What are the respiratory effects of e-cigarettes?

Electronic Cigarette-Derived Metals: Exposure and Health Risks in Vapers

Despite the popularity of electronic cigarettes (e-cigs) among adolescent and youth never-smokers and adult smokers seeking a less harmful substitute for tobacco cigarettes, the long-term health impact of vaping is largely unknown. Biochemical, molecular, and toxicological analyses of biospecimens from e-cig users as well as assays in relevant in vitro models and in silico studies can identify chemical constituents of e-cig emissions that may contribute to the disease-causing potential of vaping. E-cig aerosol contains a wide range of toxic and carcinogenic compounds, of which metals are of particular concern. This is due to the known or suspected role of various metals in the pathogenesis of numerous diseases. Many metals and metalloids (herein referred to as "metals") have been detected in e-cig liquid (e-liquid) and aerosol and/or in cells, tissues, biofluids, or other specimens from e-cig users. Metals can contaminate the ingredients of e-liquid or corrode from the internal components of the e-cig device. Metals may also be directly aerosolized from the surface of the heating element or other parts of the device. Inhalation of e-cig metal emissions in habitual vapers and nonusers through secondary exposure may increase the body burden of toxic and carcinogenic chemicals. This review summarizes the state of research on e-cig-derived metals and their contributions to the estimated health risks of vaping. Highlighting the chemical composition of e-cig liquid and aerosol, it focuses on the metal contents of the inhaled aerosol and the health risks associated with this exposure. Emphasis is placed on adolescents and youth who are vulnerable populations and bear a disproportionate burden of risk and harm from tobacco products. The gaps in knowledge, methodological challenges, and opportunities ahead are discussed. The importance of translating research findings into actionable information that can be used for the regulation of the manufacturing of tobacco products is underscored.

Young Women's Perspectives About Vaping: A Cross Sectional Study from Jordan

Vaping has become very popular among young generations in Jordan. However, less is known about women's awareness and intention to vape. The aim of this study is to assess women's knowledge and beliefs about vaping, with a focus on vaping women's attitudes and practices. This is an observational cross-sectional study. Data were collected from January through March 2024, by using a self-administrated survey inspired from the WHO GATS questionnaire. Among the 923 participating women, 12.4% were vaping. We observed significant variations in knowledge and beliefs among women. Vaping women have a substantially younger age than non-vaping. 57% of vaping women think that vape is safer to use than cigarettes compared to 14% of non-vaping. 61% of vaping women believed that vaping helps to quit cigarette smoking compared to 24% of non-vaping. Vaping women tended to underestimate the health risks associated with it compared to non-vaping women. They are also supporting legislations that allow vaping indoors and in public places. Women vape primarily for enjoyment, to cope with stress, to pass free time, and to hang out with friends. Luckily, many of them believed that smoking increases the risk of cardiovascular and respiratory ailments and limited life expectancy, which supports their future quitting plans. This study revealed misconceptions and knowledge gaps around vaping among women. Emotional demands and social interactions influenced women's vaping use in Jordan, highlighting the need for targeted public health education and legislative measures to promote women's health.

A novel online vaping intervention and smoking prevention program for young adults who vape: protocol for a randomized controlled trial

BACKGROUND

E-cigarette use (i.e., vaping) is prevalent among young adults in the U.S. Studies show that young adults who vape are more likely to initiate cigarette smoking than young adults who do not vape. Despite this, little research on vaping interventions and prevention of smoking for young adults who vape exist.

METHODS

A 2-arm pilot randomized controlled trial (RCT) will be conducted by recruiting young adults ages 18-24 who reported vaping at least once per week in the past 30 days and having never smoked cigarettes at baseline. Participants will be recruited via social media ads and be randomly assigned to an intervention arm, which will be the Live Free From E-cigarettes (LIFFE) mobile-based program (n = 50), or a waitlist control arm (n = 50). The primary outcomes are biochemically verified 7-day point prevalence abstinence for nicotine vaping, vaping reduction, and smoking susceptibility. Outcomes are measured at 2-, 4-, and 8-weeks after randomization.

DISCUSSION

This is the first RCT to evaluate the effectiveness of a mobile-based intervention that targets smoking susceptibility while also supporting vaping cessation or vaping reduction in young adults. Findings may inform future efforts to prevent transition to cigarette smoking and vaping cessation and reduction in young adults.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT06129123; Date of registration: 11/10/2023.

Electronic cigarette use, related health outcomes and policy interventions in the USA: a call for research to fill evidence gaps

The population-level health consequences of electronic cigarette (e-cigarette) use are heavily debated. This special communication provides updated evidence and identifies knowledge gaps across domains including: (1) health-related outcomes associated with e-cigarette use; (2) initiation and use of e-cigarettes among youth and young adults; (3) concurrent use of electronic and combustible cigarettes; (4) transitions from combustible cigarette use to exclusive e-cigarette use among adults who currently smoke cigarettes and (5) existing e-cigarette-related policy interventions. Literature was searched through PubMed and Medline for systematic reviews, scoping reviews, meta-analyses and primary research articles including emerging topics not covered in reviews published between 1 January 2017 and 1 January 2024. E-cigarette use is associated with several adverse acute health outcomes; there is currently insufficient longitudinal evidence to predict chronic health outcomes. Prevalence of e-cigarette use among youth is considerable and may be associated with subsequent combustible cigarette smoking. Evidence for the health and behavioural impact of dual use of e-cigarettes and combustible cigarettes is limited by imprecise measurement of exposure. Evidence on adults completely substituting combustible cigarettes for e-cigarettes is strong in clinical trials; observational studies do not show complete substitution. Finally, the effects of e-cigarette-related policy interventions to restrict e-cigarette consumption are currently limited in scope and too short-lived to draw causal inferences. Substantial evidence gaps related to the use, associated health impacts and regulation of e-cigarettes in the USA are identified, and we suggest key areas for future research to address that are crucial for informing the public health approach to e-cigarettes.

Association between e-cigarette exposure and ventilation homogeneity in young adults: a cross-sectional study

BACKGROUND

The number of young people who use e-cigarettes is rising. It remains unclear whether e-cigarette use impairs lung function. We aimed to compare ventilation distribution between young adults exposed to e-cigarettes and an unexposed group.

METHODS

Study participants included otherwise healthy young adults (18-24 years) who self-reported e-cigarette use and unexposed participants who had no history of e-cigarette, tobacco or cannabis exposure. Exposure to e-cigarettes was defined using three measures: 1) ever-exposed, 2) daily use and 3) puff frequency, which includes none (unexposed), minimal (<2 puffs·h-1), moderate (3-4 puffs·h-1) and heavy (≥5 puffs·h-1). Ventilation distribution was measured using the multiple-breath washout test and reported as lung clearance index (LCI).

RESULTS

A total of 93 participants were recruited; 38 unexposed and 41 exposed participants had LCI measures. The exposed group consisted predominately of participants who used flavoured e-liquids (94.5%) that contained nicotine (93.5%). The magnitude and direction of the difference in LCI across the exposure definitions was similar. Compared with the unexposed group, in the unadjusted models LCI was higher in those with any e-cigarette use (mean difference 0.15, 95% CI -0.004-0.31), daily users (mean difference 0.10, 95% CI -0.08-0.28) and heavy users (mean difference 0.22, 95% CI 0.03-0.41).

CONCLUSION

This preliminary work suggests that LCI may be a useful biomarker to measure the effects of e-cigarette use on ventilation distribution and to track early functional impairment of the small airways.

Composition of e-cigarette aerosols: A review and risk assessment of selected compounds

The potential harms and benefits of e-cigarettes, or electronic nicotine delivery systems (ENDS), have received significant attention from public health and regulatory communities. Such products may provide a reduced risk means of nicotine delivery for combustible cigarette smokers while being inappropriately appealing to nicotine naive youth. Numerous authors have examined the chemical complexity of aerosols from various open- and closed-system ENDS. This body of literature is reviewed here, with the risks of ENDS aerosol exposure among users evaluated with a margin of exposure (MoE) approach for two non-carcinogens (methylglyoxal, butyraldehyde) and a cancer risk analysis for the carcinogen N-nitrosonornicotine (NNN). We identified 96 relevant papers, including 17, 13, and 5 reporting data for methylglyoxal, butyraldehyde, and NNN, respectively. Using low-end (minimum aerosol concentration, low ENDS use) and high-end (maximum aerosol concentration, high ENDS use) assumptions, estimated doses for methylglyoxal (1.78 × 10-3-135 μg/kg-bw/day) and butyraldehyde (1.9 × 10-4-66.54 μg/kg-bw/day) corresponded to MoEs of 227-17,200,000 and 271-280,000,000, respectively, using identified points of departure (PoDs). Doses of 9.90 × 10-6-1.99 × 10-4 μg/kg-bw/day NNN corresponded to 1.4-28 surplus cancers per 100,000 ENDS users, relative to a NNN-attributable surplus of 7440 per 100,000 cigarette smokers. It was concluded that methylglyoxal and butyraldehyde in ENDS aerosols, while not innocuous, did not present a significant risk of irritant effects among ENDS users. The carcinogenic risks of NNN in ENDS aerosols were reduced, but not eliminated, relative to concentrations reported in combustible cigarette smoke.

Association between type of smoking and smoking cessation plans in Korean adults: A nationwide cross-sectional study

INTRODUCTION

Amid the changing tobacco product landscape, the effects of e-cigarettes on smoking cessation remain unclear. This study aims to examine the relationship between different types of smoking (conventional cigarettes, e-cigarettes, and dual use) and smoking cessation plans among adult smokers.

METHODS

A representative national dataset analysis of KHANES data (2018-2022) was conducted on 1475 current smokers. Current smokers were defined as those who had smoked more than five packs (100 cigarettes) of cigarettes in their lifetime and had smoked in the past 30 days, and type of smoking was classified as conventional cigarette, e-cigarette, or dual use. Smoking cessation plan was classified as 'yes' for smokers who intended to quit within one or six months, and 'no' for those with no plans to quit. Multivariable logistic regression analysis was used to examine the association between smoking type and smoking cessation plans, adjusting for potential confounders.

RESULTS

A total of 26.0% of male smokers and 30.7% of female smokers had a smoking cessation plan. Compared with conventional cigarette users, e-cigarette users were less likely to have a smoking cessation plan (Male: AOR=0.52; CI: 0.29-0.91; Female: AOR=0.56; CI: 0.16-1.93). The results indicated no statistical significance in female e-cigarette users. In males, e-cigarette users smoking over 20 packs/year were less likely to have smoking cessation plans (AOR=0.11; 95% CI: 0.03-0.58).

CONCLUSIONS

E-cigarette use may have a negative impact on smoking cessation plans in male smokers. The results suggest the importance of public health efforts to provide accurate information and interventions related to e-cigarettes.

Impact of E-Cigarettes on Fetal and Neonatal Lung Development: The Influence of Oxidative Stress and Inflammation

Electronic cigarettes (e-cigs) recently increased their popularity as "safer" alternatives to traditional tobacco smoking, including among pregnant women. However, the effect of e-cig exposure on fetal and neonatal developing lungs remains poorly investigated. In this review, we analysed the impact of e-cig aerosol components (e.g., nicotine, solvents, and flavouring agents) on respiratory system development. We particularly emphasized the role of e-cig-related oxidative stress and inflammation on lung impairment. Nicotine contained in e-cigs can impair lung development at anatomical and molecular levels. Solvents and flavours induce inflammation and oxidative stress and contribute to compromising neonatal lung function. Studies suggest that prenatal e-cig aerosol exposure may increase the risk of future development of respiratory diseases in offspring, such as asthma and chronic obstructive pulmonary disease (COPD). Preventive strategies, such as smoking cessation programs and antioxidant supplementation, may be essential for safeguarding respiratory health. There is an urgent need to explore the safety profile and potential risks of e-cigs, especially considering the limited studies in humans. This review highlights the necessity of regulating e-cig use during pregnancy and promoting awareness of its potential consequences on fetal and neonatal development.

Changes in Concentration of Selected Biomarkers of Exposure in Users of Classic Cigarettes, E-Cigarettes, and Heated Tobacco Products-A Narrative Review

Currently, the number of e-cigarette and heated tobacco product (HTP) users are steadily increasing, while the number of classic cigarette users are decreasing. The effects of smoking classic cigarettes on human health have been thoroughly described in the literature, but the negative health effects of e-cigarettes and HTPs on the human body are not clearly defined. Among users of different forms of tobacco, those at a particularly high risk of developing particular disease entities should be identified, allowing for the faster implementation of potential treatments, including psychotherapeutic ones. Biomarkers are used for this purpose. This paper summarizes the potential of these compounds from the different exposure groups of classic cigarettes, e-cigarettes, and HTPs, and presents changes in their concentrations in the body fluids of different tobacco users. This review discusses the impact of tobacco use in relation to levels of the following biomarkers: TNF-α, IL-1β, IL-6, IL-8, IL-17, IFN-γ, IL-10, IL-4, Il-13, TGF-β, VEGF EGF, HGF, BDNF, MMP-9, CRP, microplastics, and selected parameters of oxidative stress. This review also includes suggested forms of treatment, including Tobacco Product Use Reduction Programs, to minimize the potential negative effects of the above-mentioned products.

Chemical Transformation of Vaping Emissions under Indoor Atmospheric Aging Processes

E-cigarette emissions, which contain a variety of hazardous compounds, contribute significantly to indoor air pollution and raise concerns about secondhand exposure to vaping byproducts. Compared to fresh vape emissions, our understanding of chemically aged products in indoor environments remains incomplete. Terpenes are commonly used as flavoring agents in e-liquids, which have the ability to react with the dominant indoor oxidant ozone (O3) to produce reactive oxygenated byproducts and result in new particle formation. In this study, mixtures of propylene glycol (PG), vegetable glycerin (VG), and terpenes as e-liquids were injected into a 2 m3 FEP chamber to simulate the indoor aging process. 100 ppbv O3 was introduced into the chamber and allowed to react with the fresh vape emissions for 1 h. Complementary online and offline analytical techniques were used to characterize the changes in the aerosol size distribution and chemical composition during the aging processes. We observed more ultrafine particles and a greater abundance of highly oxygenated species, such as carbonyls, in aged e-cigarette aerosols. Compared with their fresh counterparts, the aged emissions exhibited greater cytotoxic potential, which can be attributed to the formation of these highly oxygenated compounds that are not present in the fresh emissions. This work highlights the dynamic chemistry and toxicity of e-cigarette aerosols in the indoor environment as well as the indirect risks of secondhand exposure.

Association of e-cigarette and cigarette use with self-reported chronic obstructive pulmonary disease (COPD): a multivariable analysis of a large United States data set

BACKGROUND

Prior research has linked e-cigarette use with chronic obstructive pulmonary disease (COPD). We examined the relationship between e-cigarette use and COPD prevalence in older adults with varying cigarette use status.

METHODS

Data from the 2020 National Health Interview Survey were used to estimate the association between each of 9 exposure categories based on cigarette use (never, former, current) and e-cigarette use (never, former, current), with respondent-reported physician-diagnosed COPD prevalence in individuals 40 years and older (N = 22,997). Weighted multivariable analysis accounted for cigarette pack years, age of cigarette smoking onset, race, income-to-poverty ratio, rurality, gender, age, and medical comorbidities. Sensitivity of results was tested in 3 separate models with addition of years since quit cigarettes, smoking intensity and duration.

RESULTS

39.7% of individuals reported ever smoking cigarettes and 10.2% reported ever using e-cigarettes. Among individuals with ever e-cigarette use, 88.5% also reported current or former cigarette smoking. The weighted prevalence of COPD was 7.2%; Among those who reported former cigarette smoking, the highest risk of COPD prevalence compared to never cigarette/never e-cigarette use was in those currently using e-cigarettes (adjusted risk ratio (ARR) 2.82, 95% confidence interval (CI) [1.5, 5.3]). The ARR for former cigarette/current e-cigarette use was significantly larger than the ARR for former cigarette/never e-cigarette use (p < 0.002) in 3 out of 4 models; however, one model had the ARR attenuated to 1.35 (0.67, 2.76) when years since quitting smoking was added to the model. Other cigarette/e-cigarette combinations were also sensitive to how cigarette smoking history was modeled. For example, ARR for former cigarette/former e-cigarette (1.68 [1.00, 2.80] and current cigarette/former e-cigarette (2.50 [1.56,4.02]) were reduced to 1.05 (0.62, 1.77) and 1.04 (0.62, 1.75) respectively, when cigarette smoking duration was substituted for pack-years.

CONCLUSIONS

Current e-cigarette use among former cigarette smokers was associated with significantly higher COPD prevalence compared to never e-cigarette use. However, COPD risk for most cigarette/e-cigarette combinations could be greatly attenuated by how cigarette smoking history was modeled, raising questions about the robustness of these associations in prior research and the possibility of reverse causality in prior cross-sectional research.

Behavioral intention to use electronic cigarettes in the Philippines: The role of social influence, knowledge, price and health impact

Electronic cigarettes or e-cigarettes have gained significant popularity as an alternative to traditional cigarettes, yet limited research has examined the factors influencing their adoption, particularly in developing nations like the Philippines, where usage is rising. This study investigates the behavioral drivers of e-cigarette use, with a particular focus on the role of knowledge, alongside social influence, perceived price impact, perceived health impact, and perceived usefulness. Using purposive sampling, 310 valid responses were collected from current e-cigarette users, traditional cigarette users, or individuals with prior experience with these products. A structured questionnaire with 21 indicators was administered, and data were analyzed using Partial Least Square-Structural Equation Modeling (PLS-SEM). The findings reveal that knowledge is the strongest predictor of behavioral intention, highlighting the critical role of informed awareness about the risks and impacts of e-cigarettes in shaping user decisions. Social influence, perceived price impact, and perceived health impact also significantly influence behavioral intention, demonstrating the interconnectedness of cognitive, social, and economic factors. Interestingly, perceived usefulness did not have a significant effect, challenging assumptions about the importance of functional benefits in driving e-cigarette adoption. These results underscore the importance of education and awareness campaigns in addressing misconceptions about e-cigarettes. Policymakers, regulators, and health professionals should prioritize knowledge-driven interventions to empower individuals to make informed decisions and mitigate e-cigarette use, particularly among younger and economically vulnerable populations.

Exposure to third hand e-cigarette vapour impairs cognitive function in young mice

Indoor vaping can lead to third-hand vapour exposure, evidenced by the presence of nicotine and carcinogenic nitrosamines on indoor surfaces. Children are at high risk of such exposure. This study aimed to investigate the effects of third-hand vapour exposure on cognitive function in young mice. Male mice (Balb/c, 4 weeks) were exposed to cotton towels treated with e-cigarette vapour with and without nicotine (9 L chamber filled with 20 puffs of vapour for 2 hours) and changed daily for four weeks. Vapour was generated from tobacco-flavoured e-cigarette liquids (50 % propylene glycol, 50 % vegetable glycerine, 18 mg or 0 mg nicotine) using a human e-cigarette device. Mice exposed to nicotine-free vapour showed impaired short-term memory, while those exposed to nicotine-containing vapour exhibited significantly increased anxiety-like behaviours. Both exposure groups had reduced neuron numbers in the cortex and increased microglia numbers and pro-inflammatory cytokine expression in the brain. Third-hand exposure to vapour can impair memory function and increase anxiety, with some effects being nicotine-independent. These findings highlight the potential risks of indoor vaping, especially in environments frequented by younger people, including children and adolescents, and the need for further research to identify the underlying mechanisms. SYNOPSIS: This is the first study highlighting the risks of cognitive impairment due to third-hand exposure to e-cigarette residues in a mouse model.

Epigenomic Dysregulation in Youth Vapers: Implications for Disease Risk Assessment

Despite the ongoing epidemic of youth vaping, the long-term health consequences of electronic cigarette use are largely unknown. We report the effects of vaping versus smoking on the oral cell methylome of healthy young vapers and smokers relative to nonusers. Whereas vapers and smokers differ in the number of differentially methylated regions (DMRs) (831 vs. 2,863), they share striking similarities in the distribution and patterns of DNA methylation, chromatin states, transcription factor binding motifs, and pathways. There is substantial overlap in DMR-associated genes between vapers and smokers, with the shared subset of genes enriched for transcriptional regulation, signaling, tobacco use disorders, and cancer-related pathways. Of significance is the identification of a common hypermethylated DMR at the promoter of HIC1 (hypermethylated in cancer 1), a tumor suppressor gene frequently silenced in smoking-related cancers. Our data support a potential link between epigenomic dysregulation in youth vapers and disease risk. These novel findings have significant implications for public health and tobacco product regulation.

A Systematic Review of Predictors of Vaping Cessation Among Young People

BACKGROUND AND AIMS

Understanding the factors influencing vaping cessation among young people is crucial for targeted interventions. This review aimed to summarize the individual and environmental factors that predict vaping cessation-related behaviors in the young population.

METHODS

We systematically searched five databases for studies investigating predictors of vaping cessation behaviors among young people aged 10-35 years. Studies that examined predictors of cessation of cigarettes, other tobacco products, cannabis vaping, and studies evaluating efficacy of cessation interventions were excluded. Quality in Prognosis Studies tool was used to assess risk of bias.

RESULTS

We found 24 studies analyzing predictors of intention to quit vaping (n = 15), quit attempts (n = 11), and vaping abstinence (n = 7). Most studies had low risk of bias, except for study attrition. We identified 107 predictors and grouped them into "probable," "possible," "insufficient evidence," "probably unrelated," and "inconsistent direction" categories. For "probable" predictors, we found 11 for intention to quit, eight for quit attempts and five for vaping abstinence. Overall, harm perception of vaping, current other tobacco products use, frequency of use, and level of nicotine dependence were common "probable" predictors across three outcomes, with low harm perception of vaping, dual use, and poly tobacco use associated with decreased intention to quit and quit attempts in younger population (~10-19 years).

CONCLUSIONS

Predictive modeling studies investigating vaping cessation-related behaviors among young people are still limited. Future research should specifically study the natural history of vaping in youth in different jurisdictions, populations, and age groups to expand our knowledge in this area.

IMPLICATIONS

We identified and categorized predictors of intention to quit vaping, quit attempts, and vaping abstinence among young people. While the "probable" predictors can inform public health and policymakers to plan targeted vaping cessation programs for high-risk populations, raising public harm perception of vaping and encouraging to quit other tobacco products might increase intention to quit and quit attempts among younger population. However, the "possible," "insufficient evidence" and "inconsistent direction" predictors need further testing by future prospective longitudinal research. Additionally, we emphasized the significance of appropriate study designs, conducting research across various jurisdictions, and different population groups to obtain comprehensive insights.

E-cigarettes are not associated with post-acute COVID-19 syndrome among US adults

The COVID-19 pandemic has resulted in many survivors experiencing post-acute COVID-19 syndrome (PCS) with symptoms including fatigue, breathlessness, and cognitive complaints. E-cigarette use has already been associated with increased susceptibility to COVID-19 because of its effects on ACE2 receptor expression and inflammation, raising concern that it might worsen the long-term outcomes of COVID-19, including PCS. While traditional smoking is associated with a higher risk of PCS, the role of e-cigarettes remains unclear due to conflicting evidence. Using 2022 Behavioral Risk Factor Surveillance System (BRFSS) data, this study investigated the association between e-cigarette use and PCS among US adults who tested positive for COVID-19. The final sample included 107,249 adults after the exclusion of respondents with missing information. It analyzed e-cigarette use (never, former, current) and controlled for key covariates such as age, gender, BMI, smoking, and chronic diseases. The results showed that female gender, obesity, current smoking, and a history of depression, asthma, and chronic obstructive pulmonary disease (COPD) were significantly associated with higher odds of PCS. Nevertheless, e-cigarette use was not related significantly to increased odds for PCS (current e-cigarette use: aOR = 1.07, 95 CI: 0.96, 1.20; former e-cigarette use: aOR = 1.03, 95 CI: 0.96, 1.12). The mediation analysis showed no indirect effect of the use of e-cigarettes on PCS via COPD. In conclusion our findings did not reveal an independent or indirect association between PCS with e-cigarette use.

E-cigarettes and arterial health: A review of the link between vaping and atherosclerosis progression

Recent studies have suggested an evolving understanding of the association between vaping, specifically electronic cigarette (e-cigarette) use, and the progression of atherosclerosis, a significant contributor to cardiovascular disease. Despite the prevailing perception of vaping as a safer alternative to traditional tobacco smoking, accumulating evidence suggests that the aerosols emitted by e-cigarettes contain harmful constituents that may promote endothelial dysfunction, oxidative stress, inflammation, and dyslipidemia-key mechanisms implicated in atherosclerosis pathogenesis. While past research, including experimental studies and clinical investigations, has shed light on the potential cardiovascular risks associated with vaping, gaps in knowledge persist. Future research endeavors should focus on interpreting the long-term effects of vaping on atherosclerosis development and progression, exploring the impact of different e-cigarette formulations and user demographics, and identifying effective strategies for mitigating the cardiovascular consequences of vaping. By identifying and addressing these research gaps, we can enhance our understanding of the cardiovascular implications of vaping and inform evidence-based interventions and policies to safeguard public health.

Au Ordered Array Substrate for Rapid Detection and Precise Identification of Etomidate in E-Liquid Through Surface-Enhanced Raman Spectroscopy

Etomidate (ET), a medical anesthetic, is increasingly being incorporated into e-liquids for consumption and abuse as a new psychoactive substance (NPS), leading to significant social issues. In this work, large-area Au micro- and nano-structured ordered arrays were engineered as surface-enhanced Raman spectroscopy (SERS) substrates for fast detection and precise identification of ET and its metabolites. This ordered array, characterized by abundant electromagnetic enhancement hotspots and structural uniformity, imparts unique properties to the SERS substrate, including ultra-sensitivity, spectral signal reproducibility, and precise quantitative capabilities. Furthermore, it effectively mitigates interference from the complex matrix of e-liquids, facilitating the rapid detection of trace amounts of ET molecules. This SERS rapid detection technology can act as a preliminary screening method for gold-standard spectroscopic analysis, facilitating the on-site rapid screening of suspicious samples and thereby enabling efficient detection and precise verification.

"Do all bisexuals have this power?": An exploratory study of "crippling nicotine addiction," identity, and other emergent themes in vaping messages on QueerTok

Nicotine and tobacco use disproportionally affects sexual and gender minority (SGM) populations in the United States. Social media narratives may contribute to these disparities. This qualitative study delineated perceptions and experiences depicted in SGM-related videos about nicotine vaping on TikTok. Young adult researchers engaged in every step of the research process, adding an insider perspective. Using four TikTok accounts, we used vaping and SGM-related search terms to sample videos in March-April 2022. Three TikTok accounts collected SGM-specific videos; a fourth provided non-SGM specific videos for comparison. We iteratively sorted 303 unique videos into 32 a priori and emergent codes and identified themes in SGM videos and comparison videos. In their videos, creators displayed awareness of and ambivalence toward vaping and nicotine dependence. SGM videos reflected vaping as a salient feature of identity and a consideration in romantic partnership. Studying video-based social media platforms, like TikTok, using an insider-engaged qualitative lens promotes rich interpretation of content to identify prevalent and emerging messages, which can inform appropriate interventions for SGM young people.

Socio-ecological factors that influence youth vaping: perspectives from Western Australian school professionals, parents and young people

PURPOSE

To understand from the perspectives of school professionals, parents and young people the socio-ecological factors that may facilitate and prevent e-cigarette use among young people in Perth, Western Australia.

METHODS

Purposive sampling was used to recruit school professionals, parents and young people for one-on-one (n = 35) or joint (n = 3) interviews (in-person n = 11 or online n = 27). Data were analysed using thematic analysis and classified into four domains based on the socio-ecological model: i) individual, ii) interpersonal, iii) organizational/community and iv) societal/policy.

RESULTS

Factors that were found to support vaping among young people included sensation-seeking and risk-taking behaviour; a low-risk perception of vapes; attractive characteristics of vapes; ease of access; perception vaping is a social activity; and lack of knowledge about vaping among parents and school professionals. Vaping prevention messages originating from the familial, educational and community spheres are lacking but wanted by adults and young people.

CONCLUSIONS

The pervasiveness of the e-cigarette trade and persistent challenges related to surveillance and enforcement need to be addressed to reduce exposure and access to e-cigarettes. A mixture of "hard" and "soft" public policy tools involving key stakeholders in a range of settings is needed to prevent e-cigarette access and uptake by young people.

Long-term impact of the COVID-19 pandemic on use behavior and risk perceptions of college student E-cigarette users

Objective: Work examining the long-term impact of the COVID-19 pandemic on e-cigarette use among college students is limited. Therefore, the current study examined differences in college student e-cigarette users' changes in use behavior and risk perceptions as the pandemic continues. Participants: 129 undergraduate current e-cigarette users (Mage = 19.68, SD = 1.85; 72.1% female; 85.3% White). Methods: Participants completed an online survey between October 2020 and April 2021. Results: In terms of changes in frequency of e-cigarette use, 30.5% of participants increased their use and 23.4% decreased their use. Greater e-cigarette dependence and anxiety were associated with increased use. Nearly half of e-cigarette users reported increased motivation to quit, and 32.5% had made at least one quit attempt. Conclusions: A substantial number of students increased their e-cigarette use as a result of the COVID-19 pandemic. Cessation efforts targeting increased anxiety and dependence may be useful in this population.

Respiratory symptoms among e-cigarette users without an established smoking history in the VERITAS cohort

Prior research on e-cigarettes' health impacts is inconclusive due to confounding by previous tobacco smoking. Studies of e-cigarette use among people without an established smoking history are informative for this question. A cross-sectional survey was administered across six geopolitical world regions to adults aged 18+ without a history of established cigarette smoking or regular use of other nicotine/tobacco products. Two cohorts were defined based on e-cigarette use: "Vapers Cohort" (N = 491) who used e-cigarettes in the past 7 days and "Control Cohort" (N = 247) who never regularly used e-cigarettes. Frequency of respiratory symptoms (Respiratory Symptom Evaluation Score (RSES)) were compared between cohorts, adjusting for sociodemographics. Tobacco use history and patterns of e-cigarette use was also examined. Respiratory symptoms were rare among both the Vapers and Control Cohorts: 83.3% and 88.4%, respectively, reported "rarely" or "never" experiencing all five RSES items (p = 0.125). The Vapers (vs. Control) Cohort reported modestly more frequent respiratory symptoms (adjusted mean RSES 1.61 vs. 1.43, respectively, p < 0.001); however, this difference (0.18) did not reach the threshold of clinical relevance (0.57). The Vapers (vs. Control) Cohort more often reported former cigarette experimentation (30.8% vs. 12.1%) and former infrequent use of other nicotine/tobacco products (18.1% vs. 5.8%). The Vapers Cohort most often used disposable devices (63.7%) and multiple flavors (approximately 70-80% across primary device type). In this cohort of adults without a history of established combustible tobacco use, e-cigarette use was statistically linked to more frequent respiratory symptoms, though not in a clinically meaningful way. The cross-sectional design of this study cannot establish causality between e-cigarette use and respiratory symptoms.

Variations in Adverse Events Typology Following E-Cigarette Use: The Role of Preexisting Medical Conditions

BACKGROUND

Electronic cigarettes (e-cigarettes) are often marketed as safer alternatives to traditional smoking, yet evidence suggests potential health risks, especially among vulnerable populations. This study examines the immediate adverse events following e-cigarette use in individuals with preexisting health conditions to better understand these risks.

METHODS

We conducted a STROBE-compliant observational study to identify specific preexisting medical conditions that may increase the risk of adverse events following e-cigarette use. A cross-sectional survey was deployed from January 3rd to March 3rd, 2023. A total of 4695 current and former e-cigarette users completed the survey. Logistic regression models were utilized to examine associations between 23 distinct preexisting conditions and 48 adverse events, adjusting for age, sex, race/ethnicity, education level, and income.

RESULTS

The analysis encompassed 4,421 respondents, demonstrating that individuals with solid organ transplants faced notably pronounced risks, with odds ratios indicating a seven-fold increase in mouth/tongue blisters (OR = 7.05), nearly five-fold for heart palpitations (OR = 4.92), and heartburn (OR = 4.79). Stem cell transplantation recipients also showed significantly heightened risks for similar adverse events, including mouth/tongue blisters (OR = 5.53) and heart palpitations (OR = 4.65). Metabolic diseases were linked to substantially increased odds of mouth/tongue blisters (OR = 5.63), hair loss (OR = 4.09), and migraine (OR = 3.50), highlighting a specific vulnerability to e-cigarette aerosol exposure among these groups.

CONCLUSION

The findings highlight the acute health risks associated with e-cigarette use in individuals with certain preexisting conditions. These results challenge the notion that e-cigarette use poses limited harm to human health and highlight the need for tailored public health strategies to protect vulnerable populations.

The association between smoking/vaping habits and self-reported respiratory symptoms

BACKGROUND

Smoking is well known for its harmful effect on the respiratory system, but whether vaping is less harmful is unknown. Therefore, the aim of this study was to assess the association of smoking/vaping habits with self-reported respiratory symptoms in vapers and cigarette smokers.

METHODS

An online survey was developed and shared on different vaping and smoking social media platforms and communities.

RESULTS

Out of the 891 respondents, 788 were vapers (77 pure vapers and 711 ex-smokers) and 103 were cigarette smokers. Smokers reported more frequently respiratory symptoms such as chest pain, wheezing and whistling, sputum production, cough, dry mouth, and smokers suffered from more shortness of breath, sore throat and disturbed sleep compared to vapers. The self-reported respiratory symptoms in vapers were mainly related to the nicotine strength of the product and number of puffs per use. There were no significant differences between pure vapers and vapers who were ex-smokers.

CONCLUSION

Self-reported severe respiratory symptoms were less frequent in vapers than smokers, irrespective of their smoking history. This suggests that vaping is less harmful than cigarette smoking.

Differences in young adults' perceptions of e-cigarettes by history of use

Objective: The current study examined group differences in college students' views on e-cigarettes in terms of safety, popularity, health risks, social acceptability, efficacy as a cessation aid, and promoting combustible cigarette use. Participants: 337 undergraduates (Mage = 20.84, SD = 3.79; 72.1% female; 68.5% White) divided into three groups: Never Users (n = 178), Ever Users (n = 108), and Current Users (n = 51). Methods: Participants completed questionnaires for course credit. Results: Compared to Ever and Never Users, Current Users believed e-cigarettes were safer, healthier, a useful tool to quit smoking, did not lead to combustible cigarette smoking, and that nicotine was less dangerous. Current Users also were less likely to endorse boosting social image as a motive for use. Conclusions: Public health campaigns could benefit from targeting current users' positive beliefs about e-cigarettes to reduce the prevalence of e-cigarette use among college students.

Vaping Possible Negative Effects on Lungs: State-of-the-Art From Lung Capacity Alteration to Cancer

Vaping has emerged as a popular alternative to traditional smoking. It produces smokeless vapour by heating an e-liquid mixture in an atomizer. This paper delves into the current state of knowledge surrounding electronic cigarettes, exploring the gap between the perceived safety of e-liquids and the emerging evidence of their harmful effects when inhaled. As we navigate this intricate landscape, it is crucial to unravel the complexities of vaping and its implications for public health. We conducted a three-layer systematic review of the guidelines set by the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Meta-analyses of Observational Studies in Epidemiology (MOOSE). The search was performed in three layers, including the first layer, the effect of vaping on lung function; the second layer, the effect of vaping on lung structure and inducing lung injury; and the third layer, the physiopathologic effect of vaping on the lung and a possible carcinogenic effect. Exposure to e-cigarette vapour reduced lung ventilation in adult male Long-Evans rats, indicating impaired lung function. In male Wistar rats, vaping was associated with a decrease in lung air volume and denser lung tissue structure. Studies on guinea pigs showed that vaping caused acute bronchoconstriction, contributing to lung function impairment. A case study of a young man with an E-cigarette and vaping-induced lung injury (EVALI) highlighted the detrimental effects of vaping on human lung function. The EVALI outbreak in the USA was linked to harmful substances in vapes, such as vitamin E acetate and THC, leading to serious lung injuries, including pneumonia and bronchiolitis. Vaping poses significant health risks, especially to young adults, and misconceptions regarding its safety persist despite evidence of its potential to cause various lung diseases. While vaping has positioned itself as a smoking cessation aid, the discussion surrounding its impact on lung health requires careful consideration. The lack of conclusive evidence on the long-term effects of vaping underscores the need for further research. However, existing data suggest that vaping is not without risks, and its potential association with respiratory issues and cancer underscores the urgency of public health interventions.

Exploring the Experiences, Perceptions and Social Dynamics of Electronic Cigarette Users: A Qualitative Study

INTRODUCTION

Electronic cigarettes, or e-cigarettes, are rapidly gaining popularity throughout the globe as safer alternatives to traditional cigarette smoking. There are significant public health concerns due to the uncertainty of long-term health consequences. This study aims to examine the experiences, attitudes and social dynamics of e-cigarette users to provide guidance for public health policies and interventions.

METHODS

In this qualitative descriptive study, semi-structured interviews were conducted. Fifteen e-cigarette users were recruited using a snowball sampling strategy, where initial participants referred other suitable users. All participants had at least 6 months of regular e-cigarette use. Data were collected through face-to-face interviews with open-ended questions. The interviews were transcribed verbatim and reviewed by the researchers. This review identified four main themes and eight sub-themes.

RESULTS

The four main themes identified as a result of the analysis are as follows: (1) initiation and usage experiences; (2) perceptions of health effects; (3) social and environmental factors and (4) addiction and future plans. Participants primarily began using e-cigarettes out of curiosity, due to the appealing fragrance and the belief that they were less harmful than traditional cigarettes. Usage patterns varied among participants, with some reporting minimal cravings in the early morning hours. Opinions on the long-term health effects of e-cigarettes were diverse, with many participants acknowledging uncertainty. Peers and family members perceived e-cigarettes as more socially acceptable than traditional smoking, resulting in fewer negative reactions. Finally, participants' levels of addiction and intentions to quit varied, with some expressing a desire to reduce or cease usage due to health concerns.

CONCLUSION

The findings of this study indicate that the adoption of e-cigarettes is influenced by a confluence of factors, including curiosity, the perception of reduced damage in comparison to conventional cigarettes and social acceptance. Notwithstanding these claimed advantages, users have a diverse array of beliefs and understandings concerning the enduring health consequences of e-cigarettes. The presence of varying levels of addiction and the corresponding aspirations to cease the behaviour highlight the necessity for focused public health interventions.

PATIENT OR PUBLIC CONTRIBUTION

E-cigarette users were actively involved in this study, providing essential insights and feedback throughout. Their first-hand experiences shaped the interview guide and contributed to the identification of key themes. Participants also reviewed and confirmed the accuracy of the interview transcripts, ensuring the reliability of the data.

E-cigarette use and associated factors among adults aged 18-44 years in China: Findings from an online survey

INTRODUCTION

There needs to be more up-to-date evidence on the prevalence of e-cigarette use among Chinese adults. This study aims to investigate the prevalence and associated factors of e-cigarette use among adults aged 18-44 years in China.

METHODS

Cross-sectional design and convenience sampling were used. The data for this study were obtained from an online survey conducted in mainland China from April to May 2023. The target population was adults aged 18-44 years. Descriptive analysis was employed to report the prevalence of e-cigarette use, while adjusted multivariable logistic regression was performed to examine the association between e-cigarette use and related factors.

RESULTS

A total of 4256 participants were included in this study; 12.9% were current e-cigarette users, 5.9% were frequent users, and 7.0% were occasional users. The descriptive analysis results indicated that males and cigarette users had a higher prevalence of e-cigarette use. Multivariable analysis showed that e-cigarette use was significantly associated with female gender (AOR=0.76, 95% CI: 0.60-0.96), those aged 25-34 years with monthly income 6000-8999 CNY (AOR=2.01; 95% CI: 1.18-3.41), those aged 25-34 years with monthly income ≥9000 CNY (AOR=2.20; 95% CI: 1.26-3.82), college or undergraduate degree (AOR=1.91; 95% CI: 1.22-3.00), urban residence (AOR=1.72; 95% CI: 1.34-2.20), being a current smoker (AOR=3.32; 95% CI: 2.64-4.16), perception of harm (AOR=0.66; 95% CI: 0.60-0.73), and perception of benefit (AOR=2.31; 95% CI: 2.04-2.61).

CONCLUSIONS

The prevalence of current e-cigarette use among adults in China was 12.9% within our sample. In addition to sociodemographic factors, individuals with a higher perception of the harm associated with e-cigarettes were less likely to engage in e-cigarette consumption. Conversely, individuals who perceive the 'benefits' of e-cigarettes more favorably use them. Targeted interventions, such as health education, are recommended to help adults develop a correct understanding of e-cigarettes and lower the prevalence of e-cigarette use.

Exposure to user-generated e-cigarette content on social media associated with greater vulnerability to e-cigarette use among youth non-users

INTRODUCTION

Social media are important venues for youth's exposure to e-cigarette content. This study examined how exposure to user-generated e-cigarette content (i.e., content created and shared by individual social media users) is associated with vulnerabilities to e-cigarette use among youth non-users.

METHODS

We pooled data from the 2021 and 2022 National Youth Tobacco Survey. Youth who have never used e-cigarettes were included. Weighted linear and logistic regressions were conducted to examine how exposure to user-generated e-cigarette content (from real-life friends, online-only friends, and celebrities/influencers) on social media was associated with e-cigarette use vulnerabilities measured by perceived norms, perceived risk, and susceptibility of use, controlling for demographics, advertising exposure, and mental health conditions. Multiple imputations were performed to account for missing data.

RESULTS

Exposure to e-cigarette content on social media posted by real-life friends, online-only friends, and celebrities/influencers were associated with more positive descriptive norm (βs = 1.56, 0.37, and 0.35, respectively, all ps < .001), more positive injunctive norm (βs = 0.46, 0.19, and 0.10, respectively, all ps < .001), and higher odds of e-cigarette use susceptibility (ORs = 1.48, 1.50. 1.29, respectively, all ps < .001). Exposure to content posted by real-life and online-only friends were associated with reduced risk perception of e-cigarette use (β = -0.04, p < 0.05 and β = -0.07, p < 0.001).

CONCLUSIONS

Our study highlighted that friends and celebrities/influencers are important sources on social media that can influence youth non-users' vulnerabilities to e-cigarette use. Interventional messages communicated through friends and influencers on social media may in turn help reduce e-cigarette vulnerability among youth non-users.

A review of vaping's health effects, treatment, and policy implications: Nursing's call to action

ABSTRACT

The emergence and subsequent surge in popularity of electronic nicotine delivery systems (ENDS), especially among adolescents and young adults, have reshaped the landscape of tobacco consumption, including use patterns and beliefs as well as therapeutic approaches to the condition. The health implications of ENDS are a cause for concern among NPs, as they include severe nicotine dependence, mental health consequences, and adverse effects on respiratory and cardiac systems, among other issues. This article focuses on the health implications of vaping across the lifespan and emphasizes the need for NPs to evaluate ENDS use consistently across age groups and offer age-appropriate treatment within the clinical setting. Importantly, although vaping is prevalent among various age groups, most tobacco use, including vaping, begins and becomes established during adolescence. This back-to-school season therefore marks an ideal time for NPs to educate their pediatric patients, along with their parents or caregivers, about the widespread effects of vaping on health, and it also serves as a reminder to screen for the condition in adults, regardless of smoking history. To combat this trend on a larger scale, NPs can further advocate for community health by promoting youth prevention programs and supporting policy initiatives aimed at curbing ENDS use.

Smokers' perception of the comparative health risks of cigarettes, e-cigarettes and heated tobacco products: a survey among the German population

BACKGROUND

Tobacco cigarettes, e-cigarettes and heated tobacco products can pose different health risks (harm continuum). As current tobacco smokers could benefit from switching to less harmful products, we aimed to assess current smokers' perceived comparative health risks of these three products and to explore associations between risk perceptions and specific user characteristics.

METHODS

We analysed data from 11 waves (2019-2021; N = 5657 current tobacco smokers) of a representative, cross-sectional household survey conducted in Germany. Associations were assessed with multivariable logistic regression models.

RESULTS

55.2% of smokers (95%CI = 53.8-56.5%) ranked cigarettes as the most harmful product. 36.1% of smokers (95%CI = 34.8-37.3%) perceived e-cigarettes and 33.8% (95%CI = 32.5-35.0%) heated tobacco products as more harmful than cigarettes. Misperceptions that e-cigarettes or heated tobacco products are more harmful to health than cigarettes increased over the 3-year study period and were more common among those with lower educational attainment.

CONCLUSIONS

Only half of current tobacco smokers in Germany perceive the comparative health risks of cigarettes adequately and such misperceptions have increased recently. As current smokers could benefit most from switching to less harmful products, educational campaigns are needed to inform this group about the health risks of tobacco smoking and the comparative health risks of the various nicotine and tobacco products along the harm continuum.

E-Cigarette Use Behavior and Expectancies Among Sexual Minority and Heterosexual College Student E-Cigarette Users

Background: College students who identify as a sexual minority (i.e., lesbian, gay, bisexual, or other sexual orientation) are at higher risk for e-cigarette use than their heterosexual or "straight" peers. However, little is known about factors, such as e-cigarette outcome expectancies, that might influence these differences in prevalence rates. Therefore, the current study examined differences between heterosexual and sexual minority college student e-cigarette users in terms of days of past-month e-cigarette use, e-cigarette dependence, and e-cigarette outcome expectancies. A secondary aim of the study was to examine whether outcome expectancies served as an explanatory mechanism in the association between sexual minority status and e-cigarette use frequency and dependence. Methods: Participants were heterosexual (n = 90; Mage = 19.65, SD = 2.70; 76.7% female; 77.8% White) and sexual minority (n = 44; Mage = 20.02, SD = 2.18; 68.2% female; 90.9% White) college student e-cigarette users who completed self-report measures. Results: Students who identified as a sexual minority reported greater e-cigarette dependence, more frequent past 30-day use, and greater negative consequences and positive reinforcement e-cigarette outcome expectancies. Follow-up mediation analyses indicated a significant indirect effect of sexual minority status on both days of past-month e-cigarette use and e-cigarette dependence through expectancies for negative consequences and positive reinforcement. Conclusions: These findings suggest that positive reinforcement and negative consequences outcome expectancies may be contributing to the disparities in e-cigarette use among college students who identify as a sexual minority and could be useful targets for cessation interventions for this population.

The Untapped Biomarker Potential of MicroRNAs for Health Risk-Benefit Analysis of Vaping vs. Smoking

Despite the popularity of electronic cigarettes (e-cigs) among adolescent never-smokers and adult smokers seeking a less pernicious substitute for tobacco cigarettes, the long-term health impact of vaping is largely unknown. Like cigarette smoke, e-cig vapor contains harmful and potentially harmful compounds, although in fewer numbers and at substantially lower concentrations. Many of the same constituents of e-cig vapor and cigarette smoke induce epigenetic changes that can lead to the dysregulation of disease-related genes. MicroRNAs (MiRNAs) are key regulators of gene expression in health and disease states. Extensive research has shown that miRNAs play a prominent role in the regulation of genes involved in the pathogenesis of smoking-related diseases. However, the use of miRNAs for investigating the disease-causing potential of vaping has not been fully explored. This review article provides an overview of e-cigs as a highly consequential electronic nicotine delivery system, describes trends in e-cig use among adolescents and adults, and discusses the ongoing debate on the public health impact of vaping. Highlighting the significance of miRNAs in cell biology and disease, it summarizes the published and ongoing research on miRNAs in relation to gene regulation and disease pathogenesis in e-cig users and in vitro experimental settings. It identifies gaps in knowledge and priorities for future research while underscoring the need for empirical evidence that can inform the regulation of tobacco products to protect youth and promote public health.

Longitudinal associations between exclusive, dual and polytobacco use and respiratory illness among youth

BACKGROUND

The health consequences of polytobacco use are not well understood. We evaluated prospective associations between exclusive, dual, and polytobacco use and diagnosed bronchitis, pneumonia, or chronic cough among US youth.

METHODS

Data came from Waves 1-5 of the Population Assessment of Tobacco and Health Study. We categorized time-varying past 30-day tobacco use into seven categories: (1) non-current use; exclusive use of 2) cigarettes, 3) e-cigarettes, and 4) other combustible products (OC; pipes, hookah, and cigars); dual use of 5) e-cigarettes + cigarettes or e-cigarettes + OC, and 6) cigarettes + OC; and 7) polyuse of all three products. The outcome was parent-reported diagnosis of bronchitis, pneumonia, or chronic cough among youth. We conducted weighted multilevel Poisson models (person n = 17,517, 43,290 observations) to examine the longitudinal exposure-outcome relationship, adjusting for covariates: sex, age, race and ethnicity, parental education, body mass index, secondhand smoke exposure, and household use of combustible products.

RESULTS

Compared to nonuse, exclusive cigarette use (Risk Ratio (RR) = 1.83, 95% CI 1.25-2.68), exclusive e-cigarette use (RR = 1.53, 95% CI 1.08-2.15), combustible product + e-cigarette dual use (RR = 1.90, 95% CI 1.18-3.04), cigarettes + OC dual use (RR = 1.96, 95% CI 1.11-3.48), and polytobacco use (RR = 3.06 95% CI 1.67-5.63) were associated with a higher risk of bronchitis, pneumonia, or chronic cough. In additional analyses, we found that the risk ratio for polytobacco use was higher compared to exclusive e-cigarette use (RR 2.01 CI 95% 1.02-3.95), but not higher compared to exclusive cigarette use (RR 1.67 CI 95% 0.85-3.28).

CONCLUSION

We found that exclusive, dual, and poly tobacco use were all associated with higher risk of bronchitis, pneumonia, or chronic cough compared to non-current use.

Exploring the Utility of Long Non-Coding RNAs for Assessing the Health Consequences of Vaping

Electronic cigarette (e-cig) use, otherwise known as "vaping", is widespread among adolescent never-smokers and adult smokers seeking a less-harmful alternative to combustible tobacco products. To date, however, the long-term health consequences of vaping are largely unknown. Many toxicants and carcinogens present in e-cig vapor and tobacco smoke exert their biological effects through epigenetic changes that can cause dysregulation of disease-related genes. Long non-coding RNAs (lncRNAs) have emerged as prime regulators of gene expression in health and disease states. A large body of research has shown that lncRNAs regulate genes involved in the pathogenesis of smoking-associated diseases; however, the utility of lncRNAs for assessing the disease-causing potential of vaping remains to be fully determined. A limited but growing number of studies has shown that lncRNAs mediate dysregulation of disease-related genes in cells and tissues of vapers as well as cells treated in vitro with e-cig aerosol extract. This review article provides an overview of the evolution of e-cig technology, trends in use, and controversies on the safety, efficacy, and health risks or potential benefits of vaping relative to smoking. While highlighting the importance of lncRNAs in cell biology and disease, it summarizes the current and ongoing research on the modulatory effects of lncRNAs on gene regulation and disease pathogenesis in e-cig users and in vitro experimental settings. The gaps in knowledge are identified, priorities for future research are highlighted, and the importance of empirical data for tobacco products regulation and public health is underscored.

Addressing Substance Use in the Adolescent Transplant Population

Adolescence is a unique period of physical and psychosocial changes as youth transition, over many years, to adulthood. The psychosocial changes that accompany adolescence include emotional separation from parents, greater influence of peer groups, an interest in self-identification and autonomy, and increased risk-taking behaviors. Substance use is a common form of risk-taking behavior in the adolescent developmental stage. Alcohol, nicotine, and cannabis are the most common types of substances used in the United States. In the adolescent transplant population, rates of substance use appear to be at, or slightly below, their peer counterparts. Substance use can lead to deleterious health outcomes for adolescent transplant patients as a result of impaired decision-making, reduction in medication and clinic visit compliance, increases in mental health disorders, and risk for developing dependence and a substance use disorder. Given the close relationship that many pediatric transplant providers have with their patients and families, transplant care teams are in an excellent position to help their patients by addressing adolescent substance use. This narrative review describes how providers can use proactive standardized approaches to identify and intervene with substance use behavior.

Direct health implications of e-cigarette use: a systematic scoping review with evidence assessment

Background

E-cigarettes are often marketed as a less harmful alternative to traditional tobacco cigarettes. Despite their popularity, the evidence regarding their effects on human health remains unclear and is filled with complexities.

Objectives

This systematic review aims to elucidate the direct effects of electronic cigarette use on human health, carefully distinguishing between the specific characteristics of the populations studied.

Methodology

Adhering to the PRISMA guidelines, we conducted a comprehensive search in PubMed/Medline, Web of Science, Scopus, and Google Scholar databases without date restrictions, including articles in both Spanish and English. This approach enabled the identification and analysis of primary studies to understand the direct effect of electronic cigarettes on human health.

Results

A total of 33 studies were included that evaluated cardiovascular, pulmonary, renal, weight and fertility effects. Only five studies analyzed e-cigarettes in healthy populations and seven studies compared healthy individuals against smokers. The effects evaluated on smokers or former tobacco smokers were apparently positive, however, among healthy individuals, increased heart rate, mean arterial pressure, oxidative stress, alteration of respiratory epithelial cells and increased airflow resistance were found.

Conclusion

Smokers or former smokers who switch to e-cigarettes may reduce their exposure to carcinogens and lower their risk of developing severe health issues associated with conventional smoking. However, in healthy individuals who have never smoked traditional cigarettes, the use of e-cigarettes introduces several cardiovascular and respiratory adverse effects. These findings suggest that while e-cigarettes can be a strategic harm reduction tool for smokers, they are not a safe option for non-smokers.

How does the e-cigarette industry respond to tax adjustments? Evidence from China

INTRODUCTION

China enacted an excise tax on e-cigarettes in November 2022, which offers a distinctive opportunity to examine the industry's reactions to this fiscal adjustment. This study delves into the industry's pricing strategies following the introduction of the excise tax, facilitating a thorough assessment of the subsequent impact on market dynamics and the government's revenue streams.

METHODS

We developed a TaXSiM model specifically tailored for e-cigarettes in China by integrating the country's e-cigarette tax framework. Our approach involved leveraging market data obtained from a representative product, the RELX Phantom Series, to ensure the model's effectiveness and relevance.

RESULTS

The excise implementation of 2022 significantly heightened the tax burden on e-cigarettes, marking an increase of approximately 150 RMB per device and 19 RMB per cartridge. Despite these financial pressures, electronic cigarette firms exemplified by RELX, strategically endeavored to sustain competitiveness. Their approach involved initially implementing a 'Razor blade model' and eventually a 'comprehensive under-shifting' strategy, which mitigated the health impact of the tax hike, resulting in a relatively minor decline in sales while amplifying the impact on tax revenue. However, this strategic pricing maneuver came at a cost, as it led to a substantial decrease in profits, and therefore expedited a reshuffling of the industry by compelling smaller brands to leave the market rapidly.

CONCLUSIONS

To effectively curb the use of e-cigarettes through tax policies, it is advisable to relocate the imposition of excise taxes on electronic cigarettes to the retail stage. This shift aims to narrow the scope for industry-level pricing strategies. Furthermore, this approach should be coupled with the introduction of an additional specific tax, strategically crafted to accentuate the health-related benefits associated with the excise taxation on electronic cigarettes.

E-cigarette use among university students in Palestine: Prevalence, knowledge, and determinant factors

BACKGROUND

Recent reports indicated accelerated rates of e-cigarette use, especially among youth in various Middle Eastern countries, including Palestine. Nevertheless, little is known about knowledge, attitudes, and perceptions regarding this topic in Palestine. This study aimed to assess the prevalence of e-cigarette use among Palestinian university students, along with their knowledge, attitudes, and perceptions about e-cigarette use.

METHODS

An observational cross-sectional study, utilizing an online self-administered questionnaire, was conducted on Palestinian students from five universities between 17/04/2023 and 04/11/2023.

RESULTS

A total of 1002 Palestinian university students completed the questionnaire. The prevalence of e-cigarette use among students was 18.1%. The mean knowledge score about e-cigarettes was significantly lower among the users of e-cigarettes compared to non-users. E-cigarette use was significantly associated with the participants' smoking status. Among e-cigarette users, 43.6% were also current traditional cigarette users, and 66.9% were current waterpipe users. E-cigarette use was significantly associated with having a friend who is a smoker and/ or a smoking mother. Binary logistic regression revealed a significant positive effect between the participant's smoking status, the mother's smoking status, knowledge about e-cigarettes, and the use of e-cigarettes (p-value < 0.05). Among e-cigarette users, 18.8% used them in indoor places at the university, and 25% reported using them daily in the past month. Affordability of e-cigarettes was the most reported reason for their use (47.5%).

CONCLUSION

This study concluded that e-cigarette use is prevalent and rapidly rising among university students in Palestine. This is worrisome as it is significantly associated with insufficient knowledge about the adverse health effects of E-cigarette use, and its addictive nature. These findings focus on the importance of improving the students' knowledge about e-cigarette use by implementing educational campaigns and considering age regulations on e-cigarette availability and use.

Vaping-Know the Truth: Evaluation of an Online Vaping Prevention Curriculum

BACKGROUND

Unacceptably high levels of e-cigarette use among youth paired with growing research about the dangers of vaping demonstrate a critical need to develop interventions that educate young people to reject e-cigarette use and promote cessation for current users. Vaping: Know the Truth (VKT) is a free digital learning experience prioritizing middle and high school students that aims to improve students' knowledge about the dangers of using e-cigarettes and provide quitting resources for those who already vape. The current study was designed to evaluate whether students receiving the curriculum increased knowledge of the dangers of vaping.

METHODS

The outcome measures were calculated as the change in the number of correct responses from the pre- to post-module assessments among middle and high school students who completed four modules of the VKT curriculum (N = 103,522). Linear regression was performed to determine the association between the student's pre-module assessment score and the knowledge change score after completion of the four modules.

RESULTS

Students' e-cigarette knowledge significantly improved by an average of 3.24 points (SD = 3.54), following implementation of the VKT curriculum. This indicates that participants answered more than 3 additional questions correctly, on average, after the intervention.

CONCLUSION

Findings demonstrate that the Vaping: Know the Truth curriculum is an effective resource for increasing knowledge among youth about the harms associated with e-cigarette use. Further research is needed to evaluate whether the intervention is associated with behavioral outcomes over time.

Longitudinal bidirectional association between youth electronic cigarette use and tobacco cigarette smoking initiation in Thailand

INTRODUCTION

This study quantifies the longitudinal association between e-cigarette use and subsequent conventional cigarette initiation and vice versa among Thai youths.

METHODS

Data from a longitudinal survey of 6045 Thai seventh grade students with baseline in 2019 and the 12-month follow-up in 2020 were analysed using complex survey multivariate logistic regressions to assess whether e-cigarette use was associated with subsequent cigarette smoking (ever, current and dual product users at follow-up) among baseline never smokers.

RESULTS

Consistent with prior findings from other countries, among those who had never smoked cigarettes at baseline, ever e-cigarette users were more likely to try cigarette smoking (adjusted OR 4.44; 95% CI 2.23 to 8.86; p<0.001), or become dual users (adjusted OR 5.31; 95% CI 2.63 to 10.74; p<0.001) 1 year later. Baseline current e-cigarette users were more likely to become ever smokers (adjusted OR 5.37; 95% CI 1.82 to 15.90; p=0.005), current smokers (OR 3.92; 95% CI 1.69 to 9.14; p=0.003) and dual product users (adjusted OR 6.96; 95% CI 1.54 to 31.38; p=0.015) at the 12-month follow-up than non-e-cigarette users. Similarly, among never e-cigarette users at baseline, ever cigarette smoking were more likely to try e-cigarettes (adjusted OR 3.38; 95% CI 1.66 to 6.88; p=0.002), currently use e-cigarettes (adjusted OR 2.75; 95% CI 1.47 to 5.13; p=0.003) and currently use both e-cigarettes and cigarettes (adjusted OR 4.87; 95% CI 2.92 to 8.13; p<0.001) at the follow-up than never smokers. Among never e-cigarette users at baseline, current-cigarette smoking were more likely to try e-cigarettes (adjusted OR 6.21; 95% CI 2.58 to 14.95; p<0.001), currently use e-cigarettes (adjusted OR 2.80; 95% CI 1.27 to 6.14; p=0.014) and currently use both e-cigarettes and cigarettes (adjusted OR 7.70; 95% CI 3.45 to 17.19; p<0.001) at the follow-up than never smokers.

CONCLUSIONS

This longitudinal study in Asian low-income and middle-income countries supports the prospective association of youth e-cigarette use with subsequent smoking initiation and youth cigarette use with subsequent e-cigarette initiation that is similar to that observed in high-income Western countries.

LRRK2 is involved in heat exposure-induced acute lung injury and alveolar type II epithelial cell dysfunction

Heat exposure induces excessive hyperthermia associated with systemic inflammatory response that leads to multiple organ dysfunction including acute lung injury. However, how heat impairs the lung remains elusive so far. We aimed to explore the underlying mechanism by focusing on leucine-rich repeat kinase 2 (LRRK2), which was associated with lung homeostasis. Both in vivo and in vitro models were induced by heat exposure. Firstly, heat exposure exerted core temperature (Tc) disturbance, pulmonary dysfunction, atelectasis, inflammation, impaired energy metabolism, and reduced surfactant proteins in the lung of mice. In addition, decreased LRRK2 expression and increased heat shock proteins (HSPs) 70 were observed with heat exposure in both the lung of mice and alveolar type II epithelial cells (AT2). Furthermore, LRRK2 inhibition aggravated heat exposure-initiated Tc dysregulation, injury in the lung and AT2 cells, and enhanced HSP70 expression. In conclusion, LRRK2 is involved in heat-induced acute lung injury and AT2 cell dysfunction.

E-cigarette use, psychological distress, and daily activity participation among adults in Riyadh

Objectives

The prevalence of e-cigarettes is significantly increasing among adults as an alternative method to tobacco smoking. However, the chemical products of e-cigarettes have an influence on human general health. Therefore, this study aims to investigate the association between e-cigarette use and psychological distress as well as participation in daily activities among adults in Riyadh, Saudi Arabia. It also evaluates the demographic profile and usage patterns of e-cigarette users.

Methods

This cross-sectional study involved 396 e-cigarette smokers in Riyadh city. An online survey was administered, including questions about smoking patterns and the perceived effects of e-cigarettes on activities of daily living. Additionally, mental health were assessed using the Kessler 6 scale.

Results

Most of the participants were educated young males (61.4%). About 29.5% of the participants reported using e-cigarettes primarily to quit tobacco cigarettes. In addition, e-cigarette usage was significantly associated with lower participation in activities of daily living and higher psychological distress.

Conclusion

This study found that many e-cigarette users are well-educated young individuals who use e-cigarettes as a substitute for traditional cigarettes. However, the study also revealed that using e-cigarettes is associated with negative effects on smokers' daily activities and mental health.

Perceiving E-Cigarettes as Safe and Safer Alternative to Cigarettes Among Young Adults

BACKGROUND

Young adults are using e-cigarettes at high rates. While the literature on the health risks associated with e-cigarettes is extensive and growing, little is known about young adults' thoughts and perceptions of the safety and harms of e-cigarettes.

METHODS

We conducted one-on-one interviews with young adults aged 18 to 25 years in Los Angeles, California between June 2018 and June 2019. We interviewed and audio-recorded young adults (N = 62) who consented to the study and self-reported to have used e-cigarettes on a weekly basis or more for at least 5 months prior to study enrollment. Interviews examined participants' thoughts, feelings, and experiences related to e-cigarette use. We audio-recorded, transcribed, and coded the interviews using grounded theory analysis methods.

RESULTS

Young adults often believed that e-cigarettes were safer than cigarettes and were safe to use, especially following positive vaping experiences. Young adults were skeptical of the available science on e-cigarette use and felt there was not conclusive data on the harms of e-cigarettes. In their selection of e-cigarettes over cigarettes, young adults felt they were making a conscious and healthier choice. Because young adults viewed e-cigarettes to be better for them based on their personal experiences with vaping, they felt e-cigarettes were a superior alternative to combustible tobacco.

CONCLUSIONS

Young adults in our study believed that the long-term health effects of e-cigarette use are not clearly understood and were generally skeptical of the research on e-cigarette harms. Policy, education, and anti-smoking campaigns need to clarify the negative health-related consequences of e-cigarette use for young people.

A Global Health Survey of People Who Vape but Never Smoked: Protocol for the VERITAS (Vaping Effects: Real-World International Surveillance) Study

BACKGROUND

There is only limited information about the health effects of regular vaping. Research on the health status of people who used to smoke faces the challenge that previous smoking may have caused unknown health effects. Only studies of people who vape but have never smoked combustible cigarettes can enable the detection of harms attributable to vaping. Large prospective studies of well-characterized electronic cigarette users with and without a history of combustible cigarette smoking are warranted to establish the long-term effects of regular vaping on respiratory health.

OBJECTIVE

We will conduct a global cross-sectional survey of individuals from 6 world regions. Respiratory symptoms will be assessed using a validated questionnaire-the Respiratory Symptom Experience Scale (RSES). Current vapers who are nonusers of other tobacco or nicotine products will be compared with matched controls who are nonusers of vapes and other tobacco or nicotine products.

METHODS

This will be a multicountry, cross-sectional internet-based survey of 750 adults aged ≥18 years who satisfy the criteria for inclusion in either a cohort of people who exclusively vape and who are nonusers of other tobacco or nicotine products ("vapers cohort"; target N=500) or a cohort of nonvapers who are also nonusers of other tobacco or nicotine products ("controls cohort"; target N=250). The primary end point of the study is the RSES score. RSES scores of people in the "vapers cohort" will be compared with those of people in the "controls cohort." Additionally, the study will collect data to characterize patterns of vaping product use among the vapers cohort. Data collection will include information about the age initiation of using vape products, reasons for starting and continuing the use of vape products, specific types of products used, flavors and nicotine strengths of recently used products, as well as the frequency and intensity of product use in the past 30 days.

RESULTS

Participant recruitment started in April 2023, and enrollment was completed by November 2023 with 748 participants. Results will be reported in 2024.

CONCLUSIONS

This will be the first study providing key insights into respiratory health effects associated with using electronic cigarettes in people who vape with no established use of combustible cigarettes or other tobacco or nicotine products.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/54236.

Vuse Solo e-cigarettes do not provide net benefits to public health: a scientific analysis of FDA's marketing authorisation

In October 2021, the US Food and Drug Administration (FDA) authorised marketing of RJ Reynolds Vapor Company's (RJR) Vuse Solo e-cigarette through FDA's Premarket Tobacco Product Application (PMTA) pathway. FDA concluded that RJR demonstrated Vuse products met the statutory standard of providing a net benefit to public health. A review of FDA's scientific justification reveals deficiencies: (1) not adequately considering Vuse's popularity with youth and evidence that e-cigarettes expanded the nicotine market and stimulate cigarette smoking; (2) trading youth addiction for unproven adult benefit without quantifying these risks and benefits; (3) not considering design factors that appeal to youth; (4) not addressing evidence that e-cigarettes used as consumer products do not help smokers quit and promote relapse in former smokers; (5) not discussing evidence that dual use is more dangerous than smoking; (6) narrowly focusing on the fact that e-cigarettes deliver lower levels of some toxicants without addressing direct evidence on adverse health effects; (7) downplaying significant evidence of other substantial harms; (8) not acting on FDA's own study showing no all-cause mortality benefit of reducing (but not stopping) cigarette use; and (9) improperly considering e-cigarettes' high abuse liability and potential for high youth addiction and undermining tobacco cessation. Because marketing these products is not appropriate for the protection of the public health, FDA should reconsider its Vuse marketing order as statutorily required and not use it as a template for other e-cigarette PMTAs. Policymakers outside the USA should anticipate that tobacco companies will use FDA's decision to try to weaken tobacco control regulation of e-cigarettes and promote their products.

The intention of college students to use electronic cigarettes: A study based on the theory of innovation diffusion

INTRODUCTION

The purpose of this study is to examine the use of electronic cigarettes (e-cigarettes) among college students in Hangzhou, and to analyze the influencing factors of their intention to use e-cigarettes.

METHODS

Using a stratified cluster sampling method, 775 students from two universities in Hangzhou were selected for an on-site questionnaire survey from March to April 2022. Adjusted logistic regression analysis was conducted on the influencing factors of use intention, based on innovation diffusion theory.

RESULTS

Within our sample of college students, 16.5% of students had tried e-cigarettes; 6.32% had used e-cigarettes in the past month, and 8.0% had the intention to use e-cigarettes. There were significant differences in willingness to use e-cigarettes among different genders, economic status, smoking status of close friends around them, and their own use of tobacco and alcohol (p<0.05). The logistic regression model showed that the observability of e-cigarettes (AOR=1.28; p<0.05), personal factors (AOR=1.39; p<0.05), and social systems (AOR=1.63; p<0.05), were all influencing factors of intention to use e-cigarettes.

CONCLUSIONS

College students in Hangzhou have a high intention to use e-cigarettes, and the impacts of the product itself, individual characteristics and the living environment are crucial. It is necessary to strengthen the promotion of tobacco knowledge at the social and family levels to reduce the occurrence of vaping.