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Seaman EL, Kreslake JM, Cordova J, Schillo B, Barlas F, Marynak K. Developing a National Longitudinal Tobacco Cohort of Youth and Young Adults: The Tobacco Epidemic Evaluation Network (TEEN+) Study. Nicotine Tob Res 2024:ntae064. [PMID: 38567945 DOI: 10.1093/ntr/ntae064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 01/22/2024] [Accepted: 03/11/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION Timely and relevant data are critical to monitoring the rapidly changing youth vaping epidemic and for understanding the prevalence, patterns of use, knowledge, and perceptions of tobacco products. While e-cigarettes have been the most used tobacco product among youth for nearly a decade, new nicotine delivery products continue to be introduced to the US market. Flavored tobacco products, including flavored e-cigarettes, menthol cigarettes, and flavored cigars, drive disparities in use by young people. AIMS AND METHODS To examine tobacco use among youth and young adults, the Monitoring E-Cigarette Use among Youth project established a longitudinal cohort of youth and young adults (13-24)-the Tobacco Epidemic Evaluation Network (TEEN+) study. TEEN+ focuses on e-cigarette and other tobacco products use and also includes questions about other substance use (eg, marijuana, alcohol), physical health, mental health, and social determinants of health (eg, discrimination, poverty, sexual and gender identity). Geocoding of responses allows for the evaluation of local tobacco control policies. The cohort includes an oversample of California residents to generate reliable and representative state-level estimates. This manuscript provides an overview of methods and baseline demographics from Wave 1. RESULTS The initial Wave 1 TEEN+ cohort included 10 255 in the national sample and 2761 in the California sample. CONCLUSIONS TEEN+ study data complement nationally-representative cross-sectional studies and allow for rapid evaluation of local and state policies. This manuscript describes the study's probability-based sample recruitment. Furthermore, we identify this initiative as a resource for evaluating the impact of flavored tobacco restriction policies and informing policy implementation efforts. IMPLICATIONS This manuscript provides an overview of the methodology and baseline characteristics for a new longitudinal cohort of youth and young adults, the Tobacco Epidemic Evaluation Network (TEEN+) study. The TEEN+ study data can be used to evaluate the impact of flavored tobacco product restriction policies and informing policy implementation efforts.
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Affiliation(s)
| | | | - Jamie Cordova
- CDC Foundation, Noninfectious Disease Programs, Atlanta, GA, USA
| | | | | | - Kristy Marynak
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Hefler M. Progress, setbacks and changing perception of the possible: reflections on Aotearoa/New Zealand's changed political landscape and tobacco policy plans. Tob Control 2024; 33:141-142. [PMID: 38378208 DOI: 10.1136/tc-2024-058630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Affiliation(s)
- Marita Hefler
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
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Majmundar A, Xue Z, Asare S, Bandi P, Patel M, Nargis N. Concept flavor e-cigarette unit sales in the U.S.: 2019-2022. Prev Med Rep 2023; 36:102506. [PMID: 38116272 PMCID: PMC10728460 DOI: 10.1016/j.pmedr.2023.102506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 10/06/2023] [Accepted: 11/07/2023] [Indexed: 12/21/2023] Open
Abstract
Introduction Concept flavor e-cigarettes, defined as products with vague/ambiguous flavor (tobacco flavor and non-tobacco flavor) names, may limit the intended impact and enforcement of flavored tobacco restrictions. This study assessed trends in unit sales of concept flavor e-cigarettes in the U.S. by volume, nicotine concentration levels (NCL), flavor and device type. Methods We analyzed NielsenIQ Retail Scanner point-of-sales data collected from 2182 Local Trade Areas in the contiguous 48 U.S. states and the District of Columbia aggregated weekly from August 10, 2019, through April 9, 2022. Concept flavors were categorized by: flavor type (tobacco, fruity, menthol, mint, and other); device type (pods/refillable cartridges, disposables, e-liquids, and other); and NCL (0 %-2.0 %, 2.1 %-4.0 %, > 4.1 %, unknown). Joinpoint regression was used to assess sales trends. Results Overall unit sales during the study period increased by 33.63 % from 1040.85 to 1390.88 thousand units per month (p = 0.006). Between August 2019 and September 2021, unit sales increased and peaked; between September 2021 and April 2022 sales decreased by 14.46 % (from 1626.02 to 1390.88 thousand units; p = 0.002). Sales of fruity, menthol and mint flavors concept flavor e-cigarettes increased by > 1000 %; disposable devices by 302.18 %; pods and refillable cartridges by 33.81 % overall; and products NCL > 4.0 % increased by 110.18 %. Tobacco flavor concept flavors (93.28 %), pods (94.63 %), and products with 2.1 %-4.0 % NCL (88.40 %) dominated unit share. Conclusion Sustaining the recent overall decline in the unit sales of concept flavor e-cigarettes and monitoring the sales of products with nicotine concentration greater than 2.0%, non-tobacco flavor, and pod products warrant prioritization in tobacco control efforts.
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Affiliation(s)
- Anuja Majmundar
- Tobacco Control Research, American Cancer Society, Inc., 270 Peachtree StreetAtlanta, GA 30303, USA
| | - Zheng Xue
- Tobacco Control Research, American Cancer Society, Inc., 270 Peachtree StreetAtlanta, GA 30303, USA
| | - Samuel Asare
- Tobacco Control Research, American Cancer Society, Inc., 270 Peachtree StreetAtlanta, GA 30303, USA
| | - Priti Bandi
- Risk Factors and Screening Surveillance Research, American Cancer Society, Inc., 270 Peachtree StreetAtlanta, GA 30303, USA
| | - Minal Patel
- Tobacco Control Research, American Cancer Society, Inc., 270 Peachtree StreetAtlanta, GA 30303, USA
| | - Nigar Nargis
- Tobacco Control Research, American Cancer Society, Inc., 270 Peachtree StreetAtlanta, GA 30303, USA
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Tackett AP, Han DH, Peraza N, Whaley RC, Mason T, Cahn R, Hong K, Pang R, Monterosso J, Page MK, Goniewicz ML, Leventhal AM. Effects of 'Ice' flavoured e-cigarettes with synthetic cooling agent WS-23 or menthol on user-reported appeal and sensory attributes. Tob Control 2023:tc-2023-058125. [PMID: 37940405 DOI: 10.1136/tc-2023-058125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 10/24/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND This clinical experiment tested the effects of exposure to e-cigarettes with WS-23 or menthol cooling additives on user appeal and sensory attributes, and, secondarily, whether WS-23 effects generalised across base characterising flavour, nicotine concentration, or nicotine/tobacco product use status. METHODS In this within-participant double-blind experiment, adult tobacco/nicotine users administered standardised puffs of 18 different e-cigarette solutions in randomised sequences using a pod-style device. Each of three base characterising e-cigarette flavour solutions ('bold tobacco', 'mango,' 'wintergreen') in both 2% and 4% concentrations of nicotine benzoate salt were manipulated by adding either: (1) Menthol (0.5%), (2) WS-23 (0.75%) or (3) No cooling agent. After each administration, participants rated 3 appeal and 5 sensory attributes (0-100 scales). RESULTS Participants (n=84; M(SD)=38.6 (13.6) years old) were either exclusive e-cigarette (25.0%), cigarette (36.9%) or dual (38.1%) users. WS-23 versus no coolant products produced higher liking, willingness to use again, smoothness, and coolness and lower disliking, bitterness, and harshness ratings (|B|difference range: 4.8 to 20.1; ps<0.005). Menthol (vs no coolant) increased willingness to use again and reduced harshness and coolness (ps<0.05). Flavours with WS-23 (vs menthol) were rated as smoother, cooler and less harsh (ps<0.05). Coolant effects did not differ by base flavour, nicotine concentration, or tobacco use status. CONCLUSIONS Adding synthetic coolant WS-23 to e-cigarettes appears to make the vaping user experience more appealing, regardless of characterising base flavour. Regulatory agencies should be aware that the manufacturing process of adding synthetic coolants may increase the attractiveness of various e-cigarette products.Cite Now.
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Affiliation(s)
- Alayna P Tackett
- Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Dae Hee Han
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
- Institute for Addiction Science, Univeresity of Southern California, Los Angeles, CA, USA
| | - Natalia Peraza
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Reid C Whaley
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Tyler Mason
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, California, USA
| | - Rael Cahn
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, California, USA
| | - Kurt Hong
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, California, USA
- Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Raina Pang
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - John Monterosso
- Institute for Addiction Science, Univeresity of Southern California, Los Angeles, CA, USA
- Department of Psychology, University of Southern California, Los Angeles, California, USA
| | - Michelle K Page
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Maciej Lukasz Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Adam M Leventhal
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
- Institute for Addiction Science, Univeresity of Southern California, Los Angeles, CA, USA
- Department of Psychology, University of Southern California, Los Angeles, California, USA
- USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA
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Commodore S, Sharma S, Ekpruke CD, Pepin R, Hansen AM, Rousselle D, Babayev M, Ndeke JM, Alford R, Parker E, Dickinson S, Sharma S, Silveyra P. Thirdhand vaping exposures are associated with pulmonary and systemic inflammation in a mouse model. JOURNAL OF ENVIRONMENTAL EXPOSURE ASSESSMENT 2023; 2:22. [PMID: 38741701 PMCID: PMC11090496 DOI: 10.20517/jeea.2023.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Thirdhand smoke (THS) is the accumulation of secondhand smoke on surfaces that ages with time. THS exposure is a potential health threat to children, partners of smokers, and workers in environments with current or past smoking, and needs further investigation. In this study, we hypothesized that thirdhand Electronic Nicotine Delivery Systems (ENDS) exposures elicit lung and systemic inflammation due to resuspended particulate matter (PM) and inorganic compounds that remain after active vaping has ceased. To test our hypothesis, we exposed C57BL/6J mice to cotton towels contaminated with ENDS aerosols from unflavored vape fluid (6 mg nicotine in 50/50 propylene glycol/vegetable glycerin) for 1h/day, five days/week, for three weeks. We assessed protein levels in serum and bronchoalveolar lavage fluid (BALF) using a multiplex protein assay. The mean ± sd for PM10 and PM2.5 measurements in exposed mouse cages were 8.3 ± 14.0 and 4.6 ± 7.5 μg/m3, compared to 6.1 ± 11.2 and 3.7 ± 6.6 μg/m3 in control cages respectively. Two compounds, 4-methyl-1, 2-dioxolane and 4-methyl-cyclohexanol, were detected in vape fluid and on ENDS-contaminated towels, but not on control towels. Mice exposed to ENDS-contaminated towels had lower levels of serum Il-7 (P = 0.022, n = 7), and higher levels of Il-13 in the BALF (P = 0.006, n = 7) than those exposed to control towels (n = 6). After adjusting for sex and age, Il-7 and Il-13 levels were still associated with thirdhand vaping exposure (P = 0.010 and P = 0.017, respectively). This study provides further evidence that thirdhand ENDS aerosols can contaminate surfaces, and subsequently influence lung and systemic health upon exposure.
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Affiliation(s)
- Sarah Commodore
- Department of Environmental and Occupational Health, School of Public Health Bloomington, Indiana University, Bloomington, IN 47408, USA
| | - Shikha Sharma
- Department of Environmental and Occupational Health, School of Public Health Bloomington, Indiana University, Bloomington, IN 47408, USA
| | - Carolyn Damilola Ekpruke
- Department of Environmental and Occupational Health, School of Public Health Bloomington, Indiana University, Bloomington, IN 47408, USA
| | - Robert Pepin
- Department of Chemistry, Indiana University, Bloomington, IN 47405, USA
| | - Angela M. Hansen
- Department of Chemistry, Indiana University, Bloomington, IN 47405, USA
| | - Dustin Rousselle
- Department of Environmental and Occupational Health, School of Public Health Bloomington, Indiana University, Bloomington, IN 47408, USA
| | - Maksat Babayev
- Department of Environmental and Occupational Health, School of Public Health Bloomington, Indiana University, Bloomington, IN 47408, USA
| | - Jonas M. Ndeke
- Department of Epidemiology and Biostatistics, School of Public Health Bloomington, Indiana University, Bloomington, IN 47405, USA
| | - Rachel Alford
- Department of Environmental and Occupational Health, School of Public Health Bloomington, Indiana University, Bloomington, IN 47408, USA
| | - Erik Parker
- Biostatistics Consulting Center, Department of Epidemiology and Biostatistics, School of Public Health Bloomington, Indiana University, Bloomington, IN 47405, USA
| | - Stephanie Dickinson
- Biostatistics Consulting Center, Department of Epidemiology and Biostatistics, School of Public Health Bloomington, Indiana University, Bloomington, IN 47405, USA
| | - Sunita Sharma
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Patricia Silveyra
- Department of Environmental and Occupational Health, School of Public Health Bloomington, Indiana University, Bloomington, IN 47408, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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Ali FRM, Schillo B, Crane E, Seaman EL, King BA. Evaluation of statewide restrictions on e-cigarette nicotine strength-United States, 2017-2022. Addiction 2023; 118:1701-1709. [PMID: 37039371 DOI: 10.1111/add.16206] [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: 09/05/2022] [Accepted: 03/22/2023] [Indexed: 04/12/2023]
Abstract
AIMS To evaluate statewide policies restricting e-cigarette nicotine strength. DESIGN A difference-in-difference regression analysis was used to compare e-cigarette sales in states that restrict nicotine strength with states with no restrictions. Because flavor restrictions might affect sales and nicotine strength, states with flavor restrictions were also assessed. SETTING AND CASES United States e-cigarette retail sales data during January 2017 to March 2022 were licensed from Information Resources Incorporated. States with restrictions included Massachusetts (restricted maximum nicotine strength to 3.5% and nontobacco flavored e-cigarette sales in December 2019); Utah (restricted nicotine strength to 3.6% in September 2021); and Rhode Island, New York and Washington (restricted nontobacco flavor sales in October 2019, May 2020 and October 2019 to January 2020, respectively). These were compared with data from 34 states with no e-cigarette nicotine strength or flavor restrictions. MEASUREMENTS Weighted mean nicotine strength and total unit sales. Total unit sales per 1000 state population were summed into 4-week periods by state. Models controlled for emergency responses, state demographics, tobacco control policies, time and state fixed effects. FINDINGS Restricting both nicotine strength and flavors in Massachusetts was associated with a 2.04 percentage point (pp) reduction in mean nicotine strength and 86.76-unit reduction in monthly unit sales per 1000 persons compared with states with no restrictions (all P < 0.01). Restricting nicotine strength only in Utah was associated with a 1.77 pp (P < 0.01) reduction in mean nicotine strength; however, there was no impact on unit sales. Restricting nontobacco flavor sales only in Rhode Island, New York and Washington slightly reduced mean nicotine strength (0.21, 0.62 and 0.19 pp, respectively) and sales (36.66, 34.51 and 16.37 units, respectively) (all P < 0.01). CONCLUSIONS United States statewide policies restricting e-cigarette nicotine strength appear to be associated with reductions in average nicotine strength in sales within that state; however, there appears to be no impact on unit sales. When these policies are implemented along with flavor restrictions; reductions in average nicotine strength occur in addition to reduced unit sales.
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Affiliation(s)
- Fatma Romeh M Ali
- Non-Infectious Disease Programs, CDC Foundation, Atlanta, Georgia, USA
| | - Barbara Schillo
- Truth Initiative Schroeder Institute, Washington, District of Columbia, USA
| | - Elisha Crane
- Non-Infectious Disease Programs, CDC Foundation, Atlanta, Georgia, USA
| | | | - Brian A King
- Office on Smoking and Health (OSH), Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Diaz MC, Silver NA, Bertrand A, Schillo BA. Bigger, stronger and cheaper: growth in e-cigarette market driven by disposable devices with more e-liquid, higher nicotine concentration and declining prices. Tob Control 2023:tc-2023-058033. [PMID: 37536928 DOI: 10.1136/tc-2023-058033] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/20/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE Given the evolving changes in the disposable e-cigarette market, we explore patterns of sales in the USA by e-liquid volume capacity, nicotine strength and real sales-weighted average prices by both e-cigarette unit and volume of e-liquid. METHODOLOGY We used NielsenIQ retail scanner data from January 2017 to September 2022 to examine changes over time for average product volume capacity in millilitres, nicotine strength (%) and both sales-weighted average price per disposable unit and per millilitre of e-liquid for each 4-week period. RESULTS Among disposable e-cigarettes sold between January 2017 and September 2022, average volume capacity increased 518% from 1.1 mL to 5.7 mL and average nicotine strength increased 294% from 1.7% to 5%. Sales-weighted average price per disposable unit and millilitres of e-liquid both remained relatively constant until January 2020. From January 2020 through September 2022, average unit prices increased 165.7% from US$8.49 to US$14.07, while the average price of 1 mL of e-liquid decreased 69.2% from US$7.96 to US$2.45. CONCLUSIONS The current regulatory regime around e-cigarettes has resulted in disposable e-cigarette manufacturers providing consumers with bigger, cheaper disposable e-cigarettes that come in increasingly higher nicotine strengths. Tobacco policy recommendations such as restricting e-liquid capacity and minimum price laws as well as regulations on product characteristics that affect nicotine emissions and delivery such as nicotine strength, nicotine output, device power, and puff duration should be considered in regulating the e-cigarette market.
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Affiliation(s)
- Megan C Diaz
- Schroeder Institute, Truth Initiative, Washington, DC, USA
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Muthumalage T, Rahman I. Pulmonary immune response regulation, genotoxicity, and metabolic reprogramming by menthol- and tobacco-flavored e-cigarette exposures in mice. Toxicol Sci 2023; 193:146-165. [PMID: 37052522 PMCID: PMC10230290 DOI: 10.1093/toxsci/kfad033] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
Menthol and tobacco flavors are available for almost all tobacco products, including electronic cigarettes (e-cigs). These flavors are a mixture of chemicals with overlapping constituents. There are no comparative toxicity studies of these flavors produced by different manufacturers. We hypothesized that acute exposure to menthol and tobacco-flavored e-cig aerosols induces inflammatory, genotoxicity, and metabolic responses in mouse lungs. We compared two brands, A and B, of e-cig flavors (PG/VG, menthol, and tobacco) with and without nicotine for their inflammatory response, genotoxic markers, and altered genes and proteins in the context of metabolism by exposing mouse strains, C57BL/6J (Th1-mediated) and BALB/cJ (Th2-mediated). Brand A nicotine-free menthol exposure caused increased neutrophils and differential T-lymphocyte influx in bronchoalveolar lavage fluid and induced significant immunosuppression, while brand A tobacco with nicotine elicited an allergic inflammatory response with increased Eotaxin, IL-6, and RANTES levels. Brand B elicited a similar inflammatory response in menthol flavor exposure. Upon e-cig exposure, genotoxicity markers significantly increased in lung tissue. These inflammatory and genotoxicity responses were associated with altered NLRP3 inflammasome and TRPA1 induction by menthol flavor. Nicotine decreased surfactant protein D and increased PAI-1 by menthol and tobacco flavors, respectively. Integration of inflammatory and metabolic pathway gene expression analysis showed immunometabolic regulation in T cells via PI3K/Akt/p70S6k-mTOR axis associated with suppressed immunity/allergic immune response. Overall, this study showed the comparative toxicity of flavored e-cig aerosols, unraveling potential signaling pathways of nicotine and flavor-mediated pulmonary toxicological responses, and emphasized the need for standardized toxicity testing for appropriate premarket authorization of e-cigarette products.
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Affiliation(s)
- Thivanka Muthumalage
- Department of Environmental Medicine, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York 14642, USA
| | - Irfan Rahman
- Department of Environmental Medicine, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York 14642, USA
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