee
- Environmental and Occupational Medicine and Epidemiology Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Joseph G. Allen
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - David C. Christiani
- Environmental and Occupational Medicine and Epidemiology Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
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Levy DT, Lindblom EN, Sweanor DT, Chaloupka F, O'Connor RJ, Shang C, Palley T, Fong GT, Cummings KM, Goniewicz ML, Borland R. An Economic Analysis of the Pre-Deeming US Market for Nicotine Vaping Products. TOB REGUL SCI 2019; 5:169-181. [PMID: 32864395 PMCID: PMC7454013 DOI: 10.18001/trs.5.2.8] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Public health policies are often enacted without adequate consideration of the existing market structure or their impacts on that market structure. This paper provides context for the potential impact of regulations on nicotine vaping products (NVP) use by providing a structural analysis of competition in the US NVP market before FDA regulation. METHODS A literature review was conducted with the aim of providing a framework for analysis that: 1) defines the market; 2) evaluates market concentration; 3) identifies entry barriers; and 4) examines firm conduct. RESULTS The NVP market includes retail, internet sellers and vape shops. Although conventional retail became more concentrated after the major cigarette companies entered the NVP market, the vape shop and internet sectors remain substantially less concentrated, producing an overall low market concentration, with few entry barriers and competitive behavior. CONCLUSIONS The largely unregulated US NVP market has been highly competitive, with a high degree of innovation. However, new FDA deeming regulations as applied to NVPs could make it difficult for smaller companies to remain in the market and could discourage new companies and new product innovations from entering the market.
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Affiliation(s)
- David T Levy
- Cancer Prevention and Control, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Eric N Lindblom
- Tobacco Control and Food & Drug Law, O'Neill Institute for National & Global Health Law, Georgetown University Law Center, Washington, DC
| | - David T Sweanor
- Adjunct Professor, Faculty of Law, University of Ottawa, Canada
| | - Frank Chaloupka
- Health Policy Center, Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY
| | - Ce Shang
- Department of Pediatrics and Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | | | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Maciej L Goniewicz
- Department of Health Behavior, Division of Cancer Prevention and Population Studies, Roswell Park Cancer Institute, Buffalo, NY
| | - Ron Borland
- Nigel Gray Distinguished Fellow in Cancer Prevention, Cancer Council Victoria, Melbourne, Victoria, Australia
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Jenssen BP, Boykan R. Electronic Cigarettes and Youth in the United States: A Call to Action (at the Local, National and Global Levels). CHILDREN-BASEL 2019; 6:children6020030. [PMID: 30791645 PMCID: PMC6406299 DOI: 10.3390/children6020030] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/07/2019] [Accepted: 02/14/2019] [Indexed: 12/21/2022]
Abstract
E-cigarettes have emerged and soared in popularity in the past ten years, making them the most common tobacco product used among youth in the United States (US). In this review, we discuss what the Surgeon General has called a public health “epidemic”—the precipitous increase in youth use of e-cigarettes and the health consequences of this behavior. Further, we review tobacco control policy efforts (e.g., Tobacco 21, banning flavors, advertising restrictions, and clean indoor air laws)—efforts proven to be critical in reducing cigarette smoking and smoking-related disease and death among US children and adults—including their potential and challenges regarding managing and mitigating the emergence of e-cigarettes. Finally, we close with a discussion of the efforts of transnational tobacco companies to rebrand themselves using e-cigarettes and other new products.
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Affiliation(s)
- Brian P Jenssen
- Department of Pediatrics, University of Pennsylvania School of Medicine and PolicyLab and the Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
| | - Rachel Boykan
- Department of Pediatrics, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, USA.
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Abstract
Electronic cigarettes (e-cigarettes) are the most commonly used tobacco product among youth. The 2016 US Surgeon General's Report on e-cigarette use among youth and young adults concluded that e-cigarettes are unsafe for children and adolescents. Furthermore, strong and consistent evidence finds that children and adolescents who use e-cigarettes are significantly more likely to go on to use traditional cigarettes-a product that kills half its long-term users. E-cigarette manufacturers target children with enticing candy and fruit flavors and use marketing strategies that have been previously successful with traditional cigarettes to attract youth to these products. Numerous toxicants and carcinogens have been found in e-cigarette solutions. Nonusers are involuntarily exposed to the emissions of these devices with secondhand and thirdhand aerosol. To prevent children, adolescents, and young adults from transitioning from e-cigarettes to traditional cigarettes and minimize the potential public health harm from e-cigarette use, there is a critical need for e-cigarette regulation, legislative action, and counterpromotion to protect youth.
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Affiliation(s)
- Brian P. Jenssen
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania and PolicyLab, Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Susan C. Walley
- Department of Pediatrics, The University of Alabama at Birmingham and Children’s of Alabama, Birmingham, Alabama
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Bibliometric Analysis of Electronic Cigarette Publications: 2003⁻2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16030320. [PMID: 30682767 PMCID: PMC6388121 DOI: 10.3390/ijerph16030320] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/18/2019] [Accepted: 01/20/2019] [Indexed: 12/15/2022]
Abstract
Electronic cigarettes are at the center of a public health policy debate which leverages scientific publications. This study characterizes e-cigarette publication trends over the past 15 years via a bibliometric analysis. Scopus was searched for “electronic cigarette”, “e-cig”, “e-cigarette”, “vape”, “vaping”, “juul”, or “electronic nicotine delivery system” between 2003–2018. Data included Hirsch index, document type and frequency, and publications by institution, journal, and country. VOSviewer was used to visualize authorship network maps. A total of 4490 e-cigarette publications were identified, most (62.8%) being articles. After 2009, the annual growth rate for e-cigarette publications was the largest in 2014. The annual growth rate was nearly flat in 2017 but increased in 2018. The U.S. produced 51.6% of publications. Annual National Institutes of Health NIH funding for tobacco research mapped closely with the annual volume of e-cigarette publications. Author network analyses illustrated investigator collaborative patterns. The frequency of e-cigarette publications increased significantly in the past decade. A strong relationship of NIH funding for tobacco research and e-cigarette publications demonstrates the importance of e-cigarettes in tobacco research.
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Scaioli G, Bert F, Martorana M, Gili R, Thomas R, Gualano MR, Siliquini R. Advertisement of electronic cigarettes in Italy: characteristics of online videos and the most popular promotional messages. HEALTH EDUCATION RESEARCH 2018; 33:473-480. [PMID: 30247572 DOI: 10.1093/her/cyy030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 09/18/2018] [Indexed: 06/08/2023]
Abstract
Given the increasing popularity of electronic cigarettes (ECs) and a lack of regulation of EC advertising, this study aimed to analyse online videos promoting ECs to assess the main marketing messages that could influence consumers' perceptions of associated risks and benefits. A web search of EC advertising videos was performed on YouTube by using keywords related to EC promotion. An evaluation grid was used to analyse promotional messages contained in each video. The most frequent promotional messages were related to health benefits (67.7%) and to the possibility of quitting smoking (57.4%). Messages that could also be appealing to adolescents and young adults, such as those promoting the multiple flavors available and the technological improvement of ECs, were present in 41.2% and 42.7% of the videos respectively. ECs similar to traditional cigarettes in appearance were included in 52.9% of the videos. EC promotional videos address messages not only to smokers who want to quit or decrease tobacco consumption but also to nonsmokers, especially young people. The use of ECs similar to traditional cigarettes may be a gateway to tobacco cigarette use. Since EC use may represent an important public health concern, regulatory policies on EC advertising should be established.
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Affiliation(s)
- G Scaioli
- Department of Public Health Sciences, University of Turin, Via Santena 5bis, Turin, Italy
| | - F Bert
- Department of Public Health Sciences, University of Turin, Via Santena 5bis, Turin, Italy
| | - M Martorana
- Department of Public Health Sciences, University of Turin, Via Santena 5bis, Turin, Italy
| | - R Gili
- Department of Public Health Sciences, University of Turin, Via Santena 5bis, Turin, Italy
| | - R Thomas
- Department of Public Health Sciences, University of Turin, Via Santena 5bis, Turin, Italy
| | - M R Gualano
- Department of Public Health Sciences, University of Turin, Via Santena 5bis, Turin, Italy
| | - R Siliquini
- Department of Public Health Sciences, University of Turin, Via Santena 5bis, Turin, Italy
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Assertive communication about others' smoking and vaping in public venues: Results from a National Survey of US adults. Addict Behav 2018; 87:196-199. [PMID: 30053705 DOI: 10.1016/j.addbeh.2018.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/24/2018] [Accepted: 07/18/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION This study describes prevalence and correlates of US adults' intentions to engage in assertive communication (i.e., speak up) about others' smoking and vaping in public venues. METHODS Participants from a nationally representative online survey of 1551 US adults conducted October-December 2013 reported intentions to ask others not to smoke/vape in three types of public venues (restaurants, bars/casinos/nightclubs, and parks). We examined weighted prevalence of intentions and conducted weighted logistic regression. RESULTS Fifty-two percent of participants reported being likely to ask someone not to smoke in at least one venue compared with 19% for vaping. Assertive communication intentions for smoking in restaurants (48%), bars/casinos/nightclubs (35%), and parks (32%) were higher than for vaping (16%, 14%, and 12%, respectively). Significant correlates of assertive communication intentions in one or more venues were current smoking status, ever trying e-cigarettes, gender, age, health status, political ideology, and party identification. CONCLUSIONS US adults were more willing to ask others not to smoke than vape. Intentions to speak up about smoking and vaping differed by venue, demographics, and cigarette/e-cigarette use. These findings help establish an evidence base to inform policymakers in developing strategies to promote compliance with smoke-free and vape-free laws.
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Chen R, Aherrera A, Isichei C, Olmedo P, Jarmul S, Cohen JE, Navas-Acien A, Rule AM. Assessment of indoor air quality at an electronic cigarette (Vaping) convention. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2018; 28:522-529. [PMID: 29288255 DOI: 10.1038/s41370-017-0005-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 08/22/2017] [Indexed: 05/04/2023]
Abstract
E-cigarette (vaping) conventions are public events promoting electronic cigarettes, in which indoor use of e-cigarettes is allowed. The large concentration of people using e-cigarettes and poor air ventilation can result in indoor air pollution. In order to estimate this worst-case exposure to e-cigarettes, we evaluated indoor air quality in a vaping convention in Maryland (MD), USA. Real-time concentrations of particulate matter (PM10) and real-time total volatile organic compounds (TVOCs), CO2 and NO2 concentrations were measured. Integrated samples of air nicotine and PM10 concentrations were also collected. The number of attendees was estimated to range from 75 to 600 at any single observation time. The estimated 24-h time-weighted average (TWA) PM10 was 1800 μg/m3, 12-fold higher than the EPA 24-h regulation (150 μg/m3). Median (range) indoor TVOCs concentration was 0.13 (0.04-0.3) ppm. PM10 and TVOC concentrations were highly correlated with CO2 concentrations, indicating the high number of people using e-cigarettes and poor indoor air quality. Air nicotine concentration was 125 μg/m3, equivalent to concentrations measured in bars and nightclubs. E-cigarette aerosol in a vaping convention that congregates many e-cigarette users is a major source of PM10, air nicotine and VOCs, impairing indoor air quality. These findings also raise occupational concerns for e-cigarette vendors and other venue staff workers.
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Affiliation(s)
- Rui Chen
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Angela Aherrera
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Chineye Isichei
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Pablo Olmedo
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Stephanie Jarmul
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joanna E Cohen
- Department of Health, Behavior and Society and Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ana Navas-Acien
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Ana M Rule
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Wang TW, Coats EM, Gammon DG, Loomis BR, Kuiper NM, Rogers T, King BA. National and State-Specific Unit Sales and Prices for Electronic Cigarettes, United States, 2012-2016. Prev Chronic Dis 2018; 15:E99. [PMID: 30073948 PMCID: PMC6093268 DOI: 10.5888/pcd15.170555] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Few studies have explored patterns of electronic cigarette (e-cigarette) sales and prices by product type over time. We used US retail scanner data to assess national and state-specific trends in e-cigarette unit sales and prices for 4 product types sold from 2012 through 2016. Methods Using retail scanner data from the 48 contiguous states and Washington, DC, for convenience stores; supermarkets; mass merchandisers; drug, dollar, and club stores; and military commissaries, we assessed data on monthly unit sales and inflation-adjusted prices by 4 products (rechargeables, disposables, prefilled cartridges, and e-liquids) sold during the 5-year study period. We evaluated national and state trends by using Joinpoint regression (P < .05). Results From 2012 through 2016, average national monthly unit sales significantly increased for all products, while average monthly prices of rechargeables, disposables, and prefilled cartridges significantly decreased. In 2016, prefilled cartridges had the highest average sales (766 units per 100,000 people) and the lowest average price ($14.36 per unit). By state, average monthly sales significantly increased for at least 1 of 4 e-cigarette products in all 48 states and Washington, DC. However, during the same period, average monthly prices significantly decreased in 39 states for rechargeables, in 31 states for disposables, in 20 states for prefilled cartridges, and in 8 states for e-liquids. Conclusion Overall, US e-cigarette unit sales generally increased as product prices decreased. These findings demonstrate the rapidly evolving landscape of US e-cigarette retail marketplace. Ongoing surveillance of e-cigarette unit sales and price is critical for informing and evaluating evidence-based tobacco control strategies.
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Affiliation(s)
- Teresa W Wang
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS S107-7, Atlanta, GA 30341.
| | - Ellen M Coats
- Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, North Carolina
| | - Doris G Gammon
- Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, North Carolina
| | - Brett R Loomis
- Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, North Carolina
| | - Nicole M Kuiper
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Todd Rogers
- Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, North Carolina
| | - Brian A King
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Gammon DG, Rogers T, Coats EM, Nonnemaker JM, Henriksen L. Little filtered cigars: US sales, flavours, package sizes and prices. Tob Control 2018; 28:346-349. [PMID: 30021869 DOI: 10.1136/tobaccocontrol-2018-054405] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 06/13/2018] [Accepted: 06/25/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE At least four varieties of little filtered cigars (LFCs) violate the US prohibition on flavoured cigarettes other than menthol. This study characterises the sales of prohibited products and other LFCs by flavour category and pack size, as well as the price of LFCs relative to cigarettes. METHODS Using retail sales data for 2016, we computed the sales volume in dollars and equivalent units and the percentage of total sales by flavour and pack size for the USA by region and state. Paired t-tests compared the prices for LFCs and cigarettes sold in same-sized packs and cartons. RESULTS LFC sales totalled 24 033 equivalent units per 100 000 persons in 2016. Flavoured LFC varieties accounted for almost half (47.5%) of the total sales. LFCs were sold in 12 different pack sizes, but 79.7% of sales were packs of 20. The price of 20-packs averaged $2.41 (SD=$1.49), which was significantly less than cigarettes (M=$5.90, SD=$0.85). Regional differences suggest a greater proportion of menthol/mint LFCs and lower prices in the South than in other regions. CONCLUSION Classifying all LFCs as cigarettes would require that they be offered in a minimum package of 20, eliminate flavoured varieties other than menthol and increase prices through applicable state and local cigarette taxes.
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Affiliation(s)
- Doris G Gammon
- Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, North Carolina, USA
| | - Todd Rogers
- Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, North Carolina, USA
| | - Ellen M Coats
- Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, North Carolina, USA
| | - James M Nonnemaker
- Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, North Carolina, USA
| | - Lisa Henriksen
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA
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48
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Chen H, Li G, Chan YL, Chapman DG, Sukjamnong S, Nguyen T, Annissa T, McGrath KC, Sharma P, Oliver BG. Maternal E-Cigarette Exposure in Mice Alters DNA Methylation and Lung Cytokine Expression in Offspring. Am J Respir Cell Mol Biol 2018; 58:366-377. [PMID: 28960086 DOI: 10.1165/rcmb.2017-0206rc] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
E-cigarette usage is increasing, especially among the young, with both the general population and physicians perceiving them as a safe alternative to tobacco smoking. Worryingly, e-cigarettes are commonly used by pregnant women. As nicotine is known to adversely affect children in utero, we hypothesized that nicotine delivered via e-cigarettes would negatively affect lung development. To test this, we developed a mouse model of maternal e-vapor (nicotine and nicotine-free) exposure and investigated the impact on the growth and lung inflammation in both offspring and mothers. Female Balb/c mice were exposed to e-fluid vapor containing nicotine (18 mg/ml nicotine E-cigarette [E-cig18], equivalent to two cigarettes per treatment, twice daily,) or nicotine free (E-cig0 mg/ml) from 6 weeks before mating until pups weaned. Male offspring were studied at Postnatal Day (P) 1, P20, and at 13 weeks. The mothers were studied when the pups weaned. In the mothers' lungs, e-cigarette exposure with and without nicotine increased the proinflammatory cytokines IL-1β, IL-6, and TNF-α. In adult offspring, TNF-α protein levels were increased in both E-cig18 and E-cig0 groups, whereas IL-1β was suppressed. This was accompanied by global changes in DNA methylation. In this study, we found that e-cigarette exposure during pregnancy adversely affected maternal and offspring lung health. As this occurred with both nicotine-free and nicotine-containing e-vapor, the effects are likely due to by-products of vaporization rather than nicotine.
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Affiliation(s)
- Hui Chen
- 1 Centre for Health Technologies and School of Life Sciences, University of Technology Sydney, Sydney, New South Wales, Australia.,2 Faculty of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China; and
| | - Gerard Li
- 1 Centre for Health Technologies and School of Life Sciences, University of Technology Sydney, Sydney, New South Wales, Australia.,3 Respiratory Cellular and Molecular Biology, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Yik Lung Chan
- 1 Centre for Health Technologies and School of Life Sciences, University of Technology Sydney, Sydney, New South Wales, Australia.,3 Respiratory Cellular and Molecular Biology, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - David G Chapman
- 1 Centre for Health Technologies and School of Life Sciences, University of Technology Sydney, Sydney, New South Wales, Australia.,3 Respiratory Cellular and Molecular Biology, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Suporn Sukjamnong
- 1 Centre for Health Technologies and School of Life Sciences, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Tara Nguyen
- 1 Centre for Health Technologies and School of Life Sciences, University of Technology Sydney, Sydney, New South Wales, Australia.,3 Respiratory Cellular and Molecular Biology, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Tiara Annissa
- 1 Centre for Health Technologies and School of Life Sciences, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Kristine C McGrath
- 1 Centre for Health Technologies and School of Life Sciences, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Pawan Sharma
- 1 Centre for Health Technologies and School of Life Sciences, University of Technology Sydney, Sydney, New South Wales, Australia.,3 Respiratory Cellular and Molecular Biology, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Brian G Oliver
- 1 Centre for Health Technologies and School of Life Sciences, University of Technology Sydney, Sydney, New South Wales, Australia.,3 Respiratory Cellular and Molecular Biology, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
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Margolis KA, Donaldson EA, Portnoy DB, Robinson J, Neff LJ, Jamal A. E-cigarette openness, curiosity, harm perceptions and advertising exposure among U.S. middle and high school students. Prev Med 2018; 112:119-125. [PMID: 29673886 PMCID: PMC5971002 DOI: 10.1016/j.ypmed.2018.04.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 04/10/2018] [Accepted: 04/15/2018] [Indexed: 12/15/2022]
Abstract
Understanding factors associated with youth e-cigarette openness and curiosity are important for assessing probability of future use. We examined how e-cigarette harm perceptions and advertising exposure are associated with openness and curiosity among tobacco naive youth. Findings from the 2015 National Youth Tobacco Survey (NYTS) were analyzed. The 2015 NYTS is a nationally representative survey of 17,711 U.S. middle and high school students. We calculated weighted prevalence estimates of never users of tobacco products (cigarettes, cigars/cigarillos/little cigars, waterpipe/hookah, smokeless tobacco, bidis, pipes, dissolvables, e-cigarettes) who were open to or curious about e-cigarette use, by demographics. Weighted regression models examined how e-cigarette harm perceptions and advertising exposure were associated with openness using e-cigarettes and curiosity about trying e-cigarettes. Among respondents who never used tobacco products, 23.8% were open to using e-cigarettes and 25.4% were curious. Respondents that perceived e-cigarettes cause a lot of harm had lower odds of both openness (OR = 0.10, 95% CI = 0.07, 0.15) and curiosity about e-cigarettes (OR = 0.10, 95% CI = 0.07, 0.13) compared to those with lower harm perception. Respondents who reported high exposure to e-cigarette advertising in stores had greater odds of being open to e-cigarette use (OR = 1.22, 95% CI = 1.03, 1.44) and highly curious (OR = 1.25, 95% CI = 1.01, 1.53) compared to those not highly exposed. These findings demonstrate that youth exposed to e-cigarette advertising are open and curious to e-cigarette use. These findings could help public health practitioners better understand the interplay of advertising exposure and harm perceptions with curiosity and openness to e-cigarette use in a rapidly changing marketplace.
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Affiliation(s)
- Katherine A Margolis
- US Food and Drug Administration, Center for Tobacco Products, Office of Science, Silver Spring, MD, United States.
| | - Elisabeth A Donaldson
- US Food and Drug Administration, Center for Tobacco Products, Office of Science, Silver Spring, MD, United States
| | - David B Portnoy
- US Food and Drug Administration, Center for Tobacco Products, Office of Science, Silver Spring, MD, United States
| | - Joelle Robinson
- US Food and Drug Administration, Center for Tobacco Products, Office of Science, Silver Spring, MD, United States
| | - Linda J Neff
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta, GA, United States
| | - Ahmed Jamal
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta, GA, United States
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Systemic absorption of nicotine following acute secondhand exposure to electronic cigarette aerosol in a realistic social setting. Int J Hyg Environ Health 2018; 221:816-822. [DOI: 10.1016/j.ijheh.2018.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/27/2018] [Accepted: 05/15/2018] [Indexed: 11/23/2022]
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