Trends in E-Cigarette, Cigarette, Cigar, and Smokeless Tobacco Use Among US Adolescent Cohorts, 2014-2018

Types of electronic nicotine delivery systems (ENDS) used by people of different age and smoking status groups: results from a US nationally representative survey

OBJECTIVES

The type of electronic nicotine delivery system (ENDS) used by different age groups may be associated with ENDS and cigarette use behaviours. This study sought to identify differences in the use of ENDS device type based on age and cigarette use status to inform policy about regulating ENDS.

DESIGN

This was a cross-sectional study.

SETTING

Data was derived from a national survey conducted in 2021 in the USA.

PARTICIPANTS

Participants include 2369 US youth and adults (13 years or older) who reported past 30-day ENDS use.

OUTCOME MEASURES

Past 30-day fairly regular use (i.e., several times a week or more) of ENDS device types, namely cigalikes, disposables, refillable tank/box mods, closed pods, refillable pods and drippers. Cigarette smoking status was also measured.

RESULTS

We used weighted regression models to determine the association between ENDS device type current regular use and age group and the association between each ENDS type current regular use and smoking status separately for each age group. Youth ENDS users 13-17 years old were more likely to regularly use cigalikes (OR=2.71), disposables (OR=3.44), closed pods (OR=2.57) and drippers (OR=2.86) and 18-29 years old were more likely to regularly use disposables (OR=3.67), closed pods (OR=1.58) and drippers (OR=1.94), compared with 30+ years old ENDS users (all p<0.05). Among 13-17 years old, current (vs never) smokers had greater odds of current regular use for cigalikes (OR=2.79), disposables (OR=2.33), refillable tanks (OR=2.27), closed pods (OR=2.62) and drippers (OR=6.32; all p<0.05). Similarly, 18-29 years old current (vs never) smokers had higher odds of reporting current regular use of refillable tanks (OR=1.80), refillable pods (OR=2.63), closed pods (OR=2.20) and drippers (OR=4.89; p<0.05).

CONCLUSIONS

Both age and smoking status were associated with current regular use of ENDS, especially for youth and young adults. These findings inform regulatory agencies as they monitor and enforce policy on ENDS allowed on the US market.

Smoking Cessation and Incident Atrial Fibrillation in a Longitudinal Cohort

BACKGROUND

Although smoking heightens the risk of AF, it remains unknown if that risk is amenable to modification after smoking cessation.

OBJECTIVES

This study sought to evaluate the association between smoking cessation and atrial fibrillation (AF) risk in a large longitudinal cohort.

METHODS

After excluding those with prevalent AF and no history of smoking at baseline, we evaluated 146,772 UK Biobank participants with serial smoking assessments. We compared AF risk between former smokers at baseline and those who quit smoking during the study to current smokers. Incident AF was ascertained from outpatient and inpatient encounters and identified using International Classification of Diseases codes. Cox models were used to compare the risk of incident AF among current and former smokers as well as those who quit smoking during the study while controlling for age, sex, race, body mass index, education, cardiovascular comorbidities, alcohol use, and pack-years.

RESULTS

Among the 146,772 participants (48.3% female; age: 57.3 ± 7.9 years), 37,377 (25.5%) currently smoked; 105,429 (72.0%) were former smokers; and 3,966 (2.7%) quit smoking during the study. Over a mean 12.7 ± 2.0 years of follow-up, 11,214 (7.6%) participants developed AF. Compared to current smokers, the adjusted risk of AF was 13% lower in former smokers (HR: 0.87; 95% CI: 0.83-0.91) and 18% lower in those who quit smoking during the study (HR: 0.82; 95% CI: 0.70-0.95).

CONCLUSIONS

Compared to those who continue to smoke, smoking cessation was associated with a lower risk of AF.

Hyperpolarized Gas Imaging in Lung Diseases: Functional and Artificial Intelligence Perspective

Pathophysiologic changes in lung diseases are often accompanied by changes in ventilation and gas exchange. Comprehensive evaluation of lung function cannot be obtained through chest X-ray and computed tomography. Proton-based lung MRI is particularly challenging due to low proton density within the lung tissue. In this review, we discuss an emerging technology--hyperpolarized gas MRI with inhaled 129Xe, which provides functional and microstructural information and has the potential as a clinical tool for detecting the early stage and progression of certain lung diseases. We review the hyperpolarized 129Xe MRI studies in patients with a range of pulmonary diseases, including chronic obstructive pulmonary disease, asthma, cystic fibrosis, pulmonary hypertension, radiation-induced lung injury and interstitial lung disease, and the applications of artificial intelligence were reviewed as well.

Adolescent Perspectives on the Pharmacy-Based T-EVER (Teen E-Cigarette and Vaping Educational Resource) and Its Potential Impact on Youth Vaping

BACKGROUND

While public health efforts have made tobacco smoking near obsolete among adolescents, vaping products are quickly taking their place. With the negative health consequences looming ahead of young vapers, there is a desperate need to curb youth vaping. Adolescents want to be actively engaged in their health which creates space to educate on vaping in this population segment.

METHODS

From January to May 2023, 35 adolescents aged 11-18 participated in interviews to assess the investigator-developed Teen E-cigarette and Vaping Educational Resource (T-EVER). All the interviews were recorded and transcribed for independent analysis by two study team members.

RESULTS

The participants liked the T-EVER, indicating they were engaged in the content. However, some participants wanted more information. The participants wanted health professionals to educate them on vaping but were worried about the potential barriers facing the implementation in community pharmacy settings.

CONCLUSIONS

Adolescents want to learn about vaping, but there are limited opportunities to do so. The T-EVER is designed to educate youth about vaping. This tool was well received and has the potential to be used by pharmacists as a vaping prevention and cessation intervention. More research is required to discern the true scope of the pharmacist's role in using an educational tool to address adolescent vaping.

Comprehensive vaping bans are associated with lower odds of initiation into electronic nicotine delivery systems use among young people

BACKGROUND AND AIMS

E-cigarette and other electronic nicotine delivery systems (ENDS) use has grown considerably over the past decade, with notable increases among young people. US state policy contexts for ENDS and tobacco may shape initiation into ENDS use among adolescents as they age into early adulthood. We aimed to determine whether state-level comprehensive vaping ban policies reduce the odds of youth initiation into ENDS use, net of additional state-level ENDS and tobacco policies, as well as the youth's cigarette smoking status.

DESIGN

Longitudinal data from the Population Assessment of Tobacco and Health study were merged with a state-year database on tobacco and ENDS policies. Multivariable discrete-time event history models of ENDS initiation were estimated.

SETTING

United States.

PARTICIPANTS

Twenty thousand twelve youth assessed over six waves from 2013 to 2019 (n = 53 974 observations).

MEASUREMENT

We examined comprehensive indoor vaping bans (i.e. 100% vape-free workplaces, restaurants and bars) as a key factor in initiation into ENDS use (i.e. first instance of vaping) from age 13 to 22.

FINDINGS

Among young people, residing in a state with a comprehensive vaping ban was associated with 18% lower odds of ENDS initiation (odds ratio = 0.82; 95% confidence interval =[0.71, 0.94]), even after controlling for other state ENDS and tobacco policies, the youth's cigarette smoking and socio-demographic background and state-level covariates.

CONCLUSIONS

In the United States, state-level vaping bans (i.e. 100% vape-free workplaces, restaurants and bars) are associated with reduced odds of youth initiation into electronic nicotine delivery systems use.

Trends in age of tobacco use initiation over time in Bangladesh, India and Pakistan: analysis of cross-sectional nationally representative surveys

OBJECTIVE

Tobacco use begins at an early age and typically leads to a long-term addiction. The age of initiation for tobacco use is not well studied in South Asia, where 22% of tobacco smokers and 81% of smokeless tobacco (SLT) users reside.

METHODS

Data from the nationally representative Global Adult Tobacco Surveys in India, Bangladesh and Pakistan were analysed to examine patterns of initiation among smokers and smokeless tobacco users.

RESULTS

Data on 94 651 individuals were analysed, of which 13 396 reported were ever daily smokers and 17 684 were ever SLT users. The proportion of individuals initiating tobacco use before the age of 15 years has increased over time. The rates of SLT initiation among those aged 15-24 years increased markedly in Bangladesh (by 7.8%) and Pakistan (by 37.7%) between 1983 and 1999-2000. Among males, the increase in SLT initiation was higher in individuals aged below 15 years compared with other age groups in India and Bangladesh. Smoking initiation among females aged below 15 years has also significantly increased in India over time. Compared with the initiation of tobacco smoking before the age of 15 years, a greater increase in the proportion of SLT users was observed in urban areas.

CONCLUSION

Our findings indicate that the proportion of youth initiating tobacco (both smoking and smokeless) before the age of 15 years has increased over time in all three countries. Moreover, variations in age at initiation for different types of tobacco products across countries, and by rurality, were noticeable. Younger youths (aged up to 15 years) should therefore be a priority population for tobacco control interventions. Strategies such as raising the legal age of tobacco sale and use to 21 years, and, other measures under WHO Framework Convention on Tobacco Control (FCTC), may prevent underage use and avert lifelong addiction to tobacco products.

Tobacco Policy and ENDS Policy Influences on Adolescent Vaping Across the U.S. States

INTRODUCTION

Although the use of tobacco has declined among youth, ENDS has the potential to disrupt or reverse these trends. Policies for tobacco and ENDS may have an impact on adolescent ENDS use. The impacts of state-level policies were examined for both tobacco and ENDS indoor use bans, excise taxes, and age-of-purchase laws on past-month adolescent ENDS use from 2013 to 2019.

METHODS

This study used cohort data from the Population Assessment of Tobacco and Health study and policy data from the Americans for Nonsmokers' Rights Foundation repository-3 policies for ENDS and 2 policies for tobacco products. Policies included comprehensive indoor vaping/smoking bans, purchase-age restrictions, and excise taxes. Hybrid panel models were estimated in 2022 using data merged from the 2 longitudinal sources on past-month vaping. The analytic sample (observations=26,008) included adolescents aged 12-17 years, yielding a total of 72,684 observations.

RESULTS

The odds of adolescent ENDS use were 21.4% lower when the state had an ENDS purchase-age restriction and 55.0% lower when the state had a comprehensive tobacco smoking ban than in the years when the state did not have the ban.

CONCLUSIONS

During a period of significant growth in ENDS use among U.S. youth, ENDS purchase-age restrictions and smoking bans reduced the odds of past-month vaping among adolescents. Wider implementation of policies may help intervene in youth vaping.

Perceptions of cigarettes and e-cigarettes: does health literacy matter?

OBJECTIVE

This study assessed the relationship between health literacy, perceptions of traditional and electronic cigarettes, and smoking status among college students.

PARTICIPANTS

Participants (N = 150; Mage= 20.41 years, SD 3.48), included nonsmokers (78%) and smokers (21%) of traditional (12%) and e-cigarettes (17%).

METHOD

Participants completed a novel questionnaire to assess perceptions of traditional and e-cigarettes, and the Health Literacy Skills Instrument to evaluate health literacy.

RESULTS

Traditional cigarettes were perceived as having a greater negative impact on physical health than e-cigarettes, whereas e-cigarettes were perceived as having a greater positive impact on social-emotional health than traditional cigarettes. Most participants (57%) had below basic health literacy skills.

CONCLUSIONS

This study did not find a relationship between health literacy skills and smoking status or smoking perceptions. Further research is needed to investigate correlates of smoking status and perceptions to inform prevention and cessation efforts.

Systematic Review and Critical Analysis of Longitudinal Studies Assessing Effect of E-Cigarettes on Cigarette Initiation among Adolescent Never-Smokers

Prospective longitudinal studies mainly conclude on a causal role of e-cigarettes in the initiation of cigarettes in flagrant contradiction with conclusions drawn from epidemiology and other studies showing a sharp decline in cigarette use in parallel with the spread of e-cigarette use. This systematic review explores the reasons for this discrepancy.

METHODS

Among 84 publications on e-cigarette/cigarette association in adolescents identified in the Medline database from 2011 to 2022, 23 concern 22 never-smoker longitudinal sub-cohorts.

RESULTS

A link between e-cigarette experimentation at T1 and cigarette initiation at T2 is reported in sub-cohort analyses of never-smokers (AOR: 1.41 to 8.30). However, studies exclude 64.3% of T1 e-cigarette experimenters (because of dual-use) and 74.1% of T2 cigarette experimenters. With this study design, e-cigarettes contribute only to 5.3% of T2 cigarette experimentation, casting major doubt on the external validity of results and authors' conclusions that e-cigarettes have a significant effect on the initiation of cigarettes (Gateway effect) at the population level. This sub-cohort design prohibits highlighting any Diversion effect, which is the most likely mechanism accounting for the competition between these two products.

CONCLUSIONS

While nicotine abstinence remains the best medical option, over-regulation of e-cigarettes because of misinterpretation of longitudinal study results may be detrimental to public health and tobacco control.

Looking Cool, Doing Tricks, Managing Stress, and Nicotine Addiction: Youth Perspectives on Nicotine Vaping and Implications for Prevention

PURPOSE

To understand the contextual and psychosocial factors associated with youth vaping in Colorado, the state with the highest youth vaping rates in 2019, and to propose strategies for prevention interventions.

DESIGN

Focus groups.

SETTING

In-person.

PARTICIPANTS

24 youth aged 11-17, including youth who had vaped (n = 11) and who had never vaped (n = 13).

METHOD

Qualitative responses using a semi-structured focus group guide were analyzed using a matrix approach with a mixed deductive/inductive content analysis.

RESULTS

Analysis revealed the highly social nature of vaping initiation and use; the use of vaping to control negative emotions; and the acquisition of vaping products through retail outlets, friends, family, and other youth who sell a variety of substances and devices to youth. Youth provided insight into how vaping is concealed from parents and teachers, and their attitudes about the health risks and benefits of vaping.

CONCLUSION

When considered with other studies, our findings suggest a universality in the youth vaping experience that is highly social. Interventions should include peer-to-peer messaging with an emphasis on changing social norms and highlighting undesirable outcomes of vaping such as negative reactions by friends and close adults, adverse effects on athletic success and future aspirations, expense, addiction, and punishment. Parent education is also recommended. Rigorous research is needed to test interventions to reverse the growing trend of youth vaping.

Effect of smoking on the development of chronic obstructive pulmonary disease in young individuals: a nationwide cohort study

Background

Cigarette smoking is an important risk factor for developing chronic obstructive pulmonary disease (COPD). However, the effect of smoking on the development of COPD in young individuals remains unclear. We aimed to evaluate the effect of smoking on COPD development in young individuals.

Methods

Using the Korean National Health Information Database, we screened individuals aged 20-39 years who participated in the national health check-up between 2009 and 2012. We defined physician-diagnosed COPD based on health insurance claims and searched the database until December 2019. We identified 6,307,576 eligible individuals, and 13,789 had newly developed COPD. We used multivariate Cox proportional hazards models to estimate the adjusted hazard ratio (aHR) of risk factors for COPD.

Results

The incidence rate for developing COPD was 0.26/1000 person-year. The risk of developing COPD was significantly higher in current smokers [aHR 1.46, 95% confidence interval (CI) 1.39-1.53] and former smokers (aHR 1.21, 95% CI 1.14-1.29) than in non-smokers. Furthermore, the risk increased with increasing smoking amounts (≥20 pack-years, aHR 2.24; 10-20 pack-years, aHR 1.55; <10 pack-years, aHR 1.27). Female participants had a higher relative risk of developing COPD due to smoking, compared with their male counterparts.

Conclusion

Cigarette smoking increased the risk of developing COPD in young individuals. Current and heavy smokers had higher risks of developing COPD than non-smokers. Female smokers were more likely to develop COPD than male smokers.

Twenty years of changes in the definition of early chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory airway disease that affects the quality of life of nearly one-tenth of the global population. Due to irreversible airflow obstruction and progressive lung function decline, COPD is characterized by high mortality and disability rates, which imposes a huge economic burden on society. In recent years, the importance of intervention in the early stage of COPD has been recognized and the concept of early COPD has been proposed. Identifying and intervening in individuals with early COPD, some of whom have few or no symptoms, might halt or reverse the progressive decline in lung function, improve the quality of life, and better their prognosis. However, understanding of early COPD is not yet well established, and there are no unified and feasible diagnostic criteria, which complicates clinical research. In this article, we review evolution of the definition of early COPD over the past 20 years, describe the changes in awareness of this concept, and propose future research directions.

The effects of dual IQOS and cigarette smoke exposure on airway epithelial cells: implications for lung health and respiratory disease pathogenesis

Background

Cigarette smoking remains a primary cause of chronic lung diseases. After a steady decline, smoking rates have recently increased especially with the introduction of newer electronic nicotine delivery devices, and it is also emerging that dual- or poly-product usage is on the rise. Additionally, with the introduction of IQOS (a heated tobacco product) globally, its impact on human health needs to be investigated. In this study we tested if dual exposure (cigarette smoke (CS)+IQOS) is detrimental to lung epithelial cells when compared with CS or IQOS exposure alone.

Methods

Human airway epithelial cells (BEAS-2B) were exposed to either CS, IQOS or their dual combination (CS+IQOS) at concentrations of 0.1%, 1.0%, 2.5% and 5.0%. Cytotoxicity, oxidative stress, mitochondrial homeostasis, mitophagy and effects on epithelial-mesenchymal transition (EMT) signalling were assessed.

Results

Both CS and IQOS alone significantly induced loss of cell viability in a concentration-dependent manner which was further enhanced by dual exposure compared with IQOS alone (p<0.01). Dual exposure significantly increased oxidative stress and perturbed mitochondrial homeostasis when compared with CS or IQOS alone (p<0.05). Additionally, dual exposure induced EMT signalling as shown by increased mesenchymal (α-smooth muscle actin and N-cadherin) and decreased epithelial (E-cadherin) markers when compared with CS or IQOS alone (p<0.05).

Conclusion

Collectively, our study demonstrates that dual CS+IQOS exposure enhances pathogenic signalling mediated by oxidative stress and mitochondrial dysfunction leading to EMT activation, which is an important regulator of small airway fibrosis in obstructive lung diseases.

Longitudinal transitions in adolescent polytobacco use across waves 1-4 of the Population Assessment of Tobacco and Health study

AIMS

This study aims to identify adolescent patterns of polytobacco use and measure transitions between patterns over time.

DESIGN

Longitudinal analysis using data derived from waves 1-4 (2013-18) of the Population Assessment of Tobacco and Health (PATH) study. Transitions in tobacco use patterns were examined via latent transition analysis, and then, socio-demographic characteristics were used to predict transitions via logistic regression.

SETTING

United States.

PARTICIPANTS

Participants included 975 adolescents who used at least one tobacco product at any wave (W1 mean age = 13.29, standard deviation = 0.86; W4 54.2% male; 54.5% white, 25.9% Hispanic).

MEASUREMENTS

Measurements included past 30-day use of cigarettes, electronic cigarettes (e-cigs), traditional cigars, cigarillos, filtered cigars, snus, smokeless tobacco (SLT) or hookah.

FINDINGS

Six latent classes were identified. Cigarette users (43.5-58.8%) and SLT users (50.8-79.6%) tended to persist in their use over time. E-cig users began to probably transition to non-users (80.0%), but became more likely to persist in this use over time (31.1%). Non-users at a given wave were most likely to transition to e-cig users (8.5-43.7%) or cigarette users (6.7-28.6%). Cigarillo/poly-users and hookah/poly-users displayed more variable transition patterns. Adolescents were more likely to transition to non-use (versus become/remain e-cig users) if they were older (cigarette users, SLT users), younger (e-cig users), other race (SLT users), male (SLT users) or had less-educated parents (SLT users) compared with their counterparts. Hispanic (versus white) cigarette users were more likely to transition to non-users than to persist in this use.

CONCLUSIONS

Among adolescents in the United States, patterns of tobacco use characterized by the use, mainly, of single, specific products appear to be stable, particularly by late adolescence. In contrast, patterns characterized by polytobacco use appear to be more variable and may represent experimentation without specialization.

Social Network Influences on Adolescent E-cigarette Use

Background: Determine if individual adolescent vaping is associated with the vaping behavior of their school-based friendships; whether that association stems from peer influence or peer selection; and whether it varies by age. Methods: Two wave longitudinal survey of 1,208 students in one Midwestern US school district. Students were asked if they ever vaped and to name their seven closest friends within the school district. A roster of all eligible students was pre-loaded into the survey to facilitate network data collection. Terms for network exposure, the proportion of vaping friends; and selection, the number of new friends who vape, were created. Logistic regression and Stochastic Actor Oriented Models were used to test both influence and selection effects. Results: A cross-sectional logistic regression model indicated that friend vaping was associated with individual vaping (AOR = 4.96, p < 0.01); and lagged logistic models indicated that increased friend vaping was associated with individual vaping initiation (AOR = 1.72, p < 0.05). Selecting new friends who vape was also associated with becoming a vaper (AOR = 1.25, p < 0.01). Both influence and selection were present for those less than 14 years old. Conclusions: This is the first study to use social network analysis to show that adolescents who vape or initiate vaping are more likely to do so if their friends vape, and/or they make new friends who vape. Prevention and cessation programs should address the role of friend influence and selection on e-cigarette use; particularly at younger ages.

Psychosocial Aspects of Metabolic and Bariatric Surgeries and Endoscopic Therapies

Obesity is a prevalent progressive and relapsing disease for which there are several levels of intervention, including metabolic and bariatric surgery (MBS) and now endoscopic bariatric and metabolic therapies (EBMTs). Preoperative psychological assessment focused on cognitive status, psychiatric symptoms, eating disorders, social support, and substance use is useful in optimizing patient outcomes and minimizing risks in MBS. Very little is known about the psychosocial needs of patients seeking EBMTs, though these investigations will be forthcoming if these therapies become more widespread. As MBS and EBMT inherently alter the gastrointestinal (GI) tract, considerations for the longer-term GI functioning of the patient are relevant and should be considered and monitored.

Nicotine Addiction and Intensity of e-Cigarette Use by Adolescents in the US, 2014 to 2021

IMPORTANCE

As e-cigarettes have become more effective at delivering the addictive drug nicotine, they have become the dominant form of tobacco use by US adolescents.

OBJECTIVE

To measure intensity of use of e-cigarettes, cigarettes, and other tobacco products among US adolescents and their dependence level over time.

DESIGN, SETTING, AND PARTICIPANTS

This survey study analyzed the cross-sectional National Youth Tobacco Surveys from 2014 to 2021. Confirmatory analysis was conducted using Youth Behavioral Risk Factor Surveillance System from 2015 to 2019. The surveys were administered to national probability samples of US students in grades 6 to 12.

EXPOSURES

Use of e-cigarettes and other tobacco products before and after the introduction of e-cigarettes delivering high levels of nicotine.

MAIN OUTCOMES AND MEASURES

First tobacco product used, age at initiation of use, intensity of use (days per month), and nicotine addiction (measured as time after waking to first use of any tobacco product).

RESULTS

A total of 151 573 respondents were included in the analysis (51.1% male and 48.9% female; mean [SEM] age, 14.57 [0.03] years). Prevalence of e-cigarette use peaked in 2019 and then declined. Between 2014 and 2021, the age at initiation of e-cigarette use decreased, and intensity of use and addiction increased. By 2017, e-cigarettes became the most common first product used (77.0%). Age at initiation of use did not change for cigarettes or other tobacco products, and changes in intensity of use were minimal. By 2019, more e-cigarette users were using their first tobacco product within 5 minutes of waking than for cigarettes and all other products combined. Median e-cigarette use also increased from 3 to 5 d/mo in 2014 to 2018 to 6 to 9 d/mo in 2019 to 2020 and 10 to 19 d/mo in 2021.

CONCLUSIONS AND RELEVANCE

The changes detected in this survey study may reflect the higher levels of nicotine delivery and addiction liability of modern e-cigarettes that use protonated nicotine to make nicotine easier to inhale. The increasing intensity of use of modern e-cigarettes highlights the clinical need to address youth addiction to these new high-nicotine products over the course of many clinical encounters. In addition, stronger regulation, including comprehensive bans on the sale of flavored tobacco products, should be implemented.

Expanding the E-Liquid Flavor Wheel: Classification of Emerging E-Liquid Flavors in Online Vape Shops

INTRODUCTION

Electronic cigarettes are the most popular tobacco product among U.S. youth, and over 80% of current youth users of e-cigarettes use flavored e-cigarettes, with fruit, mint/menthol, and candy/sweets being the most popular flavors. A number of new e-liquid flavors are currently emerging in the online e-cigarette market. Menthol and other flavored e-cigarettes could incentivize combustible tobacco smokers to transition to e-cigarette use.

METHODS

From February to May 2021, we scraped data of over 14,000 e-liquid products, including detailed descriptions of their flavors, from five national online vape shops. Building upon the existing e-liquid flavor wheel, we expanded the semantic databases (i.e., key terms) to identify flavors using WordNet-a major database for keyword matching and group discussion. Using the enriched databases, we classified 14,000+ e-liquid products into the following 11 main flavor categories: "fruit", "dessert/candy/sweets", "coffee/tea", "alcohol", "other beverages", "tobacco", "mint/menthol", "nuts", "spices/pepper", "other flavors", and "unspecified flavor".

RESULTS

We find that the most prominent flavor sold in the five online vape shop in 2021 was fruit flavored products, followed by dessert/candy/other sweets. Online vendors often label a product with several flavor profiles, such as fruit and menthol.

CONCLUSIONS

Given that online stores market products with multiple flavor profiles and most of their products contain fruit flavor, the FDA may have issued marketing denial orders to some of these products. It is important to further examine how online stores respond to the FDA flavor restrictions (e.g., compliance or non-compliance).

Towards the elimination of chronic obstructive pulmonary disease: a Lancet Commission

Despite substantial progress in reducing the global impact of many non-communicable diseases, including heart disease and cancer, morbidity and mortality due to chronic respiratory disease continues to increase. This increase is driven primarily by the growing burden of chronic obstructive pulmonary disease (COPD), and has occurred despite the identification of cigarette smoking as the major risk factor for the disease more than 50 years ago. Many factors have contributed to what must now be considered a public health emergency: failure to limit the sale and consumption of tobacco products, unchecked exposure to environmental pollutants across the life course, and the ageing of the global population (partly as a result of improved outcomes for other conditions). Additionally, despite the heterogeneity of COPD, diagnostic approaches have not changed in decades and rely almost exclusively on post-bronchodilator spirometry, which is insensitive for early pathological changes, underused, often misinterpreted, and not predictive of symptoms. Furthermore, guidelines recommend only simplistic disease classification strategies, resulting in the same therapeutic approach for patients with widely differing conditions that are almost certainly driven by variable pathophysiological mechanisms. And, compared with other diseases with similar or less morbidity and mortality, the investment of financial and intellectual resources from both the public and private sector to advance understanding of COPD, reduce exposure to known risks, and develop new therapeutics has been woefully inadequate.

Sociodemographic, personal, peer, and familial predictors of e-cigarette ever use in ESPAD Ireland: A forward stepwise logistic regression model

INTRODUCTION

E-cigarette ever use has risen significantly in recent years in Ireland, similar to trends elsewhere in Europe, the United States, and Asia-Pacific region. Results from ESPAD Ireland (European School Survey Project on Alcohol and other Drugs) show teenage e-cigarette ever use increased from 18% (2015) to 37% (2019). Given this increase, our aim is to profile e-cigarette ever users and never users in this age group; to examine sociodemographic, personal, peer, and familial factors associated with e-cigarette ever use; and to suggest appropriate measures to reduce use.

METHODS

A nationally representative stratified random sample of 50 ESPAD schools was surveyed in 2019, with 3495 students aged 15–17 years. Bivariate and multivariable logistic regression analyses were performed using Stata version 16.

RESULTS

E-cigarette ever use was significantly associated with ever smoking (AOR=4.15; 95% CI: 1.29–13.41), ever cannabis use (AOR=2.21; 95% CI: 1.11–4.41) and ever inhalants use (AOR=2.51; 95% CI: 1.07–5.88). Children of university-educated mothers had significantly higher odds of e-cigarette ever use (AOR=3.46; 95% CI: 1.40–8.54). Associated with reduced AORs were reading books for enjoyment (AOR=0.32; 95% CI: 0.16–0.64), living in households where smoking was regulated (AOR=0.53; 95% CI: 0.30–0.94), and perceiving moderate risk in trying e-cigarettes once or twice (AOR=0.20; 95% CI: 0.07–0.67).

CONCLUSIONS

E-cigarette ever use is part of a pattern of teenage polysubstance use including cigarette smoking, providing some support for the common liability theory. Regulation of smoking in the home, reading for enjoyment, and perceiving risk from e-cigarette use are associated with decreased likelihood of ever use, and higher parental education with increased likelihood. Thus, health education emphasizing the role of parents and risks of e-cigarette use is indicated to reduce the rise in e-cigarette ever use in teenagers.

Electronic cigarette use among adolescents in 17 European study sites: findings from the Global Youth Tobacco Survey

BACKGROUND

As new findings on public health implications of electronic cigarette (e-cigarette) use emerge, its surveillance remains of utmost importance. This study examined the latest state of e-cigarette use in youth in 17 European study sites (i.e. 16 countries and the Federation of Bosnia and Herzegovina) using the Global Youth Tobacco Survey (GYTS).

METHODS

This was an observational study. Cross-sectional data on students aged 11-17 years from the latest available GYTS round completed in 17 study sites were used to estimate crude and adjusted prevalence of e-cigarette use by sex and pocket money. Panel GYTS data from five countries were used for the trend analyses. All analyses were weighted to account for the survey design and non-response.

RESULTS

Compared to 2014, the age-adjusted prevalence of e-cigarette use more than doubled in Georgia and Italy, and nearly doubled in Latvia. Significantly more male than female students aged 11-17 years reported use of e-cigarettes, with little to no confounding by age, grade and pocket money across countries. Youth with medium or higher amount of pocket money was 20-200% more likely to use e-cigarettes than those with fewer to no pocket money in 14 study sites.

DISCUSSION

As e-cigarette use is becoming widespread throughout the world, there is variation in use among and between countries. Expanded and consistent surveillance of e-cigarette use by all World Health Organization member states is essential to generate data on the extent and correlates of youth e-cigarette use for evidence-based planning and evaluation of the electronic nicotine delivery systems and electronic non-nicotine delivery systems national and global control programmes.

Examining Cannabis, Tobacco, and Vaping Discourse on Reddit: An Exploratory Approach Using Natural Language Processing

Background: Perceptions of tobacco, cannabis, and electronic nicotine delivery systems (ENDS) are continually evolving in the United States. Exploring these characteristics through user generated text sources may provide novel insights into product use behavior that are challenging to identify using survey-based methods. The objective of this study was to compare the topics frequently discussed among Reddit members in cannabis, tobacco, and ENDS-specific subreddits. Methods: We collected 643,070 posts on the social media site Reddit between January 2013 and December 2018. We developed and validated an annotation scheme, achieving a high level of agreement among annotators. We then manually coded a subset of 2,630 posts for their content with relation to experiences and use of the three products of interest, and further developed word cloud representations of the words contained in these posts. Finally, we applied Latent Dirichlet Allocation (LDA) topic modeling to the 643,070 posts to identify emerging themes related to cannabis, tobacco, and ENDS products being discussed on Reddit. Results: Our manual annotation process yielded 2,148 (81.6%) posts that contained a mention(s) of either cannabis, tobacco, or ENDS with 1,537 (71.5%) of these posts mentioning cannabis, 421 (19.5%) mentioning ENDS, and 264 (12.2%) mentioning tobacco. In cannabis-specific subreddits, personal experiences with cannabis, cannabis legislation, health effects of cannabis use, methods and forms of cannabis, and the cultivation of cannabis were commonly discussed topics. The discussion in tobacco-specific subreddits often focused on the discussion of brands and types of combustible tobacco, as well as smoking cessation experiences and advice. In ENDS-specific subreddits, topics often included ENDS accessories and parts, flavors and nicotine solutions, procurement of ENDS, and the use of ENDS for smoking cessation. Conclusion: Our findings highlight the posting and participation patterns of Reddit members in cannabis, tobacco, and ENDS-specific subreddits and provide novel insights into aspects of personal use regarding these products. These findings complement epidemiologic study designs and highlight the potential of using specific subreddits to explore personal experiences with cannabis, ENDS, and tobacco products.

Focus on Early COPD: Definition and Early Lung Development

Chronic obstructive pulmonary disease (COPD) is a disease with high incidence rate and mortality rates worldwide. It is the third leading cause of death in the world. Nevertheless, little progress has been made in treating and preventing the disease. Under these circumstances, the concept of “early COPD” was proposed. Although this concept is not new, most health-care workers do not fully understand early COPD and tend to confuse it with mild COPD. In this review, we mainly discuss the definition of early COPD and the developmental trajectory of lung function. Although patients with early COPD have no symptoms, their lung function is already lower than that of normal people. A relatively complete definition is needed to identify this group of people. Reduced lung function is the diagnostic criterion for COPD, but lung development is a long-term dynamic process. In addition to smoking and air pollution, we should pay more attention to prenatal and childhood risk factors, for example, parents smoking, birth weight, preterm birth, mode of delivery, childhood respiratory infections and childhood asthma. Health-care workers need to be fully aware of early COPD, to reduce the morbidity of COPD and take effective measures to prevent these risk factors.

Co-creating opportunities to incorporate cessation for electronic nicotine delivery systems in family medicine - a qualitative program evaluation

BACKGROUND

The number of Americans who use tobacco has decreased in the twenty-first century, but electronic nicotine delivery systems (ENDS) have increased the complexity of treating tobacco dependence. The experiences of 18 family medicine practices were explored and opportunities to improve ENDS cessation were co-created in this study.

METHODS

Eighteen family medicine practices were enrolled into an implementation project to incorporate ENDS cessation into their practice. The participants' experiences were explored throughout the project using an iterative qualitative approach. The research team provided technical assistance. Semi-structured group interviews and focus groups were held with participants at the beginning, middle, and end of the project to explore participants' experiences. The collective knowledge and experiences of participants, expert consultants and the research team were fused together to co-create opportunities to improve ENDS cessation.

RESULTS

Nine opportunities to improve ENDS cessation were identified in three larger categories. The first category was leading change. This included: creating a vision for change to establish buy-in from key stakeholders and educate health care professionals to improve their confidence to address ENDS. The second category was creating processes. This included: establishing criteria for screening and quality improvement for ENDS cessation; being specific when asking about ENDS; creating electronic health record systems to support incorporating ENDS cessation; using chart audits if electronic health records cannot support incorporating ENDS into tobacco cessation; and assigning roles and responsibilities to members of the clinical care team. The third category was assisting patients who use ENDS. This included: educating patients and their parents/caregivers about ENDS and their potential harms, avoiding dual use, and developing a plan to quit.

CONCLUSIONS

This study highlights challenges and opportunities for incorporating ENDS cessation into family medicine. The opportunities outlined here provide a practical approach which is rooted in the experiences of family physicians and their clinical care teams working to improve how they address ENDS and based on peer reviewed literature and expert input. Improving how ENDS are addressed in family medicine will require more than clinical expertise. It will also require leadership skills and the ability to create process improvements.

TRIAL REGISTRATION

Not applicable.

Association between age at first reported e-cigarette use and subsequent regular e-cigarette, ever cigarette and regular cigarette use

BACKGROUND AND AIMS

Association of electronic cigarette use and subsequent smoking has received considerable attention, although age of first use has not. This study tested differences in regular (e-cigarettes, cigarettes) and ever (cigarettes) use between e-cigarette user groups: early versus never users, late versus never users, early versus late users and effects of controlling for covariates.

DESIGN

Prospective study with 12- and 24-month follow-up of e-cigarette/cigarette ever/regular use with data from an intervention.

SETTING

Forty-five schools in England (Staffordshire and Yorkshire).

PARTICIPANTS

Never smokers (3289 13-14-year-olds) who were part of a cluster randomized controlled trial.

MEASUREMENTS

The sample was divided into groups of e-cigarette users: early users (at 13-14 years), late users (at 14-15 years) and never users (at 13-14 and 14-15 years). Dependent variables were self-reported regular e-cigarette and cigarette use and ever cigarette use at 15-16 years. Covariates were assessed.

FINDINGS

Early and late users compared with never users were significantly more likely to be regular e-cigarette users [early: odds ratio (OR) = 9.42, 95% confidence interval (CI) = 5.38, 16.49, P < 0.001; late: OR = 6.89, 95% CI = 4.11, 11.54, P < 0.001], ever cigarette users (early: OR = 7.96, 95% CI = 6.02, 10.53, P < 0.001; late: OR = 5.13, 95% CI = 3.85, 6.84, P < 0.001) and regular cigarette users (early: OR = 7.80, 95% CI = 3.99, 15.27, P < 0.001; late: OR = 4.34, 95% CI = 1.93, 9.77, P < 0.001) at age 15-16 years. Late users compared with early users had significantly lower rates of ever use of cigarettes at 15-16 years (OR = 0.48, 95% CI = 0.35, 0.66, P < 0.001), although this difference was non-significant at 12 months after first use of e-cigarettes (OR = 0.89, 95% CI = 0.64, 1.25, P = 0.498). Controlling for covariates did not change the findings.

CONCLUSIONS

Adolescents in England who report using e-cigarettes at age 13-14 years have higher rates of subsequently initiating cigarette use than adolescents who report using e-cigarettes at age 14-15 years, a difference that may be attributable to a longer period of time to initiate cigarette use in former group.

E-cigarettes and smoking in Irish teens: a logistic regression analysis of current (past 30-day) use of e-cigarettes

Aim

Electronic cigarette (e-cigarette) use among Irish teenagers has risen significantly. In 2019, prevalence of current use (last 30 days) among 15–17-year-olds was 17.3%. We examine social determinants of adolescent e-cigarette current use.

Subject and methods

A stratified random sample of 50 schools in Ireland was surveyed in 2019, part of the European School Survey Project on Alcohol and other Drugs (ESPAD), with 3495 students aged 15, 16, and 17. Bivariate and multivariable logistic regression [providing adjusted odds ratios (AORs)] analyses were performed using Stata version 16.

Results

Current e-cigarette users were more likely to be male (AOR = 0.55, 95% CI:0.32–0.96, p < .01), younger (AOR = 0.34, 95% CI: 0.17–0.67, p = < .05), to participate in sport (AOR = 2.21, 95% CI: 1.05–4.65, p < .05), to have higher-educated parents (maternal higher education: AOR = 27.54, 95% CI: 1.50–505.77, p = < .05, paternal higher education: AOR = 2.44, 95% CI: 1.00–5.91, p < .05), and less likely to consider their families better off (AOR = 0.29, 95% CI: 0.13–0.65, p < .01), or to report familial support (AOR = 0.78, 95% CI: 0.64–0.95, p < .05). They were more likely to be cigarette smokers (AOR = 7.22, 95% CI: 3.97–13.12, p < .001), to report problem cannabis use (AOR = 3.12, 95% CI: 1.40–6.93, p < .01), to be ‘binge’ drinkers (AOR = 1.81, 95% CI : 1.00–3.32, p = .054), and to have friends who get drunk (AOR = 5.30, 95% CI: 1.34–20.86, p < .05).

Conclusion

Boys, smokers, binge drinkers, problem cannabis users, and sport-playing teenagers from higher-educated families, are at particular risk. As the number of young people using e-cigarettes continues to rise, including teenagers who have never smoked, improved regulation of e-cigarettes, similar to other tobacco-related products, is needed urgently to prevent this worrying new trend of initiation into nicotine addiction.

Successful Smoking Cessation among Women Smokers Based on Utilizing National Smoking Cessation Service Type in Korea

Background: This study aimed to evaluate the successful smoking cessation across different national smoking cessation services. Methods: This study included data that had been previously entered into the integrated information system for smoking cessation services and comprised 144,688 participants after excluding missing data. These clinics provide face-to-face counseling, phone calls, text messages, and e-mail services for six months and nine sessions. Results: The women-only program had the lowest success rate (11.3%). Compared with the women-only program, the six-month success rate of smoking cessation clinic at public health centers (OR = 3.72, CI = [3.52, 3.92]), visiting-type smoking cessation clinics (OR = 2.97, CI = [2.79, 3.16]), the residential 4 -night 5-day program (OR = 7.79, CI = [6.49, 9.35]), and a program for inpatients (OR = 2.36, CI = [1.89, 2.94]) showed a significant increase. Conclusions: Emotional labor workers who participated in the women-only program had low smoking cessation success rates, while those who participated in the residential 4-night 5-day program had high success rates.

Experimenting first with e-cigarettes versus first with cigarettes and transition to daily cigarette use among adolescents: the crucial effect of age at first experiment

BACKGROUND AND AIMS

Most studies in English-speaking countries have found a positive association between e-cigarette experimentation and subsequent daily tobacco smoking among adolescents. However, this result may not be valid in other cultural contexts; in addition, few studies have assessed whether this association varies with the subject' age at the time of e-cigarette experimentation. This study aimed to estimate the association between experimenting first with e-cigarette (rather than tobacco) and subsequent daily smoking according to age at the time of experimentation.

DESIGN

Secondary analysis; risk ratios (RRs) computed using modified Poisson regressions with inverse probability weighting.

SETTING

A cross-sectional nation-wide representative survey performed in 2017 in France.

PARTICIPANTS

French adolescents (n = 24 111), aged 17 to 18.5 years, who had previously experimented with either e-cigarettes or tobacco.

MEASURES

Exposure was defined as the experimentation with e-cigarettes first (whether or not followed by experimentation with tobacco); the outcome as daily tobacco smoking at the time of data collection. Gender, age, literacy, socio-economic status, pre-exposure repeat school years and experimentation with drunkeness, 3 licit and 8 illicit drugs were adjusted for. Uncertainties about the sequence of events defining exposure were handled by the definition of three patterns of exposure, to avoid a misclassification bias.

FINDINGS

Exposure reduced the risk of transition to daily smoking: RR = 0.58, 95% confidence interval (CI) = 0.54, 0.62. This effect increased in a linear manner with age at exposure (RR = 0.87, 95% CI = 0.78; 0.98 for 1 year, P < 0.001): from RR = 1.30, 95% CI = 1.09; 1.54 at age 9 to RR = 0.38, 95% CI = 0.32; 0.45 at age 17.

CONCLUSIONS

Experimenting with e-cigarettes first (as opposed to tobacco first) appears to be associated with a reduction in the risk of daily tobacco smoking among French adolescents aged 17-18.5, but this risk varies negatively with age at experimentation, and early e-cigarette experimenters are at higher risk.

Prospective estimation of the age of initiation of cigarettes among young adults (18-24 years old): Findings from the Population Assessment of Tobacco and Health (PATH) waves 1-4 (2013-2017)

OBJECTIVES

To prospectively estimate the age of cigarette initiation among young adults (18-24 years old) who were never cigarette users at their first wave of adult study participation overall, by sex, and by race/ethnicity given recent increases in cigarette initiation occurring in young adulthood.

METHODS

Secondary analyses were conducted using the PATH restricted-use adult datasets among young adult never users of cigarettes in waves 1-3 (2013-2016) with outcomes followed-up in waves 2-4 (2014-2017). Interval censoring survival methods were used to estimate the age of initiation of (i) ever, (ii) past 30-day, and (iii) fairly regular cigarette use. Among never cigarette users when they first entered the adult study, interval censoring Cox proportional hazard models were used to explore differences in the estimated age of initiation of the three cigarette use outcomes by sex and by race/ethnicity, controlling for the effect of previous e-cigarette use and the total number of other tobacco products ever used (0-5 products) before cigarette initiation outcomes.

RESULTS

Among the young adults who were never cigarette users at their first wave of adult participation, the highest increase in cigarette initiation occurred between 18 and 19 years old. By age 21, 10.6% (95% CI: 9.5-11.7) initiated ever cigarette use, 7.7% (95% CI: 6.1-8.1) initiated past 30-day of cigarette use, and 1.9% (95% CI: 1.4-2.5) initiated fairly regular cigarette use. After controlling for other tobacco products: (a) males were 83% more likely to initiate past 30-day cigarette use at earlier ages than females; (b) Hispanic and Non-Hispanic Black young adults had increased risk to initiate past 30-day cigarette use at earlier ages than Non-Hispanic White young adults (62% and 34%, respectively).

CONCLUSIONS

The substantial amount of cigarette initiation among young adults reinforces the need for prevention strategies among this population. Although, interventions are needed for all young adult populations, strategies should target 18-21-year-olds, with potentially differential prevention targets by sex and by race/ethnicity.

Impact of Individual, Familial and Parental Factors on Adolescent Smoking in Turkey

The burden of adolescent cigarette smoking is substantial. We assess mothers’ and fathers’ attitudes and behaviours on adolescent smoking using a cross-sectional study of n = 707 adolescents. Associations between parental attitudes and behaviours in adolescent smoking were assessed using logistic regression separately for boys and girls. Occasional alcohol use by both parents increased odds of smoking once a day (OR = 2.44, 95% CI 1.26, 4.71, OR = 1.51, 95% CI 0.97, 2.35, respectively). Fathers smoking increased odds for girls (OR = 1.59, 95% CI 1.01, 2.52). A democratic mother decreased odds for boys (OR = 0.32, 95% CI 0.10, 0.93) whereas a protective, demanding mother increased the odds for girls (OR = 8.65, 95% CI 1.38, 54.22). Public health smoking prevention programs could support changing parental behaviours and attitudes in early years to address this burden in countries with authoritarian parenting styles.

Age at Initiation of Cigarette Use in a Nationally Representative Sample of US Youth, 2013-2017

IMPORTANCE

Cigarettes are still a commonly used tobacco product among youth despite recent declines in cigarette use.

OBJECTIVE

The aim of this study was to prospectively estimate the age of cigarette use initiation among youth (aged 12-17 years) overall, by sex, and by race/ethnicity.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study used data from waves 1 through 4 of the nationally representative Population Assessment of Tobacco and Health (PATH) study, conducted from September 12, 2013, to January 3, 2018. Two subpopulations of youth were assessed: (1) those nonsusceptible to cigarette use and (2) never users of cigarettes at their first wave of PATH participation. Weighted interval-censoring survival analyses were used to prospectively estimate the age of initiation of cigarette use outcomes. Weighted interval-censoring Cox proportional hazard models were used to estimate differences in the age of initiation by sex and by race/ethnicity. Statistical analyses were performed from October 7, 2019, to May 1, 2020.

EXPOSURES

Differences in the age of initiation by sex and race/ethnicity.

MAIN OUTCOMES AND MEASURES

Age of initiation of susceptibility to cigarette use, ever use, past 30-day use, and fairly regular cigarette use overall, by sex, and by race/ethnicity.

RESULTS

A total of 15 776 youth never users and, among them, 11 022 youth who were nonsusceptible to cigarette use, were included in this study (weighted mean [SE] age, 13.5 [0.01] years; 58.6% [SE, 0.46%] non-Hispanic White; and 51.0% [SE, 0.32%] boys) and 15 776 were never users of cigarettes at their first wave of PATH participation (weighted mean [SE] age, 13.7 [0.01] years; 55.0% [SE, 0.29%] non-Hispanic White; and 51.0% [SE, 0.15%] boys). By age 18 years, among those who were nonsusceptible, 46.2% (95% CI, 44.3%-48.2%) became susceptible to cigarette use. Among never users, 24.4% (95% CI, 22.9%-25.9%) initiated ever cigarette use, 16.4% (95% CI, 15.2%-17.6%) initiated past 30-day cigarette use, and 4.3% (95% CI, 3.9%-4.8%) initiated fairly regular cigarette use. Boys had a higher risk of initiating ever (hazard ratio [HR], 1.21; 95% CI, 1.08-1.36) and past 30-day cigarette use (HR, 1.27; 95% CI, 1.10-1.47) at earlier ages compared with girls. Non-Hispanic White youth had a higher risk of an earlier age of initiation of susceptibility to cigarette use (HR, 0.77; 95% CI, 0.68-0.88), ever use (HR, 0.59; 95% CI, 0.49-0.71), past 30-day use (HR, 0.64; 95% CI, 0.52-0.77), and fairly regular cigarette use (HR, 0.25; 95% CI, 0.14-0.43) compared with non-Hispanic Black youth.

CONCLUSIONS AND RELEVANCE

The results of this cohort study suggest that, despite current interventions and existing laws, a large number of youth initiated cigarette use before the legal age to purchase tobacco products.

Estimating the Population Attributable Fraction of Asthma Due to Electronic Cigarette Use and Other Risk Factors Using Kentucky Behavioral Risk Factor Survey Data, 2016-2017

Introduction: Electronic nicotine delivery systems ENDS have become popular in the United States among both new users of nicotine and those seeking less harmful alternatives to traditional cigarettes. Users often perceive ENDS as being less harmful than traditional cigarettes. This study investigated the relationship between use of ENDS and asthma in a representative sample of adults. Methods: For this cross-sectional study, we used data from the Kentucky Behavioral Risk Factor Surveillance System telephone survey data from 2016-2017. Using a weighted multivariable logistic regression analysis, we identified important covariates to adjust for to calculate the population attributable fraction (PAF) of asthma due to ENDS and other modifiable risk factors factors (cigarette use, obesity, education, and employment). The confidence intervals for the PAFs were estimated using bootstrap methods of variance estimation. Results: We found that 10.6% of those aged 18-30 reported currently had asthma. After adjusting for noted covariates, ENDS use did not significantly increase the odds of asthma. In the final PAF model, the PAF of asthma due to ENDS was 0.4% (95% CI: -5.41, 6.21). Conclusion: While these findings suggest only modest effects of ENDS use on asthma prevalence, future research including older age groups and more long-term users might produce different results.

Sociodemographic and Clinical Characteristics of Vapers Using E-Cigarettes Exclusively: The French Vapoquid Study

Electronic cigarettes are increasingly being used as smoking cessation aids. Most studies assess the dual use of e-cigarettes and traditional cigarettes, but there remains a paucity of literature concerning individuals who use e-cigarettes exclusively. Objective: The aim of this study is to examine the sociodemographic and clinical characteristics of exclusive e-cigarette users, and consider their willingness to quit e-cigarette use. Methods: A French online survey was conducted from March to December 2017. We assessed the following factors: sociodemographic factors; the clinical characteristics of e-cigarette use and its social acceptability; and the self-perceived effectiveness of nicotine replacement therapy (NRT). Associations between the listed factors and a willingness to quit e-cigarette use were examined. Results: A total of 386 exclusive e-cigarette users (70% men) participated in the study and were included in the analysis. Most respondents were not planning to quit e-cigarette use (75%). Compared to those who did not want to quit, a desire to quit was associated with using smoking cessation services (OR [95%CI]: 3.45 [1.82-6.56]), e-cigarette craving (OR [95%CI]: 2.63 [1.44-4.80]) and NRT past-use (1.78 [1.12-2.87]). Users who planned to quit expressed more concerns about smoking initiation among youths using e-cigarettes (OR [95%CI]: 3.62 [1.90-6.93]). In multivariate analysis, these associations remained significant for the use of smoking cessation services, e-cigarette cravings, and concerns about youth tobacco initiation. Conclusion: Most exclusive e-cigarette users were not likely to quit. Planned cessation was associated with using smoking cessation services, experiencing e-cigarette dependence symptoms, and being concerned about smoking initiation among teenager e-cigarette users.

Use of Cigarettes and E-Cigarettes/Vaping Among Transgender People: Results From the 2015 U.S. Transgender Survey

INTRODUCTION

This study examines the demographic characteristics, transgender-specific factors, and discrimination experiences associated with current cigarette smoking, e-cigarette use/vaping, and dual use in a large sample of transgender people.

METHODS

This was a secondary analysis of the 2015 U.S. Transgender Survey (n=27,715). Conducted in 2019, logistic regression models were used to estimate the AORs and 95% CIs of current smoking, e-cigarette use/vaping, and dual use among transgender people.

RESULTS

Overall, 23.6% of respondents used cigarettes, 9.3% used e-cigarettes/vaping products, and 5.2% reported dual use within the past 30 days. Visually nonconforming individuals had greater odds (cigarettes: AOR=1.49, 95% CI=1.35, 1.65; e-cigarettes/vaping: AOR=1.43, 95% CI=1.25, 1.65; dual use: AOR=1.81, 95% CI=1.52, 2.15) than visually conforming individuals. Transgender people who had disclosed their transgender identity to their social networks had greater odds of cigarette smoking (AOR=1.30, 95% CI=1.17, 1.45), e-cigarette use/vaping (AOR=1.30, 95% CI=1.12, 1.52), and dual use (AOR=1.95, 95% CI=1.61, 2.35) than individuals who were out to none or some people within their networks. Experiencing discrimination (i.e., unequal treatment, verbal harassment, or physical assault) significantly increased the odds for cigarette smoking, e-cigarette use/vaping, and dual use. Transgender people who experienced all 3 types of discrimination had 2 times greater odds of current cigarette smoking (AOR=2.06, 95% CI=1.79, 2.37) and dual use (AOR=2.17, 95% CI=1.73, 2.74) than those who had not experienced discrimination.

CONCLUSIONS

Discrimination, visual nonconformity, and being out as transgender increased the odds of cigarette smoking, e-cigarette use/vaping, and dual use. This study informs disease prevention efforts for transgender populations with increased risks for these health behaviors.

The rise of electronic nicotine delivery systems and the emergence of electronic-cigarette-driven disease

In 2019, the United States experienced the emergence of the vaping-associated lung injury (VALI) epidemic. Vaping is now known to result in the development and progression of severe lung disease in the young and healthy. Lack of regulation on electronic cigarettes in the United States has resulted in over 2,000 patients and 68 deaths. We examine the clinical representation of VALI and the delve into the scientific evidence of how deadly exposure to electronic cigarettes can be. E-cigarette vapor is shown to affect numerous cellular processes, cellular metabolism, and cause DNA damage (which has implications for cancer). E-cigarette use is associated with a higher risk of developing crippling lung conditions such as chronic obstructive pulmonary disease (COPD), which would develop several years from now, increasing the already existent smoking-related burden. The role of vaping and virus susceptibility is yet to be determined; however, vaping can increase the virulence and inflammatory potential of several lung pathogens and is also linked to an increased risk of pneumonia. As it has emerged for cigarette smoking, great caution should also be given to vaping in relation to SARS-CoV-2 infection and the COVID-19 pandemic. Sadly, e-cigarettes are continually promoted and perceived as a safer alternative to cigarette smoking. E-cigarettes and their modifiable nature are harmful, as the lungs are not designed for the chronic inhalation of e-cigarette vapor. It is of interest that e-cigarettes have been shown to be of no help with smoking cessation. A true danger lies in vaping, which, if ignored, will lead to disastrous future costs.

Smoking-associated interstitial lung disease: update and review

INTRODUCTION

Smoking-associated interstitial lung disease manifests as several heterogeneous disorders involving the airways, pleura, and lung parenchyma with various radiological patterns. The clinical history, radiologic, and pathologic findings are important to distinguish these more uncommon diseases. A multidisciplinary approach is recommended for diagnosis and to manage these conditions appropriately.

AREAS COVERED

This review provides an overview of the epidemiology, risk factors, pathogenesis, clinical features, diagnosis, and treatment of acute eosinophilic pneumonia, e-cigarettes, or vaping associated lung injury, respiratory bronchiolitis interstitial lung disease, desquamative interstitial pneumonitis, pulmonary Langerhans cell histiocytosis, idiopathic pulmonary fibrosis, and combined pulmonary fibrosis emphysema.

EXPERT OPINION

Cigarette smoking is associated with a variety of pathologic conditions that affect the airways and lungs. E-cigarette use and vaping present new challenges to the clinician. Consensus between the clinical, radiographic, and pathologic findings is important in identifying and differentiating between the various entities to properly diagnose smoking-related interstitial lung diseases discussed in this review.

PROSPECTIVELY ESTIMATING THE AGE OF INITIATION OF E-CIGARETTES AMONG U.S. YOUTH: FINDINGS FROM THE POPULATION ASSESSMENT OF TOBACCO AND HEALTH (PATH) STUDY, 2013-2017

CONTEXT

There is a lack of research that prospectively estimates the age of initiation of electronic cigarette use in U.S. youth. Younger ages of initiation of tobacco product use are associated with greater exposure to nicotine, and recently e-cigarette use has been associated with subsequent cigarette initiation. This study sought to estimate the distribution of the age of first reporting of e-cigarette use outcomes among youth never e-cigarette users overall, by sex and by race/ethnicity, prospectively.

METHODS

Secondary analysis of the Population Assessment of Tobacco and Health (PATH) youth dataset (ages 12-17) across waves 1 (2013-2014), 2 (2014-2015), 3 (2015-2016), and 4 (2016-2017) were conducted. Four outcomes are presented, age of first report of: (i) susceptibility to use, (ii) ever use, (iii) past 30-day use, and (iv) "fairly regular" e-cigarette use. Each outcome was prospectively estimated using participant age when they entered the study and the number of weeks between the last report of never use and the first report of each outcome across waves. Weighted survival analyses for interval censoring accounting for the complex survey design were implemented.

RESULTS

Among youth non-susceptible to e-cigarettes, 50.2% became susceptible to e-cigarette use by age 18. There were no statistically significant differences in the age of first report of susceptibility to e-cigarette use by sex or by race/ethnicity in this nationally representative sample of U.S. youth. Among never users, 41.7%, 23.5% and 10.3% initiated ever, past 30-day and "fairly regular" e-cigarette use by the age of 18, respectively. Less than 10% initiated ever e-cigarette use between the ages of 18 and 21. Boys had a higher risk of first reporting ever, past 30-day and "fairly regular" e-cigarette use at earlier ages than girls. Non-Hispanic Blacks and Other racial/ethnic groups were less likely than Non-Hispanic Whites to initiate ever e-cigarette use at earlier ages, and there was no difference between Non-Hispanic Whites and Hispanics. Hispanic, Non-Hispanic Black and Other racial/ethnic youth were less likely to first report past 30-day use and "fairly regular" e-cigarette use at earlier ages than Non-Hispanic White youth.

CONCLUSION

This paper provides information on specific ages of the first report of e-cigarette use behaviors by sex and by race/ethnicity that can be used to culturally tailor e-cigarette interventions on specific windows of opportunity before youth begin using e-cigarettes or escalating their use.