E-Cigarettes-a review of the evidence-harm versus harm reduction

Perspectives, motivations, and experiences of adolescents and young adults using nicotine vapes: a qualitative review

The emergence of vaping represents a novel phenomenon, highlighting its distinctive role within contemporary society. Nevertheless, the comprehensive understanding of the cultural significance and social norms associated with vaping remains incomplete. This scoping review aimed to report the perspectives, motivations, and experiences of adolescents and young adults (10-25 years) engaging in the use of nicotine vapes. Peer-reviewed primary research published in English from 2003 to February 2024 was identified using the databases PubMed, Scopus, CINAHL, and PsycINFO. Qualitative studies reporting on the perspectives, motivations, and experiences of adolescents and young adults who currently engage in nicotine and tobacco vape use were included. Thematic analysis revealed three key themes in adolescents and young adults vaping: understanding and reasons for vaping, the challenges of addiction and withdrawal, and varied responses from families and caregivers. Adolescents and young adults are often introduced to vaping by peers and siblings, drawn by the desire to fit in and the appealing flavours. Despite awareness of potential health risks, addiction makes quitting difficult, leading to intense cravings and withdrawal challenges. Families show a spectrum of responses, from ignorance to reluctant acceptance, indicating a need for better awareness and intervention strategies to address adolescent vaping. Establishing a withdrawal pathway for vaping is imperative as an intervention strategy to address the prevalence of vaping among adolescents and young adults.

Comparing self-rated health among exclusive e-cigarette users and traditional cigarette smokers: an analysis of the Health Survey for England 2019

The health implications of e-cigarette use compared to traditional cigarette smoking continue to attract significant public health interest. This study examines self-rated health (SRH) outcomes among exclusive e-cigarette users versus exclusive traditional cigarette smokers, using data from the Health Survey for England 2019. From an initial sample of 10,299 participants, the study focused on 8204 adults, excluding those aged 0-15. Further refinement to exclusive nicotine product users led to 274 e-cigarette users and 1017 cigarette smokers, after excluding dual users, never users, ex-users, non-responders, and users of other tobacco products such as pipes and cigars. SRH was derived from participants' responses to a question asking how they rated their general health, with five possible options: "very good", "good", "fair", "bad", and "very bad". For the purposes of this study, these responses were collapsed into two categories: "Good Health" (combining "very good" and "good") and "Poor Health" (combining "fair", "bad", and "very bad"). Consequently, 834 participants were classified as reporting good health, while 457 reported poor health. Binary logistic regression, adjusted for factors such as age, sex, ethnicity, residence, education, body mass index, alcohol use, age started smoking, physical or mental health conditions, and frequency of GP visits, revealed that exclusive e-cigarette users were significantly more likely to report good health compared to exclusive cigarette smokers, with an odds ratio (OR) of 1.59 (95% CI: 1.10 - 2.32, p = 0.014). As a sensitivity analysis, a generalized ordered logistic regression model was performed using the original five SRH categories. The adjusted model confirmed consistent results, with exclusive e-cigarette users showing higher odds of reporting better health across the full range of SRH outcomes (OR = 1.40, 95% CI: 1.08-1.82, p = 0.011). These findings suggest that exclusive e-cigarette users perceive their health more positively than traditional cigarette smokers, contributing useful insights to the discussions around harm reduction strategies.

Pavlovian conditioning with the internal stimulus effects of intravenous nicotine heightens later nicotine taking with variation by dose and sex

We have previously demonstrated that the interoceptive stimulus effects of intravenous nicotine (0.03 mg/kg/inf) can acquire conditioned reinforcing value through appetitive Pavlovian conditioning. In this report, we replicate and extend that work by examining the dose- and sex-generality of this effect. 240 male and female Sprague-Dawley rats were divided into groups defined by infusion dose (0, 0.003, 0.01, or 0.03 mg/kg nicotine). These were further divided into rats who received Paired or Unpaired appetitive conditioning between infusions and sucrose presentations. Interoceptive conditioning took place over 24 daily sessions. The Paired group received 10 trials of response-independent infusions of their assigned nicotine dose followed 30 s afterwards by 4-s access to sucrose. The Unpaired group also received 10 infusions and 10 deliveries of sucrose but spaced 4-8 min apart. Thereafter, the chambers were refitted with nosepokes and all groups could self-administer infusions of their assigned solution according to a progressive ratio schedule. Paired conditioning history enhanced the later self-administration of 0.01 and 0.03 mg/kg/inf nicotine in females. Males self-administered 0.03 mg/kg/inf nicotine-regardless of conditioning history. These data demonstrate that appetitive learning involving the stimulus effects of nicotine can substantially alter the reinforcing effects of nicotine in later self-administration, which effect is both dose- and sex-dependent.

Assessing the Complex Impact of Smoking Habits on Allergic Rhinitis: A National Cross-Sectional Study

OBJECTIVES

Allergic rhinitis (AR) significantly impacts quality of life and incurs socioeconomic costs. The influence of smoking habits, including the use of conventional cigarettes (CCs) and electronic cigarettes (ECs), on the prevalence and management of AR remains a subject of debate. This study aims to explore the association between smoking status (CC and EC use) and the prevalence and management of AR among Koreans by analyzing data from the Korea National Health and Nutrition Examination Survey (KNHANES) VII (2018) and VIII (2019-2021).

METHODS

This cross-sectional study involved 22,290 participants aged 19 years and older from the KNHANES. Participants self-reported their smoking status, and urinary cotinine levels were measured to assess nicotine exposure. We employed statistical analyses, including logistic regression, to examine the relationships between smoking status, cotinine levels, and the prevalence and management of AR.

RESULTS

In univariable logistic regression analysis, EC users exhibited a 35.8% increased risk of AR compared to non-smokers, whereas CC users experienced a 27.7% reduced risk. Multivariable logistic regression analysis showed a 20.3% lower risk of AR among CC users; however, no significant association was observed for EC users. Higher cotinine levels (>500 ng/mL) were associated with a lower prevalence of AR. Specifically, heavy CC users with high cotinine levels demonstrated a 35% reduced risk of AR. Nonetheless, after adjusting for confounders, this association was no longer significant, indicating that other variables might influence this relationship.

CONCLUSION

Smoking status is associated with the prevalence of AR in Koreans. Notably, heavy use of CCs is negatively correlated with the prevalence of AR.

Vaping among young adults in Singapore: a qualitative study of motivations, challenges and antivaping intervention perceptions

INTRODUCTION

The increasing use of electronic cigarettes among young adults in Southeast Asia is concerning. This study explores the motivations and challenges faced by young adults in quitting vaping and their perceptions of current public health messages and interventions in Singapore, which has stringent antivaping laws and active public health campaigns.

METHODS

A qualitative descriptive study was conducted involving in-depth interviews with 15 participants aged 18-35. Thematic analysis was performed by two independent researchers trained in qualitative methods.

RESULTS

Participants identified negative health outcomes and legal risks as major motivations for quitting vaping. Challenges included nicotine addiction, psychological dependency and entrenched vaping routines. The study revealed general scepticism towards current antivaping messages, which were seen as too generic and lacking credibility. Participants recommended that public health messages be more specific, transparent and engaging, incorporating independent research and visual aids to highlight vaping risks. They also suggested regulating e-cigarette sales instead of implementing blanket bans, ensuring anonymity for those seeking help and providing comprehensive nicotine cessation support. Additionally, the use of real-life testimonials and influencers was proposed to improve message relatability and effectiveness.

CONCLUSION

This study provides valuable insights into the motivations and barriers of quitting vaping among young adults. Enhancing the transparency and specificity of antivaping messages, along with more tailored and supportive interventions, could increase their effectiveness and offer guidance for other Southeast Asian countries facing similar issues.

Usage, knowledge and attitudes towards electronic cigarettes use among nursing students in Croatia: a cross-sectional study

BACKGROUND

Evidence shows harmful effects of e-cigarettes on health. There is limited data on the use of e-cigarettes among nursing students. This study aimed to investigate the usage, knowledge, and attitudes towards e-cigarettes among nursing students in Croatia, as well as their views on the role of nurses in counseling patients and assisting with smoking cessation.

METHODS

This cross-sectional study was conducted via an online questionnaire among nursing students at 10 universities in Croatia in March/April 2024. Students were asked questions about socio-demographics, knowledge and attitudes towards e-cigarettes and their views on the role of nurses in counseling patients and assisting with smoking cessation.

RESULTS

The study included 1,039 participants; 89% were women, 43% were smokers; 53% used e-cigarettes and 76% used them for recreational purposes. 21% of participants agreed that e-cigarettes are an effective method for quitting smoking. More than half indicated that e-cigarettes could encourage non-smokers to start smoking. The majority (60%) reported that they had never received education on smoking cessation at university. Furthermore, 66% stated that they did not feel confident advising smokers about e-cigarettes. The majority (70%) considered physicians to be the most knowledgeable health experts to advise and educate users of e-cigarettes. There were no significant differences in attitudes between smokers and non-smokers on the use of e-cigarettes. Participants demonstrated insufficient knowledge about e-cigarettes. Non-smokers had more positive attitudes towards the role of nurses in combating smoking compared to smokers. Participants who had received education on smoking cessation were more willing to advise smokers and had clearer views on the risks and the importance of the nurse's role in the quitting process compared to those who had not received such education. Smoking status and age were significant predictors of counseling confidence.

CONCLUSION

The study found a high prevalence of smoking and e-cigarette use among Croatian nursing students, along with limited knowledge and generally negative attitudes towards e-cigarettes. It highlighted gaps in education regarding the health risks of e-cigarettes and the lack of practical skills needed to help smokers quit, suggesting that nursing programs should update their curricula to better prepare students in these areas.

Interest in Quitting and Utilizing Quitline Services Among Long-Term E-Cigarette Users

BACKGROUND

Electronic cigarettes (e-cigs) contain fewer hazardous ingredients than traditional cigarettes, yet they still pose health hazards. This study evaluates experienced e-cig users' quitting interest and Quitline utilization.

METHODS

In a 2012 (Wave 1) baseline survey, 1875 (28.9%) provided consent consented to future study contact. This study focused on a follow-up survey sent in 2022 (4). The main indicators assessed were participants' were participants awareness, willingness, and motivations to utilize Quitlines to quit e-cigs. The Penn State Electronic Cigarette Nicotine Dependence Index (PSECDI) was used to assess the level of dependence on e-cigs. Descriptive statistics were used to examine the outcomes of interest. Additionally, a thematic analysis was performed to evaluate qualitative data.

RESULTS

Participants (n = 195) had a mean age of 52.4 (SD = 12.1) years, 64.6% (n = 126) were male, and the majority were Caucasian/White (88.2%, n = 172). About 42% (n = 82/195) of respondents had previously tried to quit e-cig use. Of these, more than half (63.4%, n = 52/82); had heard of Quitline; however, very few (9.8%, n = 8/82) were interested in utilizing Quitline services for assistance with quitting e-cigs. The themes that emerged included the impersonal nature of telephone counseling, lack of trust in external assistance, belief in participants' ability to quit without help, and skepticism about the effectiveness of Quitline interventions.

CONCLUSION

There was widespread reluctance to utilize Quitline cessation services among experienced e-cig users. To enhance engagement in cessation programs, such as Quitline, it may be helpful to consider specialized counseling and support tailored to the unique challenges among e-cig users.

Differences in Pain Severity and Interference between Latinx Combustible Cigarette Smokers and Dual Users with Current Pain

Latinx individuals who smoke represent a tobacco health disparities group. Yet, limited research has focused on examining dual combustible and electronic cigarette use among Latinx populations. Importantly, Latinx persons who smoke also evince elevated rates of pain problems and symptoms and prior research has consistently linked pain problems and severity to smoking prevalence, maintenance, and behavior. Accordingly, the current study sought to build from the limited work that exists among dual combustible cigarette and electronic cigarette Latinx users comparing levels of pain severity and interference. The current sample consists of 196 adult Latinx daily cigarette smokers (35.48 years old; 39.4% female), of which 72 reported current daily dual use of an e-cigarette. Results indicated that Latinx dual users reported greater levels of pain severity (ηp2 = .12) and pain interference (ηp2 = .10) than exclusive combustible cigarette users. The study adds uniquely to the limited literature on the clinical importance of dual cigarette use in relation to pain severity and interference in that pain may serve as an important risk factor for the initiation and maintenance of dual use for increased analgesic nicotine effects.

Childhood traumatic experiences and vaping among Australian adolescents: A prospective investigation

INTRODUCTION

Childhood traumatic experiences (CTE) have been identified as a robust risk factor for a range of substance use behaviours. However, little is known about their association with adolescent vaping. We explored prospective associations between CTEs and vaping among a sample of Australian adolescents.

METHODS

The sample comprised 2234 adolescents (baseline Mage = 12.7 years, SD = 0.5; 49.9% female) enrolled in the Health4Life cluster randomised controlled trial. Using mixed effects logistic regression analyses, data from the baseline and 36-month assessment waves were used to examine whether CTEs (by ~ age 12) were associated with current or lifetime vaping and future intentions to vape (~ age 15).

RESULTS

Adjusting for socio-demographic variables, CTE exposure at baseline was associated with higher odds of ever having vaped (odds ratio 1.64, 95% confidence interval 1.34, 2.02), and of being a current regular vape user (odds ratio 1.63, 95% confidence interval 1.11, 2.39). Experiencing CTEs was also associated with higher odds of intending to vape in the future (odds ratio 1.44, 95% confidence interval 1.11, 1.86).

DISCUSSION AND CONCLUSIONS

This study is the first to identify CTEs as a risk factor for vaping, and intentions to vape in the future, among Australian adolescents. These findings align with global research and highlight another common risk factor across various forms of substance use. CTE exposed adolescents represent a priority group who may require earlier and more targeted vaping intervention.

Nicotine and Vape: Drugs of the Same Profile Flock Together

Smoking, a major behavioral health burden, causes preventable and premature deaths globally. Nicotine, the addictive component present in tobacco products and Electronic cigarettes (E-cigarettes, vape), can bind to nicotinic acetylcholine receptors in the brain to trigger a dopamine release that reinforces smoking. Despite the widespread usage of nicotine, its mechanisms of toxicity, particularly in e-cigarettes, are poorly understood. Using Drosophila melanogaster as a model organism, this study aims to investigate the mechanism of the toxicity of nicotine and vape. Behavioral parameters, oxidative stress indicators, mRNA expression levels of Dopamine 1- receptor 1 (Dop1R1), Acetyl-coenzyme A synthetase (AcCoAs), and apoptotic proteins were assessed in the flies after a 5-day exposure to varying concentrations of nicotine (0.15, 0.25, and 0.35 mg/mL diet) and vape (0.06, 0.08, and 0.12 mg/mL diet). Furthermore, Gas Chromatography-Mass Spectrometry (GC/MS) and Gas Chromatography-Flame Ionization Detection (GC/FID) analyzes were conducted to gain more insight on the composition of the vape used in study. Findings indicate that both nicotine and vape exposure significantly reduced lifespan, impaired locomotor activity, and disrupted sleep patterns. Notably, nicotine exposure stimulated Dop1R1 transcription and altered Acetyl-CoA gene expression, impacting the viability and behavior of the flies. Elevated levels of reactive oxygen biomarkers were observed, contributing to cellular damage through oxidative stress and apoptotic mechanisms mediated by the Reaper and DIAP1 proteins. Additionally, the composition analysis of vape liquid revealed the presence of propylene glycol, nicotine, methyl esters, and an unidentified compound. This study highlights the complex interplay between nicotine, gene expression, and physiological responses in Drosophila.

E-cigarette use and respiratory illnesses among U.S. adults: An analysis of the Population Assessment of Tobacco and Health Study

INTRODUCTION

Electronic cigarettes (e-cigarette) entered the United States marketplace in 2007. Because of the chemical composition of e-cigarette liquid, there are concerns related to its effects on respiratory illnesses.

METHODS

Using Wave 4 (2016-2018) of the adult (≥18 years of age) Population Assessment of Tobacco and Health study, logistic regression was used to quantify the association between e-cigarette use and any respiratory illness (asthma, chronic bronchitis, COPD, emphysema, or other lung or respiratory conditions). Age, gender, and the use of other tobacco products were assessed as modifiers of this relationship via interactions on the additive and multiplicative scales.

RESULTS

After adjustment, ever e-cigarette use was associated with a 1.32 (95 % confidence intervals [CI]:1.03, 1.69) greater odds of any respiratory illness compared with never e-cigarette users among U.S. adults. When comparing ever and never e-cigarette users, older adults (Odds Ratio [OR] = 1.65, 95 %CI:1.20, 2.26), and ever users of other tobacco products (OR = 1.77, 95 %CI:1.37, 2.29) had greater odds of reporting any respiratory illness than younger adults and those who never used other tobacco products. Among never e-cigarette users, men (OR = 1.51, 95 %CI:1.12, 2.04) were less likely to report any respiratory illness than women. Only the joint effect of age and e-cigarette use on any respiratory illness was statistically significant, suggesting this effect was greater than expected on the additive and multiplicative scales.

CONCLUSION

These findings suggest that the relationship between e-cigarette use and any respiratory illness varies with age. Interventions and policies to reduce e-cigarette use should target high-risk groups for any respiratory illness.

Evaluating MIR and NIR Spectroscopy Coupled with Multivariate Analysis for Detection and Quantification of Additives in Tobacco Products

The detection and quantification of additives in tobacco products are critical for ensuring consumer safety and compliance with regulatory standards. Traditional analytical techniques, like gas chromatography-mass spectrometry (GC-MS), liquid chromatography-mass spectrometry (LC-MS), and others, although effective, suffer from drawbacks, including complex sample preparation, high costs, lengthy analysis times, and the requirement for skilled operators. This study addresses these challenges by evaluating the efficacy of mid-infrared (MIR) spectroscopy and near-IR (NIR) spectroscopy, coupled with multivariate analysis, as potential solutions for the detection and quantification of additives in tobacco products. So, a representative set of tobacco products was selected and spiked with the targeted additives, namely caffeine, menthol, glycerol, and cocoa. Multivariate analysis of MIR and NIR spectra consisted of principal component analysis (PCA), hierarchical clustering analysis (HCA), partial least squares-discriminant analysis (PLS-DA) and soft independent modeling of class analogy (SIMCA) to classify samples based on targeted additives. Based on the unsupervised techniques (PCA and HCA), a distinction could be made between spiked and non-spiked samples for all four targeted additives based on both MIR and NIR spectral data. During supervised analysis, SIMCA achieved 87-100% classification accuracy for the different additives and for both spectroscopic techniques. PLS-DA models showed classification rates of 80% to 100%, also demonstrating robust performance. Regression studies, using PLS, showed that it is possible to effectively estimate the concentration levels of the targeted molecules. The results also highlight the necessity of optimizing data pretreatment for accurate quantification of the target additives. Overall, NIR spectroscopy combined with SIMCA provided the most accurate and robust classification models for all target molecules, indicating that it is the most effective single technique for this type of analysis. MIR, on the other hand, showed the overall best performance for quantitative estimation.

Impact of smoke-free legislation on stroke risk: A systematic review and meta-analysis

PURPOSE

Secondhand smoke significantly increases the risk of cerebrovascular diseases, prompting recent public smoking bans. We aimed to ascertain the effects of smoke-free legislation on stroke incidence and mortality.

METHODS

We systematically searched Medline, Embase, Cochrane Library, and Scopus up to August 13, 2023, for studies reporting changes in stroke incidence following partial or comprehensive smoking bans. A random-effects meta-analysis was conducted on hospital admissions and mortality for stroke, stratified based on comprehensiveness of the ban ((i) workplaces-only, (ii) workplaces and restaurants, (iii) workplaces, restaurants and bars). The effect of post-ban follow-up duration was assessed visually by a forest plot, while meta-regression was employed to evaluate for any dose-response relationship between ban comprehensiveness and stroke risk.

FINDINGS

Of 3987 records identified, 15 studies analysing bans across a median follow-up time of 24 months (range: 3-67) were included. WRB bans were associated with reductions in the rates of hospital admissions for stroke (nine studies; RR, 0.918; 95% CI, 0.872-0.967) and stroke mortality (three studies; RR, 0.987; 95% CI, 0.952-1.022), although the latter did not reach statistical significance. There was no significant difference in the risk of stroke admissions for studies with increased ban comprehensiveness and no minimum duration for significant post-ban effects to be observed.

DISCUSSION AND CONCLUSION

Legislative smoking bans were associated with significant reductions in stroke-related hospital admissions, providing evidence for its utility as a public health intervention.

Breaking the Myths Around e-Cigarettes: A Narrative Review Exploring the Impact of e-Cigarette on Human Health

In 2006, electronic cigarettes, or e-cigarettes, made their debut on the international scene. The term Electronic Nicotine Delivery Systems (ENDS) was introduced by the World Health Organization (WHO) in 2009 to refer to the many kinds of electronic cigarettes that include nicotine. This review article will provide a full investigation of the relationship between vaping and its effects on the body. The keywords utilized for search include "smoking cessation," "smoking," "e-cigarette use in adolescents," "human health," and "e-cigarettes." Our review goes into detail on the mechanism and components that make up a vaporizer. It explains how the components cause various side effects on human health. It is illustrated that vaping has various side effects and suggested that the risk of using vape should be educated to all. e-Cigarettes should be subjected to the same marketing limitations and establish quality standards for ingredients and functioning of e-cigarette devices. Thus, by deepening our understanding of these relationships and providing the results of the analysis accompanied by concise and meaningful illustrations to aid in understanding vaping and the physiological effects of the potential harm from vaping, we pave the way for future research on the quantity of puff to determine the harm level.

Assessment of Respiratory Health Implications of Vaping: A Systematic Review of Toxicity Mechanisms and Adverse Effects of Electronic Nicotine Delivery Systems

E-cigarettes are thought to aid in tobacco smoking cessation, but there are concerns about their overall effectiveness and safety for the general population, particularly adults. This review aims to investigate the mechanisms of toxicity and adverse effects of e-cigarettes on the respiratory system, comparing these effects with those of conventional smoking. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches were performed on PubMed, Embase, and the Cochrane Library using keywords, controlled vocabulary, and text words, with the following criteria: studies published in English from 2014 to 2024, open access, peer-reviewed, and full-text availability. Study selection, quality assessment, and data extraction were carried out by two independent reviewers. The Cochrane Risk of Bias 2.0 tool was used to evaluate the risk of bias in included randomized controlled trials, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool was employed to assess the strength of evidence and determine its generalizability. Electronic nicotine delivery systems (ENDS) have diverse mechanisms of toxicity, including inflammation, hypoxia, cardiovascular stress, and metabolic changes. Reported adverse effects include cough, throat irritation, nausea, and hemodynamic changes. However, ENDS are associated with fewer risks compared to conventional cigarette smoking. ENDS users experience fewer respiratory and cardiovascular issues and have lower levels of biomarkers such as NNAL and CO compared to traditional smokers. Additionally, ENDS are more effective than nicotine replacement therapy (nicotine patches) for smoking cessation, particularly in pregnant women. The side effects of ENDS and nicotine-free vaping are similar to those of conventional smoking in pregnant women, with the exception of a lower birth weight among newborns exposed to ENDS (p < 0.05). ENDS present a complex balance of benefits and risks regarding respiratory health. While there are adverse effects, ENDS are considered less detrimental than conventional smoking and a viable option for smoking cessation. Longitudinal studies are needed to evaluate their safety with long-term use (>16 weeks). Policymakers and health practitioners should use these findings to develop balanced public health policies that weigh the benefits of ENDS against potential health risks, enabling informed decision-making for users.

Stimulus mediation, specificity and impact of menthol in rats trained to discriminate puffs of nicotine e-cigarette aerosol from nicotine-free aerosol

RATIONALE

It is unclear if e-cigarettes have reduced abuse liability relative to traditional cigarettes, especially when considering advanced devices which deliver nicotine more efficiently. Translatable and predictive animal models are needed to addresses this question.

OBJECTIVES

Our goal was to explore the subjective stimulus effects of e-cigarettes by training rats to discriminate puffs of nicotine aerosol from vehicle aerosol using an aerosol delivery system designed to model e-cigarette use patterns in humans.

METHODS

Rats were trained to discriminate between ten, 10 s puffs of aerosol generated from 3 mg/ml nicotine e-liquid and nicotine-free e-liquid using a food-reinforced operant procedure. Following acquisition, tests were conducted to determine the specificity of the nicotine aerosol stimulus as well as the impact to the stimulus effects of nicotine resulting from the addition of menthol to e-liquid.

RESULTS

Rats learned the nicotine aerosol puff vs vehicle puff discrimination in a mean of 25 training sessions. Injected nicotine fully substituted for the stimulus effects of nicotine aerosol. The stimulus effects of nicotine aerosol were blocked by the nicotinic receptor antagonist mecamylamine. The nicotinic receptor partial agonist, varenicline as well as the stimulant d-amphetamine substituted more robustly for nicotine aerosol puffs than did the NMDA antagonist, ketamine. Menthol enhanced the stimulus effects of nicotine aerosol without altering nicotine blood plasma levels.

CONCLUSIONS

Nicotine aerosol puffs can function as a training stimulus in rats. The stimulus effects were CNS-mediated and receptor specific. Menthol appears to enhance the stimulus effects of nicotine aerosol through a pharmacodynamic rather than pharmacokinetic mechanism.

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.

Vaping, Smoking and Lung Cancer Risk

Nicotine exposure through the use of electronic delivery systems (vaping) has been found to elevate the risk of certain conditions of the lungs, e.g., vaping associated lung injury, EVALI). However, the potential impact of vaping on lung cancer risk remains unexplored. We, therefore, examined the association of vaping and cigarette smoking with lung cancer risk in a case control study conducted in central Ohio. The study design compared 4,975 individuals with recently diagnosed pathologically confirmed carcinoma of the lung to 27,294 controls without cancer that were group matched at a 5:1 ratio to the cases by age, gender, race and location of residence. Odds ratios (OR) adjusted for gender, age and race revealed a fourfold higher risk of lung cancer among individuals who vaped in combination with chronic smoking (OR=58.9, 95% CI=47.3-70.5) versus individuals who only smoked cigarettes (OR=13.9, 95% CI=12.7-15.3, P<0.001). Further adjustment for prevalent comorbidities, chronic obstructive pulmonary disease and coronary artery disease, reduced the magnitude of the OR, but the risk for vaping and smoking (OR=38.7, 95% CI =31.5-47.6) remained fourfold higher than for smoking alone (OR=9.6, 95% CI=8.7-10.6, P<0.001). This finding was consistent for men and women, with adjustment for pack-years of smoking, and for the main histological cell types of lung cancer. Our results suggest that the addition of vaping to smoking accelerates the risk of developing lung cancer.

State of art of micronuclei assay in exfoliative cytology as a clinical biomarker of genetic damage in oral carcinogenesis: A systematic review and meta-analysis

Oral squamous cell carcinoma (OSCC) is the most common oral malignancy, often preceded by oral potentially malignant disorders (OPMDs). Currently, no clinical biomarker exists to predict malignancy, necessitating OPMD follow-up. Habits and environmental factors, such as smoking, and alcohol consumption, influence OSCC onset. Increased micronuclei (MNs) formation has been observed in the development of OSCC. Non-invasive diagnostic tests like exfoliative cytology offer painless and regular monitoring options. This study evaluates the impact of tobacco, alcohol, and pesticide exposure on MNs occurrence in exfoliative cytology-collected oral mucosal cells, assessing their potential as non-invasive biomarker for OSCC development prediction and monitoring in high-risk patients. Despite results from this meta-analysis supporting the existence of a stepwise increase from controls to patients with OPMD to OSCC, the translation of these findings into clinical practice is limited due to intra- and inter-individual heterogeneity, as well as methodological variability in MNs quantification. Various factors contribute to this heterogeneity, including demographic variables, methodological variability of different laboratories, staining techniques, sample collection location, and patient characteristics. All these points were discussed to provide further insights and improve standardization for future studies.

E-cigarette use among Ecuadorian adults: A national cross-sectional study on use rates, perceptions, and associated factors

INTRODUCTION

Electronic cigarettes (e-cigarettes) have emerged as a new paradigm in nicotine delivery systems. Although they are marketed as safer alternatives to tobacco, public perceptions of their safety and utility vary widely. This study aims to understand the percentage of use, factors associated, perceptions, and attitudes about e-cigarettes among Ecuadorian adults.

METHODS

A cross-sectional survey was conducted among the Ecuadorian population aged 18-65 years through a convenience sample, using a structured online questionnaire designed to collect responses from voluntary participants over three months, from February to April 2023. The questionnaire assessed the respondents' attitudes and perceptions towards e-cigarettes. Data were analyzed using descriptive statistics, chi-squared tests, and adjusted logistic regression analyses to identify factors associated with e-cigarette use.

RESULTS

Out of a total of 3047 Ecuadorian adults, the percentage of e-cigarette ever use was 27.9% (n=850), with 19.4% being current users and 8.5% former users. A negative stance towards e-cigarettes was predominant, with 66.3% considering e-cigarette use a public health problem in Ecuador. A significant association was observed between e-cigarette use and perceived harmfulness (p<0.001). Among non-users, there was a predominant stance in favor of control measures and disapproval of e-cigarette use among minors (p<0.001). The factors associated with the use of electronic cigarettes included being health personnel (AOR=1.51; 95% CI: 1.26-1.80). Older age (aged >24 years) and a history of tobacco use were associated with lower e-cigarette use (current users, OR=0.31; 95% CI: 0.25-0.38; previous users, OR=0.23; 95% CI: 0.18-0.28).

CONCLUSIONS

The findings highlight a significant percentage of e-cigarette use among Ecuadorian adults, especially among younger groups. There is a need for comprehensive public health education about e-cigarettes in Ecuador. There is strong support from the public for control measures, suggesting the potential acceptability of regulations concerning e-cigarettes.

Susceptibility to Electronic Cigarette and Consumption Patterns in Adolescents

The use of electronic cigarettes (ECs) is a major problem globally. Susceptibility and curiosity are important factors that develop prior to the onset of substance use, such as ECs, and are therefore considered as predictors. Both factors are used to obtain an extended index of susceptibility (ESIe-c), which allows the identification of adolescents who are at risk of starting to use these devices. The aim of this study was to determine the prevalence of EC consumption and to assess the association of possible predictors with susceptibility to use and experimentation with ECs among adolescents. A cross-sectional study was carried out in 377 adolescents (53.0% female). Participants were compared according to their experimentation with ECs. A total of 45.9% had already used electronic cigarettes, and 20.8% were current users. Among those who had not tried electronic cigarettes, 43.3% had a medium-high susceptibility to EC initiation. Consumption among close friends, receiving offers of consumption and alcohol consumption were associated with initiation. There was an inverse association between a medium susceptibility index electronic cigarette score and the consumption of cigarettes and positive affect; on the other hand, the lack of premeditation was associated with a higher susceptibility index score. Intrapersonal factors and social factors seem to influence the ESIe-c and onset of EC use, respectively. The main conclusion in this study is that susceptibility is influenced by intrapersonal factors such as affectivity and impulsivity through the lack of premeditation, and by social factors such as EC consumption by best friends.

Comparison of Acute Effects of E-cigarettes With and Without Nicotine and Tobacco Cigarettes on Hemodynamic and Endothelial Parameters: A Systematic Review and Meta-analysis

INTRODUCTION

Smoke from traditional cigarettes and e-cigarette aerosols have distinct chemical compositions that may impact blood pressure (BP) and heart rate (HR) differently.

AIMS

This study compared the impact of nicotine-containing e-cigarettes (EC+) versus nicotine-free (EC-) on BP, HR and endothelial markers, and assessed if EC+ posed fewer risks than tobacco cigarettes (TC).

METHODS

Electronic databases were searched from inception until November 2023 for studies reporting changes in systolic and diastolic BP (SBP, DBP) and HR and endothelial parameters before and after the use of EC+, EC- and TC. Data were analyzed using weighted mean differences (WMDs) and 95% confidence intervals (CIs).

RESULTS

Fifteen studies (n = 752) were included in our meta-analysis. We demonstrate that EC+ significantly increased systolic BP (WMD = 3.41, 95% CI [0.1,6.73], p = 0.04], diastolic BP (WMD = 3.42, 95% CI [1.75, 5.09]; p < 0.01], and HR (WMD = 5.36 BPM, 95% CI [1.87, 8.85]; p < 0.01) compared to EC-. However, EC+ was observed to cause less detrimental effect on SBP (WMD = - 4.72 mmHg, 95% CI [- 6.58, - 2.86], p < 0.01), and HR (WMD = - 3.11 BPM, 95% CI [- 4.54, - 1.68]; p < 0.01) as compared to TC with no difference on DBP (WMD = - 1.14 mmHg, 95% CI [- 2.38, 0.1]; p = 0.07). EC+ also led to greater deterioration of endothelial parameters as compared to EC- but to a lesser degree as compared to TC.

CONCLUSION

EC+ shows greater impairment in hemodynamic and endothelial parameters than EC- but less than TC. Additional studies are needed to evaluate prolonged effects of EC use.

Implications of Switching from Conventional to Electronic Cigarettes on Quality of Life and Smoking Behaviour: Results from the EQualLife Trial

INTRODUCTION

Electronic cigarettes and "vaping" have become popular since their appearance in Europe and the USA in approximately 2006. They are often perceived as having fewer health risks than conventional cigarettes, which makes them of interest as a support tool in smoking cessation. However, its efficacy regarding cessation or reduction of smoking under real-life conditions remains controversial. Our objective was to clarify this question in an observational study of smoking habits after initiating vaping without targeted intervention, as compared to a validated cessation programme.

METHODS

From October 2015 to April 2018, 80 subjects (60 in the e-cigarette group and 20 in the supervised smoking cessation group) were included in two trial visits, one at the start of the trial and the second after 3 months, plus 4 questionnaire surveys: at the start of the trial and after a 1, 2, and 3 month period. The questionnaire included a nicotine use inventory, a modified Fagerström test for nicotine dependence, and the WHO-QOL-BREF survey.

RESULTS

E-cigarettes were effective, leading to a significant (p < 0.03) reduction (p < 0.03) in tobacco consumption and nicotine dependence, with an abstinence rate of 43% after 3 months. Compared to participants in the smoking cessation programme, their use was not associated with an improvement in quality of life during the quitting attempt, and there were no significant differences in clinical symptoms between groups. The reduction in nicotine dependence was more pronounced (p < 0.012) for the smoking cessation programme, with higher abstinence rates (p = 0.011 after 12 weeks) and lower (p < 0.003) remaining tobacco consumption compared to electronic cigarettes.

DISCUSSION/CONCLUSIONS

The use of electronic cigarettes reduced nicotine dependence and tobacco consumption, but a supervised smoking cessation programme was superior in terms of achieved cessation in both regards. Electronic cigarettes did not improve the quality of life. Since e-cigarettes could be associated with long-term health risks, their usefulness in smoking cessation remains questionable, and a professionally guided and validated smoking cessation programme still appears to be superior and preferable, in terms of achieved cessation. Although this trial is limited regarding the number of participants and follow-up time, it highlights the need for additional, large clinical trials evaluating the efficacy of e-cigarettes for smoking cessation in comparison to a professionally guided smoking cessation programme.

Comparative systematic review on the safety of e-cigarettes and conventional cigarettes

BACKGROUND

This systematic review evaluated the health risks of electronic cigarettes (e-cigarettes) compared to traditional cigarettes. It examines various studies and research on the subject to provide a comprehensive analysis of potential health risks associated with both smoking methods.

METHODS

The systematic review, incorporating searches in PubMed, Scopus, Web of Science, and the Cochrane Library up to July 2023, examines the results obtained in relevant studies, and provides a critical discussion of the results.

RESULTS

E-cigarettes exhibit reduced exposure to harmful toxins compared to traditional cigarettes.

CONCLUSION

However, concerns persist regarding respiratory irritation and potential health risks, especially among youth, emphasizing the need for comprehensive, long-term research and protective legislation.

Topic prediction for tobacco control based on COP9 tweets using machine learning techniques

The prediction of tweets associated with specific topics offers the potential to automatically focus on and understand online discussions surrounding these issues. This paper introduces a comprehensive approach that centers on the topic of "harm reduction" within the broader context of tobacco control. The study leveraged tweets from the period surrounding the ninth Conference of the Parties to review the Framework Convention on Tobacco Control (COP9) as a case study to pilot this approach. By using Latent Dirichlet Allocation (LDA)-based topic modeling, the study successfully categorized tweets related to harm reduction. Subsequently, various machine learning techniques were employed to predict these topics, achieving a prediction accuracy of 91.87% using the Random Forest algorithm. Additionally, the study explored correlations between retweets and sentiment scores. It also conducted a toxicity analysis to understand the extent to which online conversations lacked neutrality. Understanding the topics, sentiment, and toxicity of Twitter data is crucial for identifying public opinion and its formation. By specifically focusing on the topic of "harm reduction" in tweets related to COP9, the findings offer valuable insights into online discussions surrounding tobacco control. This understanding can aid policymakers in effectively informing the public and garnering public support, ultimately contributing to the successful implementation of tobacco control policies.

In vitro toxicological evaluation of aerosols generated by a 4th generation vaping device using nicotine salts in an air-liquid interface system

BACKGROUND

Electronic cigarettes (EC) have gained popularity, especially among young people, with the introduction of fourth-generation devices based on e-liquids containing nicotine salts that promise a smoother vaping experience than freebase nicotine. However, the toxicological effects of nicotine salts are still largely unknown, and the chemical diversity of e-liquids limits the comparison between different studies to determine the contribution of each compound to the cytotoxicity of EC aerosols. Therefore, the aim of this study was to evaluate the toxicological profile of controlled composition e-liquid aerosols to accurately determine the effects of each ingredient based on exposure at the air-liquid interface.

METHODS

Human lung epithelial cells (A549) were exposed to undiluted aerosols of controlled composition e-liquids containing various ratios of propylene glycol (PG)/vegetable glycerin (VG) solvents, freebase nicotine, organic acids, nicotine salts, and flavoured commercial e-liquids. Exposure of 20 puffs was performed at the air-liquid interface following a standard vaping regimen. Toxicological outcomes, including cytotoxicity, inflammation, and oxidative stress, were assessed 24 h after exposure.

RESULTS

PG/VG aerosols elicited a strong cytotoxic response characterised by a 50% decrease in cell viability and a 200% increase in lactate dehydrogenase (LDH) production, but had no effects on inflammation and oxidative stress. These effects occurred only at a ratio of 70/30 PG/VG, suggesting that PG is the major contributor to aerosol cytotoxicity. Both freebase nicotine and organic acids had no greater effect on cell viability and LDH release than at a 70/30 PG/VG ratio, but significantly increased inflammation and oxidative stress. Interestingly, the protonated form of nicotine in salt showed a stronger proinflammatory effect than the freebase nicotine form, while benzoic acid-based nicotine salts also induced significant oxidative stress. Flavoured commercial e-liquids was found to be cytotoxic at a threshold dose of ≈ 330 µg/cm².

CONCLUSION

Our results showed that aerosols of e-liquids consisting only of PG/VG solvents can cause severe cytotoxicity depending on the concentration of PG, while nicotine salts elicit a stronger pro-inflammatory response than freebase nicotine. Overall, aerosols from fourth-generation devices can cause different toxicological effects, the nature of which depends on the chemical composition of the e-liquid.

Marketing claims, promotional strategies, and product information on Malaysian e-cigarette retailer websites-a content analysis

BACKGROUND

Marketing and sales of e-cigarettes are unregulated in Malaysia. We analyzed content displayed on e-cigarette retailer websites to identify marketing claims, promotional strategies, and product details in the year 2022.

METHODS

We analyzed 30 Malaysia-based retailer websites using a mixed methods approach. Data were extracted as the frequency of occurrences of marketing claims, presence of regulatory information, product types, and flavors of e-juice as per a predefined codebook based on published literature. We also extracted textual details published on the websites about marketing claims, and slogans.

RESULTS

Most retailer websites provided contact information and physical store addresses (83%) but only half had 'click through' age verification (57%) that seldom needed any identification proof for age (3%). Marketing claims were related to health (47%), smoking cessation (37%), and modernity/trend (37%) and none had health warnings. Promotional strategies were discounts (80%). starter kits (57%) and email subscriptions (53%). Product types displayed were rechargeable (97%) and disposable (87%) devices and e-liquids (90%) of an array of flavors (> 100). Nicotine presence, its concentration, and "nicotine is an addictive chemical" were displayed in 93%, 53%, and 23% of websites respectively.

CONCLUSION

Surveillance of content displayed online on e-cigarette retailer websites and regulation of online marketing and sales should be implemented by the Ministry of Health, Malaysia. Such measures are needed to prevent access to, and initiation of e-cigarette use among the youth and adults who do not smoke.

Dysregulation of immunity by cigarette smoking promotes inflammation and cancer: A review

Smoking is a serious global health issue. Cigarette smoking contains over 7000 different chemicals. The main harmful components include nicotine, acrolein, aromatic hydrocarbons and heavy metals, which play the key role for cigarette-induced inflammation and carcinogenesis. Growing evidences show that cigarette smoking and its components exert a remarkable impact on regulation of immunity and dysregulated immunity promotes inflammation and cancer. Therefore, this comprehensive and up-to-date review covers four interrelated topics, including cigarette smoking, inflammation, cancer and immune system. The known harmful chemicals from cigarette smoking were summarized. Importantly, we discussed in depth the impact of cigarette smoking on the formation of inflammatory or tumor microenvironment, primarily by affecting immune effector cells, such as macrophages, neutrophils, and T lymphocytes. Furthermore, the main molecular mechanisms by which cigarette smoking induces inflammation and cancer, including changes in epigenetics, DNA damage and others were further summarized. This article will contribute to a better understanding of the impact of cigarette smoking on inducing inflammation and cancer.

Perceptions of harmfulness of heated tobacco and nicotine vaping products compared to cigarettes, and the association of advertising exposure on harm perceptions among adults who smoke in South Korea: Cross-sectional findings from the 2020 ITC Korea Survey

INTRODUCTION

Heated tobacco products (HTPs) and nicotine vaping products (NVPs) both are legal consumer products in the Republic of Korea. Little is known about perceptions of harmfulness of HTPs and NVPs relative to cigarettes in South Korea among adults who smoke, and how exposure to marketing may be associated with harmfulness perceptions.

METHODS

This study used data from the 2020 International Tobacco Control (ITC) Korea Survey, and included 3713 adult (aged 19 years) cigarette smokers who were: 1) exclusive smokers (n=1845); 2) dual HTP + cigarette consumers (n=1130); 3) dual NVP + cigarette consumers (n=224); and 4) triple consumers (all three products, n=514). Weighted multinomial regression models were conducted to estimate smokers' perceptions of harmfulness of HTPs and NVPs compared to cigarettes, NVPs to HTPs, and self-reported exposure to HTP/NVP advertising. Analyses compared the perceptions of harmfulness between the four different consumer groups, and tested whether exposure to HTP/NVP advertising was associated with perceptions of lower relative harm.

RESULTS

Among all respondents, 27.5% believe that HTPs are less harmful than cigarettes and 23.4% believe that NVPs are less harmful than cigarettes. Exclusive cigarettes smokers were significantly less likely to perceive that HTPs and NVPs are less harmful than cigarettes compared to dual HTP + cigarette consumers, dual NVP + cigarette consumers, and triple consumers (all p<0.001). Half of respondents perceive NVPs as equally harmful as HTPs (14.1% perceive NVPs as more harmful than HTPs). Exposure to HTP/NVP advertising was associated with perceiving these products as less harmful than cigarettes.

CONCLUSIONS

About one-quarter of Korean cigarette smokers perceive HTPs and NVPs as less harmful than cigarettes. Further investigation is required to understand how harm perceptions and HTP/NVP advertising are related to changes in product use, such as switching between products, using multiple products, or discontinuing all product use.

Tobacco products and electronic cigarettes' legislation violations - observational study in 31 European countries, 2005-2022

BACKGROUND

European Union (EU) law regulates the manufacture, presentation, and sale of tobacco and related products in all member states. This study examined whether legislation non-compliant tobacco products and electronic cigarettes were available for sale in the European market.

METHODS

We queried the EU Rapid Information System for dangerous non-food products, covering 28 current and former EU member states and 3 associated countries, also known as Rapex, for non-compliant tobacco and related products reported between 2005 and 2022.

FINDINGS

During the operation of the Rapex system, 183 violations were reported (six on tobacco, three on traditional cigarettes, and 174 on e-cigarettes). Insufficient product safety information was found in 86% of the reports on e-cigarettes and 74% of the refills. Violations regarding the volume of the liquid container were observed in 26% of the e-cigarette reports and 20% of the refill reports. Approximately 15% of the reported e-cigarettes and 17% of refill liquids exceeded permissible nicotine levels. More serious standard violations were recorded for refills than for e-cigarettes. Approximately one-third of Rapex system countries submitted no notifications.

INTERPRETATION

E-cigarettes were the most frequently reported items in the European market of tobacco and non-tobacco nicotine products. The most common concerns were inadequate product safety information, incorrect liquid container volume, and excessive nicotine concentration. Identifying the most recognized legal infringements did not require laboratory tests and was based only on packaging and the manufacturer's declaration analysis. Further studies are necessary to corroborate whether products available in countries where no violations have been reported meet EU safety standards.

Prenatal nicotine exposure during pregnancy results in adverse neurodevelopmental alterations and neurobehavioral deficits

Maternal tobacco use and nicotine exposure during pregnancy have been associated with adverse birth outcomes in infants and can lead to preventable pregnancy complications. Exposure to nicotine and other compounds in tobacco and electronic cigarettes (e-cigarettes) has been shown to increases the risk of miscarriage, prematurity, stillbirth, low birth weight, perinatal morbidity, and sudden infant death syndrome (SIDS). Additionally, recent data provided by clinical and pre-clinical research demonstrates that nicotine exposure during pregnancy may heighten the risk for adverse neurodevelopmental disorders such as Attention-Deficit Hyperactivity (ADHD), anxiety, and depression along with altering the infants underlying brain circuitry, response to neurotransmitters, and brain volume. In the United States, one in 14 women (7.2%) reported to have smoked cigarettes during their pregnancy with the global prevalence of smoking during pregnancy estimated to be 1.7%. Approximately 1.1% of women in the United States also reported to have used e-cigarettes during the last 3 months of pregnancy. Due to the large percentage of women utilizing nicotine products during pregnancy in the United States and globally, this review seeks to centralize pre-clinical and clinical studies focused on the neurobehavioral and neurodevelopmental complications associated with prenatal nicotine exposure (PNE) such as alterations to the hypothalamic-pituitary-adrenal (HPA) axis and brain regions such as the prefrontal cortex (PFC), ventral tegmental area (VTA), nucleus accumbens (NA), hippocampus, and caudate as well as changes to nAChR and cholinergic receptor signaling, long-term drug seeking behavior following PNE, and other related developmental disorders. Current literature analyzing the association between PNE and the risk for offspring developing schizophrenia, attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), anxiety, and obesity will also be discussed.

Misconceptions of Vaping Among Young Adults

Background Vaping is growing in popularity worldwide, especially among young adults. To develop effective tobacco prevention interventions, first, there must be an understanding of the attitudes and perceptions of young adults toward the use of vaping. Highlighting perception discrepancies between races may allow physicians to more effectively counsel their patients regarding the risks of vaping. Methodology We conducted an online survey using Amazon Mechanical Turk (MTurk, https://www.mturk.com/) to identify misconceptions about vaping among adults aged 18 to 24 years who currently vape. The survey consisted of 18 questions evaluating reasons for vaping, history of tobacco use, and thoughts on the adverse effects of vaping. The Penn State Electronic Cigarette Dependence Index was implemented to assess dependence. Exclusion criteria comprised respondents who did not vape and were under the age of 18 or over the age of 24. Results A total of 1,009 responses were received with 66% identifying as male (n = 667) and 33% (n = 332) identifying as female. Sixty-nine percent of patients smoked cigarettes or used another form of tobacco previously (n = 692). Of those respondents, 81% indicated that they had since quit using tobacco products (excluding vaping). Switching to vaping was the most common reason for quitting cigarettes or other forms of tobacco, with health concerns and social purposes being the second and third most common reasons provided, respectively. When asked whether vaping had negative health impacts, only 238 (24%) participants strongly agreed with this statement, while a majority (64%) neither agreed nor disagreed or only somewhat agreed. Most participants were white or Caucasian (n = 777). When asked whether smoking or vaping had more severe health implications, 55% of white or Caucasian participants, 41% of Asian participants, and 32% of black or African American participants indicated that vaping was worse than smoking cigarettes. The average Penn State dependence score was 8.7, suggesting medium dependence. Conclusions Our survey sample of 1,006 young adults who vape indicated that the majority did not perceive vaping as significantly harmful. A comprehensive smoking prevention policy, educational interventions, and quit support are needed to enhance awareness among young adults about the health effects associated with vaping. Such interventions should also consider the novel shift toward the replacement of smoking with vaping.

Electronic Nicotine Delivery Systems (ENDS) use Among Members of a Community Engagement Program

Electronic nicotine delivery systems (ENDS) are relatively new and ENDS use data from community engagement programs may help us understand usage patterns and facilitate targeted longitudinal studies. Community members in Florida, USA, were asked about ENDS use, tobacco use, and health history/concerns by Community Health Workers. Among 7253 members recruited during 2014 to 2021 into our HealthStreet program, 1177 had ever used ENDS; the proportion increased from 12 to 27% from 2014 to 2021 (adjusted odds ratio (aOR) 2.5; 95% CI 1.7-3.5; Ever versus never used ENDS). Ever tobacco use was strongly associated with ENDS use; 69% of ever users were current tobacco users. Demographic determinants (sex, age, race) and food insecurity were strongest predictors of ENDS use. Most who had ever used ENDS were aged 18-25 (aOR 5.9; 95% CI 4.6-7.6; vs. aged 60 + years), White (aOR 3.7; 95% CI 3.2-4.3; vs. Black/African American), male (aOR 1.5; 95% CI 1.3-1.7; vs. female), and recently food insecure (aOR 1.8; 95% CI 1.5-2.0; vs. not recently food insecure). Those with respiratory issues were more likely to have used ENDS compared to those without (aOR 2.0; 95% CI 1.6-2.6; aOR 1.3; 95% CI 1.1-1.5). Members concerned about hypertension were less likely to have used ENDS (aOR 0.7; 95% CI 0.5-0.9). In this relatively rural, micropolitan sample, tobacco use, socio-economic determinants, and certain health history/concerns were strongly associated with ENDS use. Community outreach approaches are needed to further understand these factors and implement interventions.

Anesthesiologists and the Other Pandemic: Tobacco Use

Tobacco use will kill a projected 1 billion people in the 21st century in one of the deadliest pandemics in history. Tobacco use disorder is a disease with a natural history, pathophysiology, and effective treatment options. Anesthesiologists can play a unique role in fighting this pandemic, providing both immediate (reduction in perioperative risk) and long-term (reduction in tobacco-related diseases) benefits to their patients who are its victims. Receiving surgery is one of the most powerful stimuli to quit tobacco. Tobacco treatments that combine counseling and pharmacotherapy (e.g., nicotine replacement therapy) can further increase quit rates and reduce risk of morbidity such as pulmonary and wound-related complications. The perioperative setting provides a great opportunity to implement multimodal perianesthesia tobacco treatment, which combines multiple evidence-based tactics to implement the four core components of consistent ascertainment and documentation of tobacco use, advice to quit, access to pharmacotherapy, and referral to counseling resources.

E-Cigarettes Reexamined: Product Toxicity

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

Electronic Cigarettes in Thailand: Behaviour, Rationale, Satisfaction, and Sex Differences

Electronic cigarettes (e-cigarettes) use is trending in Thailand. Electronic cigarettes are banned and illegally imported. This study aimed to investigate the behaviour, rationale, and satisfaction of e-cigarettes users and compared them between males and females. A cross-sectional study was conducted involving 1050 participants using e-cigarettes from December 2019 to February 2020. The participants were recruited by an online questionnaire posted on social media. The participants were current e-cigarettes users aged 18 years and older. Of 1050 participants, 936 were male (89.1%). The average age was 31.2 ± 8.4 years. The participants were from all regions of the country, but most (64.5%) were from central Thailand. Most e-cigarettes users comprised private employees (43.2%). The main source of e-cigarettes in Thailand is online sources such as social media. Tank-style e-cigarettes were popular among users. Amongst e-cigarettes users, the top three rationales for using e-cigarettes were fewer harmful effects from e-cigarettes than conventional cigarettes (81.0%), smoking cessation aids (80.6%), and their lack of attaching cigarette odour (58.2%). The top three reasons for satisfaction were using e-cigarettes as a conventional cigarette cessation aid (5.1 ± 1.3), lessening cravings for conventional cigarettes (5.1 ± 1.3), and reducing conventional cigarettes withdrawal symptoms (5.0 ± 1.3). Online purchase was the main source of e-cigarettes in Thailand. The general rationale for using electronic cigarettes was that they are less harmful and to quit conventional cigarettes. Thai users were satisfied to use e-cigarettes as a conventional cigarette cessation aid. Males and females differed in behaviour, rationale, and satisfaction of e-cigarettes. Public health organisations should provide accurate information about the harm of electronic cigarettes and their efficacy for tobacco cessation.