A Study of the Use, Knowledge, and Beliefs About Cigarettes and Alternative Tobacco Products Among Students at One U.S. Medical School

A literature review addressing midwakh and e-cigarette use in the Gulf region

A notable decrease in conventional cigarette smoking has been witnessed on a global scale. However, this decrease has been accompanied by an equally striking global increase in the consumption of alternative tobacco products (ATPs), namely e-cigarettes and midwakh in the Arabian Gulf region. A literature review was used to outline the chemical composition of these two ATPs and review their impacts on health. The study was conducted using databases like PubMed, Google Scholar, MDPI, and WorldCat. The literature search included terms such as "e-cigarettes," "midwakh," "dokha," "heath impacts," "psychological effects," "social influences," and "cigarette smoking" with emphasis on literature from the Arabian Gulf region. Data shows that midwakh contains markedly high levels of tar, nicotine, and various compounds of notable effects on the human body. Similarly, it was found that e-cigarettes contain non-negligible amounts of nicotine and other chemical compounds that may not have been extensively investigated. Alarming reports of system-specific effects brought about by midwakh, and e-cigarette consumption, have been reported, although further research is needed to deduce the mechanism. We also discussed some of the social and psychological factors leading to their consumption within this population. Hence, this review raises questions around the safety of these two types of ATPs and encourages comprehensive studies globally and regionally.

Oxidative Stress in Pregnancy

Recent years have seen an increased interest in the role of oxidative stress (OS) in pregnancy. Pregnancy inherently heightens susceptibility to OS, a condition fueled by a systemic inflammatory response that culminates in an elevated presence of reactive oxygen species (ROS) and reactive nitrogen species (RNS) in the circulatory system. The amplified OS in pregnancy can trigger a series of detrimental outcomes such as underdevelopment, abnormal placental function, and a host of pregnancy complications, including pre-eclampsia, embryonic resorption, recurrent pregnancy loss, fetal developmental anomalies, intrauterine growth restriction, and, in extreme instances, fetal death. The body's response to mitigate the uncontrolled increase in RNS/ROS levels requires trace elements that take part in non-enzymatic and enzymatic defense processes, namely, copper (Cu), zinc (Zn), manganese (Mn), and selenium (Se). Determination of ROS concentrations poses a challenge due to their short half-lives, prompting the use of marker proteins, including malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GPx), glutathione reductase (GR), catalase (CAT), and glutathione (GSH). These markers, indicative of oxidative stress intensity, can offer indirect assessments of pregnancy complications. Given the limitations of conducting experimental studies on pregnant women, animal models serve as valuable substitutes for in-depth research. This review of such models delves into the mechanism of OS in pregnancy and underscores the pivotal role of OS markers in their evaluation.

Education for Tobacco Use Disorder Treatment: Current State, Evidence, and Unmet Needs

Background

Tobacco use is undertreated in the medical setting. One driver may be inadequate tobacco use disorder treatment (TUDT) training for clinicians in specialties treating tobacco-dependent patients.

Objective

We sought to evaluate the current state of TUDT training for diverse professionals and how these skills are assessed in credentialing exams.

Methods

We performed a focused review of current educational practices, evidence-based strategies, and accreditation exam contents focused on TUDT.

Results

Among medical students, participants in reviewed studies reported anywhere from 45 minutes to 3 hours of TUDT training throughout their 4-year programs, most often in the form of didactic sessions. Similarly, little TUDT training was reported at the post-graduate (residency, fellowship, continuing medical education) levels, and reported training was typically delivered as time-based (expected hours of instruction) rather than competency-based (demonstration of mastery) learning. Multiple studies evaluated effective TUDT curricula at varied stages of training. More effective curricula incorporated longitudinal sessions and active learning, such as standardized patient encounters or proctored patient visits. Knowledge of TUDT is minimally evaluated on certification exams. For example, the American Board of Internal Medicine blueprint lists TUDT as <2% of one subtopic on both the internal medicine and pulmonary exams.

Conclusion

TUDT training for most clinicians is minimal, does not assess competency, and is minimally evaluated on certification exams. Effective, evidence-based TUDT training incorporating active learning should be integrated into medical education at all levels, with attention paid to inclusion on subsequent certifying exams.

Electronic Cigarette Prevalence and Knowledge Among Medical Students in Saudi Arabia and Bahrain: A Cross-National Study

Background Electronic cigarettes (e-cigarettes and vapour devices) are the most commonly used form of alternative tobacco products (ATPs). The use of these vapour devices has been dramatically increasing worldwide, especially among current and former traditional cigarette smokers. A strong influence that will affect patients' health attitudes and play a crucial role in tobacco control and smoking cessation are medical students, as they are future physicians. Therefore, in our study, we aimed to determine the prevalence rate of e-cigarettes and the level of knowledge among medical students in Saudi Arabia and Bahrain. Methods  We conducted a cross-sectional study of medical students in Saudi Arabia and Bahrain using an online survey. This was distributed through social media platforms such as Twitter, WhatsApp, Telegram, and Facebook. Medical students of all years were included. The questionnaire was adapted from two previous studies. Results  The study enrolled 1730 medical students. The majority of the participants did not recommend the use of e-cigarettes as a method for smoking cessation or believed that these types of ATPs lower the risk of cancer in comparison with traditional cigarettes. The data showed a strong association between gender and e-cigarette smoking, with the majority of current smokers being men (n = 184) and experimental smokers being women (n = 800). Moreover, an educational gap was discovered, as few of the students had received an education in their medical school's curriculum on the use of e-cigarettes. There was a significant association between receiving an education at a medical school and having adequate knowledge of e-cigarettes. Conclusion  The increasing number of e-cigarette users among medical students is concerning. Our study showed that students are not receiving a decent education on the use of ATPs during medical school, which urges further adjustment of the curriculum. This will play a huge role in their behaviour and the provision of future treatment plans to patients as physicians.

Cannabis Use in Physicians: A Systematic Review and Meta-Analysis

Background: Cannabis use by physicians can be detrimental for them and their patients. We conducted a systematic review and meta-analysis on the prevalence of cannabis use by medical doctors (MDs)/students. Method: PubMed, Cochrane, Embase, PsycInfo and ScienceDirect were searched for studies reporting cannabis use in MDs/students. For each frequency of use (lifetime/past year/past month/daily), we stratified a random effect meta-analysis depending on specialties, education level, continents, and periods of time, which were further compared using meta-regressions. Results: We included 54 studies with a total of 42,936 MDs/students: 20,267 MDs, 20,063 medical students, and 1976 residents. Overall, 37% had used cannabis at least once over their lifetime, 14% over the past year, 8% over the past month and 1.1 per thousand (‱) had a daily use. Medical students had a greater cannabis use than MDs over their lifetime (38% vs. 35%, p < 0.001), the past year (24% vs. 5%, p < 0.001), and the past month (10% vs. 2%, p < 0.05), without significance for daily use (0.5% vs. 0.05%, NS). Insufficient data precluded comparisons among medical specialties. MDs/students from Asian countries seemed to have the lowest cannabis use: 16% over their lifetime, 10% in the past year, 1% in the past month, and 0.4% daily. Regarding periods of time, cannabis use seems to follow a U-shape, with a high use before 1990, followed by a decrease between 1990 and 2005, and a rebound after 2005. Younger and male MDs/students had the highest cannabis use. Conclusions: If more than a third of MDs tried cannabis at least once in their lifetime, this means its daily use is low but not uncommon (1.1‱). Medical students are the biggest cannabis users. Despite being common worldwide, cannabis use is predominant in the West, with a rebound since 2005 making salient those public health interventions during the early stage of medical studies.

Perceptions and preparedness toward tobacco cessation counseling amongst clinical medical students in Chongqing, Southwest China: A cross-sectional study

Background

Medical students play an indispensable role in providing smoking cessation counseling. Despite the rapid increase in tobacco use, there is little data on what Chinese medical students know or are taught about it. This study aims to investigate the relationship between medical students' tobacco education level, clinical experience, and tobacco cessation counseling (TCC) provided by medical students.

Methods

This cross-sectional study was carried out among clinical medical students of Chongqing medical university. An anonymous, self-administered questionnaire included items on demographic information, perceptions, and perceived preparedness, clinical medical students' self-reported level of education about alternative tobacco products, and traditional cigarettes. We assessed their perspectives toward TCC using a 5-point Likert scale. Descriptive and binary logistic regression analyses were carried out.

Results

A total of 1,263 medical students completed the questionnaire. The majority of students (85%) expressed a willingness to provide TCC to patients in need. However, only half of the students stated unequivocally that they knew some ways and methods of tobacco cessation, while 18% stated that they did not know methods of tobacco cessation. Tobacco education and clinical experience were significantly associated with the ability to provide TCC. Our findings revealed that students with more clinical experience (undergraduates: B = 0.326, P &lt; 0.001; postgraduates: B = 0.518, P &lt; 0.001) were significantly more likely to have a greater self-reported comprehensive ability to provide TCC.

Conclusion

Tobacco education and clinical experience can enhance the ability of medical students to provide smoking cessation counseling. There is a need to focus on alternative tobacco products with changing times, and curriculum planners should collaborate to incorporate comprehensive tobacco prevention and cessation training into the medical school curriculum.

Knowledge and Use of Electronic Cigarettes in Young Adults in the United Arab Emirates, Particularly during the COVID-19 Pandemic

(1) Background: The popularity of electronic cigarettes (e-cigarettes) has recently increased. Although they are less harmful than regular cigarettes, they still cause health consequences and their use for smoking cessation is inconclusive. The objective of this study was to evaluate patterns of use, knowledge about, and attitude towards e-cigarettes among youth in the United Arab Emirates (UAE) while also researching the impact of the COVID-19 pandemic on smoking behavior. (2) Methods: An online cross-sectional survey was distributed across three major universities in the UAE (n = 240) between March and November 2021. Descriptive analysis, comparison across gender and nationality groups, and correlates between 30-day e-cigarette use and self-reported increases in nicotine consumption during the pandemic were studied. (3) Results: About 37% of students had used an e-cigarette in their lifetime, and 23% had smoked e-cigarettes in the past month. During the pandemic, 52% of university students self-reported no change in nicotine consumption, while only 17.5% had reported an increase. The current smoking of regular cigarettes, waterpipe, and medwakh increased the odds of having an increase in smoking during the pandemic by 5.3 times. (4) Conclusions: The findings inform about youth behavior and knowledge about vaping in the UAE and could also support the development of awareness interventions.

Otolaryngology Resident Education and Perceptions of e-cigarettes

OBJECTIVE

To date, there are no reports of otolaryngology residents' knowledge and confidence in discussing e-cigarette use. The purpose of this study was to evaluate otolaryngology resident e-cigarette knowledge and confidence in counseling patients on e-cigarette use.

STUDY DESIGN

Cross-sectional national survey.

SETTING

Accreditation Council for Graduate Medical Education otolaryngology residents in the United States.

METHODS

US otolaryngology residents were distributed surveys electronically in September 2020.

RESULTS

A total of 150 participants replied for a response rate of 8.88%. The majority, 93.10% have not received formal education on e-cigarettes during their residency training. The most common resource of e-cigarette information overall was social media (78.46%). Within academia, the most common resources of e-cigarette education were patient interactions (63.16%) and colleagues (54.74%). Patients commonly inquire residents about e-cigarettes for smoking cessation (85.07%) and their long-term health effects (83.58%). Almost 67% of residents rarely or never ask patients about e-cigarette use. Only 4.35% of residents are not confident discussing traditional cigarette use, while 58.70% are not confident discussing e-cigarettes.

CONCLUSION

Otolaryngology residents have not received formal education in e-cigarettes and are not confident discussing e-cigarettes with their patients. This highlights the need for e-cigarette education during otolaryngology residency to improve patient e-cigarette counseling.

E-cigarette use, opinion about harmfulness and addiction among university students in Bratislava, Slovakia

OBJECTIVES

The study aimed to investigate the use of electronic cigarettes (EC) among medical students, their knowledge and beliefs (opinion about harmfulness and addiction potential) on ECs, perceptions of the risk, as well as to assess the type of education and cessation training they received during their study at Faculty of Medicine, Comenius University in Bratislava, Slovakia.

METHODS

This cross-sectional, anonymous online e-mailed survey was conducted among medical students via the Study Department by sending e-mails containing the survey link. Participants completed the online questionnaire adapted from the American Survey on Tobacco and Alternative Tobacco Products. It included questions about the personal use of EC, perceptions about the harms and their role in disease causation, education and cessation training, and practices related to conventional cigarettes (CC), EC, and alternative tobacco products (ATP). The e-mailed questionnaire filled in 577 medical students (71.9% women) from Comenius University in Bratislava, the average age was 23 ± 2 years. The sample comprised 486 (84.2%) Slovak and 91 (15.8%) foreign students. The data were analysed using the Statistical Package for Social Science (SPSS) version 25.

RESULTS

There were 385 (66.7%) non-smokers, 111 (19.3%) ex-smokers and 81 (14%) current smokers in the study sample. EC currently use 13.5% of medical students, with a statistically significant intersexual difference (22.2% males vs. 10.12% females; OR = 2.53, 95% CI: 1.55-4.13), more foreign students than Slovak students (24.2% vs. 11.52%; OR = 2.44, 95% CI: 1.41-4.26), more smokers of conventional cigarettes than non-smokers (46.9% vs. 8.06%; OR = 10.07, 95% CI: 5.85-17.34). EC seems to be less harmful to 59.97% of students, mostly in the age group ≤ 24 (61.76% vs. 51.49%; OR = 1.46, 95% CI: 1.03-2.07), 41.25% of students consider EC to be less addictive, 55.6% think they do not get enough education on EC during their medical study.

CONCLUSION

The results overall show the high consumption of tobacco products and the lack of knowledge and awareness among medical students, future health care providers. In health promotion and disease prevention, they should serve as a model for their patients and for the general public as well. Our study emphasizes the need for intervention in this field at medical faculties and for support of further monitoring in Slovakia and other countries and draws attention to the ongoing lack of EC regulation.

Vaping education in baccalaureate nursing curriculum and effects on practice: A cross-sectional exploratory study

BACKGROUND

Vaping has become increasingly more prevalent, and nurses need to understand the risks, assess health effects, and provide education on vaping cessation and avoidance.

OBJECTIVE

The purpose of the study was to evaluate nursing students' vaping behaviors and knowledge as well as the extent that vaping education is integrated into curriculum and clinical practice.

DESIGN

A cross-sectional exploratory study.

SETTING/PARTICIPANTS

Baccalaureate nursing students from across the United States.

METHODS

Questionnaires were electronically delivered to nursing programs for distribution. The questionnaire assessed vaping behaviors, knowledge of health risks related to vaping and smoking, the extent to which participants integrated vaping education into their clinical practice, and vaping education in nursing curriculum. Pearson correlations and t-tests were performed to assess the relationships and differences between the variables.

RESULTS

The prevalence of vaping in US nursing students identified in this study exceeds most of the previous studies in this area. In the states represented, programs were more likely to teach smoking content than vaping. If vaping was part of the curriculum, most programs were more likely to teach vaping through informal class discussion versus within the formal curriculum. Correlations were noted between knowledge of vaping health outcomes and clinical practice behaviors of students. Overall, there was a correlation between comfort assessing/discussing vaping in the clinical setting and the presence of vaping curriculum, however the correlation was stronger when taught as part of the formal curriculum rather than through informal discussion.

CONCLUSIONS

While vaping is rapidly increasing in use, students were less likely to include vaping into their clinical practice if they lack knowledge of the effects. When formal curriculum is in place, students were more likely to include vaping assessment and education into clinical practice. Including vaping content within the formal curriculum is a warranted approach to address this growing crisis.

E-cigarette use and tobacco harm reduction: Pilot survey study evaluating perspectives of head and neck surgeons

BACKGROUND

Electronic cigarettes (EC) are popular devices that aerosolize a nicotine and have been controversially considered tool for smoking cessation and tobacco harm reduction (THR). The purpose of this pilot study was to identify head and neck cancer (HNC) surgeons' attitudes/perspectives of EC and smoking cessation counseling.

METHODS

Cross-sectional survey administered to American Head and Neck Society (AHNS) members.

RESULTS

Response rate was 136 members (15.1%) with the majority 102 (75.00%) having unfavorable attitude toward EC for smoking cessation. Fifty-eight respondents (42.7%) were familiar with THR. Those familiar with THR 37 (63.79%) routinely inquire about EC use. Compared between THR familiarity, 22 (37.93%) believed the benefits of EC for smoking cessation outweighed the potential risks.

CONCLUSIONS

HNC specialists have an unfavorable attitude toward EC. Those familiar with THR were more likely to inquire about EC use. They were also less likely to have a definitive opinion on the benefits of quitting combustible cigarettes.

E-cigarettes use among university students in Jordan: Perception and related knowledge

The use of e-cigarettes has been increasing in popularity among people, especially young adults. Assessing young individuals’ perceptions of e-cigarettes can help to identify factors that may influence their decision to use e-cigarettes. To examine prevalence, perceptions, and knowledge of e-cigarettes among university students in Jordan, an observational cross-sectional study using an online self-administered questionnaire was conducted among students from public and private universities between October 2020 and January 2021. A total of 1259 university students completed the questionnaire. Approximately, 11% of participants reported e-cigarettes use. Among users, 26.5% used it for the purpose of smoking cessation, while 22% of them used it out of curiosity, and 20.5% used it as they believed it is less harmful than other tobacco products. Multivariate analysis showed that conventional cigarette smokers were independently associated with a better knowledge about e-cigarettes (OR = 1.496, 95CI% = 1.018–2.197, p-value = 0.040). In addition, medical students showed a significantly better knowledge compared to non-medical students (OR = 1.710, 95CI% = 1.326–2.204, p-value = <0.001). In Jordan, e-cigarettes use is less popular compared to other countries. Nonetheless, educational interventions are needed to correct misconceptions about e-cigarettes among young adults.

The impact of smoking different tobacco types on the subgingival microbiome and periodontal health: a pilot study

Smoking is a risk factor for periodontal disease, and a cause of oral microbiome dysbiosis. While this has been evaluated for traditional cigarette smoking, there is limited research on the effect of other tobacco types on the oral microbiome. This study investigates subgingival microbiome composition in smokers of different tobacco types and their effect on periodontal health. Subgingival plaques were collected from 40 individuals, including smokers of either cigarettes, medwakh, or shisha, and non-smokers seeking dental treatment at the University Dental Hospital in Sharjah, United Arab Emirates. The entire (~ 1500 bp) 16S rRNA bacterial gene was fully amplified and sequenced using Oxford Nanopore technology. Subjects were compared for the relative abundance and diversity of subgingival microbiota, considering smoking and periodontal condition. The relative abundances of several pathogens were significantly higher among smokers, such as Prevotella denticola and Treponema sp. OMZ 838 in medwakh smokers, Streptococcus mutans and Veillonella dispar in cigarette smokers, Streptococcus sanguinis and Tannerella forsythia in shisha smokers. Subgingival microbiome of smokers was altered even in subjects with no or mild periodontitis, probably making them more prone to severe periodontal diseases. Microbiome profiling can be a useful tool for periodontal risk assessment. Further studies are recommended to investigate the impact of tobacco cessation on periodontal disease progression and oral microbiome.

Affective Temperament Traits and Age-Predicted Recreational Cannabis Use in Medical Students: A Cross-Sectional Study

The use of cannabis among college students is increasing. Cannabis abuse has been proposed to be associated with personality dimensions. However, there are currently no known studies on the relationship of temperament traits and recreational cannabis use among college students. This is a cross-sectional study that investigated 328 students at a Podiatric Medical College. We evaluated the association between temperament and recreational cannabis use by the students. Temperament was investigated using the Memphis, Pisa, Paris and San Diego Auto- Questionnaire (TEMPS-A (short version)). Additionally, we assessed demographics variables and perceived stress in the context of cannabis use, and analyzed the findings using logistic regression. The prevalence of recreational cannabis use was 8.45%. Recreational cannabis use among these students was highly associated with irritable and cyclothymic temperament traits. There was no association between recreational cannabis use and perceived stress, and demographic variables or other substance use. Furthermore, logistic regression analysis indicated that higher scores in cyclothymic or irritable temperament traits are significant predictors for recreational cannabis use. Our study has identified key temperament traits, with a strong association with recreational use of cannabis of the studied student population. Our findings are useful in designing screening and educational strategies directed towards increasing the wellbeing of medical students.

Pharmacy Students' Perceptions of Electronic Nicotine Delivery Systems as Compared to Those of Other Health Care Students

Objective. To determine how pharmacy students' perceptions of electronic nicotine delivery systems (ENDS) differ from those of other health care students. Methods. A 33-item questionnaire was sent to health professional students at a Midwestern university to assess their tobacco use, insights regarding ENDS, cessation education, and perceptions. Health professions included were pharmacy, nursing, public health, optometry, dental hygiene, and others. Results. The overall response rate to the questionnaire was 41% (1152/2799). The study population reported high ENDS use. Almost half (47%) of the respondents had ever used ENDS and 14% were current users (6% pharmacy students vs 19% other health care students). A lower percentage of pharmacy students than other health care students agreed that using ENDS is healthier than using tobacco (18% vs 26%). Overall, pharmacy students more strongly agreed that they had received enough education to counsel patients regarding tobacco cessation (rated 4.7 by pharmacy students vs 3.6 by other health care students on a seven-point Likert scale) and ENDS cessation (rated 3.3 by pharmacy students vs 2.9 by other health care students). Finally, pharmacy students were less likely than other health care students to recommend the use of ENDS to aid patients in quitting traditional cigarette use (2.9 vs 3.2, respectively). Conclusion. The rapid rise in use of ENDS and the continued use of cigarettes in the United States makes it imperative for health care professionals to be knowledgeable about these products and prepared to counsel patients regarding them. We found that pharmacy students tended to have more negative perceptions about ENDS and a lower percentage of pharmacy students than other health care students agreed that ENDS should be used as a cessation tool for quitting traditional cigarettes.

Are Medical Students Prepared to Model Healthy Behaviors for Their Future Patients? A Survey Comparing Aged-Matched Peers

BACKGROUND

Osteopathic medical students (OMS) who establish healthy behaviors for themselves are more likely to counsel their future patients on appropriate self-care. This study compared the lifestyle habits of OMS with those of age-matched peers in other areas of study, which served as the control group.

METHOD

In the fall of 2018, a survey was administered to OMS of the New York Institute of Technology College of Osteopathic Medicine (NYIT-COM) (group I) and graduate programs from the same school (group II), to assess their lifestyle habits. Questions on demographics were additionally included.

RESULTS

There were 398 total responses: 83.2% (N = 331) from group I and 16.9% (N = 67) from group II, with 25 being the mean age of the respondents. Group I (53.2%) reported to studying at least 5-10 h per day, while 20.1% reported to studying more than 10 h. Group II reported 37.3% and 9.0%, respectively, of study time. Group I exercised more times per week (2-3 times) than group II and for a longer duration (30-60 min). Group I slept more than group II (6-8 h), yet reported to using more substances to stay awake.

CONCLUSIONS

OMS studied, exercised, and slept more than age-matched peers, but used more substances to stay awake. Aspects of this study are encouraging, but suggest that further evaluation is needed for schools to assist students establish lifelong habits to encourage the wellness of their future patients.

Dental Students' Knowledge and Attitudes About Electronic Cigarettes: A Cross-Sectional Study at One Saudi University

There is limited information about what dental students know about the risks and effects of e-cigarettes, and there is even less information regarding their attitudes about e-cigarettes. The aim of this study was to assess dental students' knowledge, education, and attitudes regarding e-cigarettes and their confidence in discussing e-cigarettes with patients. All fourth- to sixth-year students registered at the King Abdulaziz University Faculty of Dentistry were invited to participate in this cross-sectional study conducted during a three-week period in December 2018. The focus was a comparison of never versus ever e-smokers ("ever" meaning current or former e-smokers). The response rate was 38.7% (193/498). Among the responding students, 43.2% (n=83) had ever used an e-cigarette, and 11 (5.7%) reported being current users. Almost 95% (n=183) of the total participants said they did not feel confident about their e-cigarette education in dental school. Students who had ever used an e-cigarette said they were more confident discussing e-cigarettes with patients than did students who had never used them and also demonstrated greater belief that e-cigarettes lower the risk of cancer for patients who use them as an alternative to smoking traditional cigarettes (p<0.001). This study provides evidence of a gap in dental students' attitudes and knowledge regarding e-cigarettes, making it necessary to integrate e-cigarette education into future curricula.

E-cigarette use among medical students at Qassim University: Knowledge, perception, and prevalence

Background:

The popularity of e-cigarettes is increasing rapidly worldwide and advertisements for such products are becoming ubiquitous in the media. Health concerns and smoking cessation are the most commonly reported reasons for traditional tobacco smokers to shift to e-cigarettes. As a result, the global market for e-cigarettes is on the rise. However, they are still a potential cause for many diseases.

Methods:

This is a cross-sectional study carried out at Qassim University in Buraydah, Saudi Arabia. A prevalidated questionnaire was distributed to medical students in April 2018 to evaluate the experience, knowledge, and awareness of e-cigarettes among the participants.

Results:

About one in ten students confirmed having smoked an e-cigarette. There was no significant relationship between e-cigarette users and demographic factors, such as gender, academic level, or age. However, the study showed a significant association between e-cigarette smoking and having an e-cigarette smoker among family members or friends. Most students 71.9% were not sure whether e-cigarettes were approved by the Food and Drug Administration (FDA) for smoking cessation. Only 23.3% of those surveyed believed that e-cigarettes can help in smoking cessation, whereas only 11% said that they would recommend it for a patient. On the contrary, 49.6% agreed that e-cigarettes are addictive. In response to another question, 92% reported receiving no education in medical school about e-cigarettes.

Conclusion:

Our study showed that medical students lacked knowledge about e-cigarettes. Therefore, more studies are needed to raise awareness about e-cigarettes, especially since the habit of using e-cigarettes is invading our society.

Knowledge and use of e-cigarettes among nursing students: results from a cross-sectional survey in north-eastern Italy

Background

Data on electronic cigarette (e-cigarette) use among health professional students, who can play a central role in promoting healthy habits and smoking cessation, are sparse. Moreover, the association between e-cigarettes and smoking habits is still debated. The present study aimed to investigate the diffusion of e-cigarette use among nursing students in north-eastern Italy and explore its association with tobacco smoking.

Methods

In 2015, a questionnaire focused on e-cigarette use and tobacco smoking habits was anonymously administered to 2020 students attending nursing courses held by Verona University in 5 different centres. Of these students, 1463 (72.4%) answered the questionnaire. The influence of e-cigarette ever use on both tobacco smoking initiation in all subjects and smoking cessation among ever smokers was investigated by multivariable logistic models.

Results

Most responders were female (77.1%), and the mean (SD) age was 23.2 (4.2) years. Nearly all students (94.7%) had heard about e-cigarettes. Approximately one-third (30.3, 95% CI 27.9–32.7%) had ever used e-cigarettes, but only 2.1% (1.5–3.0%) had used e-cigarettes in the last month. Very few (2.1%) of those responders who had never used e-cigarettes were willing to try them. Prevalence values were much higher for tobacco smoking: 40.9% of responders reported being current tobacco smokers, and 10.1% reported being past smokers. Ever use and current use of e-cigarettes were reported by 57.2 and 4.4% of current tobacco smokers and by 12.0 and 0.6% of never or past smokers, respectively (p < 0.001). In multivariable analysis, students who ever used e-cigarettes had 13 times greater odds of being an ever tobacco smoker than never users, whereas they had three times lower odds of being a former smoker.

Only 26 students were currently using both electronic and tobacco cigarettes, and most declared that they used e-cigarettes to stop or reduce tobacco smoking. Of note, only three students reported that they had completely stopped smoking thanks to e-cigarette use.

Conclusion

Use of e-cigarettes seemed to be rather rare among Italian nursing students and was mainly restricted to current smokers. E-cigarette use was not associated with smoking cessation in nursing students.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7250-y) contains supplementary material, which is available to authorized users.

Effects of exposure to direct and secondhand hookah and e-cigarette aerosols on ambient air quality and cardiopulmonary health in adults and children: protocol for a panel study

INTRODUCTION

Use of alternative nicotine delivery systems, such as electronic cigarettes and hookahs, has increased dramatically in the USA, but limited research has been conducted on the secondhand effects of these products, especially in children. The objective of this study is to assess the cardiopulmonary effects of e-cigarette and hookah use in vaping and smoking adults, and in non-smoking/non-vaping adults and children exposed to secondhand particles and gases.

METHODS AND ANALYSIS

This study uses a pre/post design, with four groups: two control groups (non-smoking/non-vaping and cigarette smoking) and two test groups (hookah smoking and e-cigarette vaping). Participants will be recruited by household, so that each home includes one smoking or vaping adult and one non-smoking/non-vaping adult and/or child (5-18 years). Non-smoking/non-vaping homes include an adult and child who do not smoke or vape and do not live with individuals who do. Air quality measures will be completed during a household smoking or vaping session (ambient air for non-smoking/non-vaping group), while cardiopulmonary measures and biological samples will be taken directly before and after the smoking/vaping session, and again 24 hours later, for all participants. Air quality measures include carbon monoxide, black carbon, particulate matter, trace elements, nicotine and carbonyls; cardiopulmonary measures include heart rate variability, blood pressure, pulmonary function and exhaled carbon monoxide; biological samples will assess cotinine, inflammatory cytokines and biomarkers in urine, saliva and nasal mucosa.

ETHICS AND DISSEMINATION

This study was approved by the Institutional Review Board at New York University School of Medicine (s16-02226 and s17-01143). Special attention was given to the inclusion of children, who are likely significantly impacted by the use of these products at home, and thus should be included in research. Results of the study will be distributed at conferences, in peer-reviewed journals and to relevant public health authorities for use in developing policy.

Waterpipe tobacco use in college and non-college young adults in the USA

BACKGROUND

Waterpipe tobacco smoking (WTS or 'hookah') is common among adolescents and college students in the USA. However, there has not yet been a large-scale, nationally representative study independently examining WTS among young adults who are not in college.

OBJECTIVE

This study sought to examine associations between attitudes, normative beliefs, certain socio-demographic factors and current WTS among young adults not in college and compare them to young adults in college.

METHODS

A total of 3131 US adults ages 18-30 completed an online survey about WTS behaviour, attitudes, normative beliefs and relevant socio-demographic factors. Multivariable logistic regression was used to examine independent associations between these variables and current WTS stratified by student status.

RESULTS

Ever WTS was reported by 29% of young adults not in college and by 35% of those in college, and current use rates were 3 and 7%, respectively. Multivariable models demonstrated that positive attitudes and perceived peer acceptability of WTS were significantly associated with increased current WTS for both young adults not in college [adjusted odds ratio (AOR) = 2.72; 95% CI: 2.00-3.71 and AOR = 2.02; 95% CI: 1.50-2.71, respectively] and young adults in college (AOR = 3.37; 95% CI: 2.48-4.58 and AOR = 2.05; 95% CI: 1.49-2.83, respectively). The magnitude of these associations was not significantly different when comparing individuals in college and not in college.

CONCLUSIONS

Among young adults, WTS is common in non-college-based populations as well as in college-based populations. Therefore, prevention programming should extend to all young adults, not only to those in college.

Electronic cigarette among health science students in Saudi Arabia

BACKGROUND:

Electronic cigarette (E-cigarette) is an electronic nicotine delivery device that has been advocated as a safe alternative for cigarette smokers. Since the introduction of E-cigarette internationally and in the Kingdom of Saudi Arabia (KSA), it gained popularity, particularly among the youth and young adults. Moreover, many nonsmoker (nicotine-naïve) youth started to use E-cigarette as a new social habit. Recent researches have casted shadows on the E-cigarette safety profile.

OBJECTIVE:

The aim of this study is to assess the prevalence of E-cigarette use among students of health science colleges in Jeddah-KSA. It also assesses E-cigarette effectiveness as a smoking cessation method and its possible addictiveness.

METHODS:

The study is an epidemiological, cross-sectional study, which was conducted between November 2017 and December 2017 in three different universities in Jeddah. A self-administered online questionnaire related to E-cigarette and the conventional cigarette was used.

RESULTS:

A total of 1007 completed an electronic survey which was distributed to 3000 health sciences colleges' students. Of the participants 14.1% were cigarette smoker, 46% of them smoke regularly. Students who smoke half a pack per day and above were 22% of the smokers. More college students use the E-cigarette (27.7%). Moreover, one-fifth of the E-cigarettes users were using it on the regular daily basis. The study found that 42.7% of E-cigarettes users have used it as a tool to quit smoking. Interestingly, more than half (56.7%) of the students who used it to stop smoking has succeeded. However, only 46% of E-cigarettes users who tried to quit vaping have succeeded. Young aged, students believed that smoking is more addictive than vaping or recommended E-cigarette for smoking cessation found to have a higher chance of quitting smoking in the univariate regression analysis. While, in the multivariate analysis, students who believed that conventional smoking is more addictive than E-cigarettes; students started vaping to quit smoking, or used E-cigarettes with fruit flavor found to have significantly higher chance of quitting.

CONCLUSION:

The E-cigarettes vaping is more prevalent than conventional cigarette smoking among health sciences students in Jeddah-KSA. E-cigarettes are used as a tool to help smoking cessation in less than half of the user. E-cigarettes help some smokers to quit smoking. However, it seems as addictive to the users as conventional cigarette smoking.

Prevalence of Cannabis Use Among Medical Students: A Systematic Review and Meta-analysis

OBJECTIVE

Cannabis is reported to be the most common illicit substance used among medical students; however, the number of related studies is limited and their results are not systematically reviewed. The aim of our study was to analyze the prevalence of lifetime and current use of cannabis among medical students worldwide.

METHODS

A systematic review and meta-analysis was performed with adherence to the PRISMA guidelines. The electronic databases PubMed, Scopus, and Cochrane library were searched for studies on the prevalence of cannabis use among medical students. Prevalence of lifetime, past-year, and past-month cannabis use was extracted. Pooled prevalence and relative risk for sex were calculated using the random effects model and subgroup analyses were conducted.

RESULTS

A total of 38 observational (cross-sectional and cohort) studies were included (total number of participants 19 932), and most of them were conducted in Europe, Central and Southern America, and the United States. Overall pooled prevalence of lifetime cannabis use was 31.4% (95% confidence interval [CI]: 23.7%-39.6%), past-year use was 17.2% (95% CI: 10.8%-24.6%), and past-month use was 8.8% (95% CI: 5.6%-12.5%). Men displayed higher rates of cannabis use with a pooled relative risk of 1.55 (95% CI: 1.32-1.81). Heterogeneity was high (I 2 > 75%) and there were differences among continents in all outcomes (P < .001).

CONCLUSIONS

In conclusion, 1 in 3 medical students has used cannabis, whereas 8.8% were current users. Significant differences among continents were observed, but common finding was that male students tend to consume cannabis more often than female students.

Distinct Motives for Use Among Polytobacco Versus Cigarette Only Users and Among Single Tobacco Product Users

Background

Alternative tobacco product (ATP) use as well as co-use of various tobacco products has increased in recent years, particularly among young adults. However, little is known about the differential role of motives for ATP or polytobacco use.

Methods

We examined (1) motives for tobacco use in relation to polytobacco versus cigarette only use and (2) motives for tobacco use in relation to levels of tobacco use across products. We analyzed data from past 30-day tobacco users at Wave 2 (Spring 2015) of a six-wave longitudinal study of 3418 students aged 18-25 years from seven U.S. colleges/universities. Variables included sociodemographics, tobacco use (cigarettes, little cigars/cigarillos [LCCs], smokeless tobacco [SLT], hookah, and e-cigarettes), and tobacco use motives (social, self-enhancement, boredom relief, and affect regulation).

Results

Multivariate analyses found that boredom relief motives were associated with polytobacco use versus cigarette only use (p = .007). Higher consumption levels demonstrated the following associations: cigarettes-positively with boredom relief (p = .025) and affect regulation motives (p < .001); LCCs-positively with affect regulation motives (p = .035); SLT-negatively with social (p = .003) and positively with self-enhancement (p = .017) and boredom relief motives (p = .007); and hookah-positively with social (p = .002) and boredom relief motives (p = .033) and negatively with self-enhancement (p = .004) and affect regulation motives (p = .001).

Conclusions

Distinct motives for use were associated with polytobacco use among smokers. Moreover, higher levels of use among single product users also demonstrated distinct associations across use motives. These data should inform targeted cessation interventions addressing motives for use in ATP and polytobacco users.

Implications

Interventionists, public health practitioners, and health care providers must address the increasing issue of ATP and polytobacco use and tailor interventions to reduce ATP and polytobacco use in light of the distinct motives for use.

Patterns of tobacco use in the United Arab Emirates Healthy Future (UAEHFS) pilot study

INTRODUCTION

Self-reported tobacco use in the United Arab Emirates is among the highest in the region. Use of tobacco products other than cigarettes is widespread, but little is known about specific behavior use patterns. There have been no studies that have biochemically verified smoking status.

METHODS

The UAE Healthy Future Study (UAEHFS) seeks to understand the causes of non-communicable diseases through a 20,000-person cohort study. During the study pilot, 517 Emirati nationals were recruited to complete a questionnaire, provide clinical measurements and biological samples. Complete smoking data were available for 428 participants. Validation of smoking status via cotinine testing was conducted based on complete questionnaire data and matching urine samples for 399 participants, using a cut-off of 200ng/ml to indicate active smoking status.

RESULTS

Self-reported tobacco use was 36% among men and 3% among women in the sample. However, biochemical verification of smoking status revealed that 42% men and 9% of women were positive for cotinine indicating possible recent tobacco use. Dual and poly-use of tobacco products was fairly common with 32% and 6% of the sample reporting respectively.

CONCLUSIONS

This is the first study in the region to biochemically verify tobacco use self-report data. Tobacco use in this study population was found to be higher than previously thought, especially among women. Misclassification of smoking status was more common than expected. Poly-tobacco use was also very common. Additional studies are needed to understand tobacco use behaviors and the extent to which people may be exposed to passive tobacco smoke.

IMPLICATIONS

This study is the first in the region to biochemically verify self-reported smoking status.

Students working against tobacco: A novel educational program to improve Canadian medical students' tobacco counselling skills

BACKGROUND

Medical professionals should be appropriately trained in the field of smoking cessation counseling and be familiar with related tobacco-control issues. Sadly, Canadian medical students receive little education regarding smoking cessation.

METHODS

University of Ottawa medical students created Students Working Against Tobacco (SWAT), a program that provides its members with tobacco education and opportunities to discuss tobacco use, smoking prevention and cessation with elementary-school students. Surveys assessing student knowledge and confidence in addressing tobacco issues were administered to the participating students at the start of the program and following their delivery of a school presentation.

RESULTS

Students initially lacked knowledge, skills and experience in addressing tobacco issues and discussing smoking prevention and cessation counselling. Following their involvement in the SWAT program, students' smoking cessation counselling knowledge and skills improved, and they expressed confidence in becoming more engaged in this important preventive health issue.

CONCLUSION

Until smoking cessation is incorporated into undergraduate medical education programs, gaps will remain in the preparation of tomorrow's physicians regarding the provision of effective smoking cessation counselling and their broader understanding of this important health issue. Currently, there are constraints limiting the number of medical undergraduates that SWAT is able to involve and influence.

Students working against tobacco: A novel educational program to improve Canadian medical students' tobacco counselling skills

BACKGROUND

Medical professionals should be appropriately trained in the field of smoking cessation counseling and be familiar with related tobacco-control issues. Sadly, Canadian medical students receive little education regarding smoking cessation.

METHODS

University of Ottawa medical students created Students Working Against Tobacco (SWAT), a program that provides its members with tobacco education and opportunities to discuss tobacco use, smoking prevention and cessation with elementary-school students. Surveys assessing student knowledge and confidence in addressing tobacco issues were administered to the participating students at the start of the program and following their delivery of a school presentation.

RESULTS

Students initially lacked knowledge, skills and experience in addressing tobacco issues and discussing smoking prevention and cessation counselling. Following their involvement in the SWAT program, students' smoking cessation counselling knowledge and skills improved, and they expressed confidence in becoming more engaged in this important preventive health issue.

CONCLUSION

Until smoking cessation is incorporated into undergraduate medical education programs, gaps will remain in the preparation of tomorrow's physicians regarding the provision of effective smoking cessation counselling and their broader understanding of this important health issue. Currently, there are constraints limiting the number of medical undergraduates that SWAT is able to involve and influence.

What do medical students know about e-cigarettes? A cross-sectional survey from one U.S. medical school

BACKGROUND

Although electronic cigarette (e-cigarette) use has rapidly increased, there is little data about what United States medical students know or are taught about them. This study examined medical students' experiences, knowledge, and attitudes regarding e-cigarettes, as well as their evaluation of their education on e-cigarettes.

METHODS

A cross-sectional online survey of medical students currently enrolled at the University of Minnesota Medical School (n = 984) was conducted over a three-week period in August and September 2015. Primary outcomes included students' personal experiences with e-cigarettes, knowledge and attitudes about e-cigarettes, and students' assessment of their education on e-cigarettes.

RESULTS

66.9% medical students completed the survey. 58% (n = 382) of participants identified as female. 35.8% (n = 235) were "not sure" whether e-cigarettes were approved by the FDA for smoking cessation, while 4.1% (n = 27) falsely believed they were. While 82.9% (n = 543) agreed or strongly agreed that they felt confident in their ability to discuss traditional cigarette use with patients, only 12.4% (n = 81) agreed or strongly agreed that they felt confident in their ability to discuss e-cigarettes with patients. 94.8% (n = 619) of participants believed that they had not received adequate education about e-cigarettes in medical school. A higher proportion of males reported ever using an e-cigarette.

CONCLUSIONS

The gaps in medical student knowledge and wide variances in attitudes about e-cigarettes at one medical school together with their report of inadequate education in an environment of increasing use of e-cigarette use in the U.S. speaks to a need for the development of medical school curriculum on e-cigarettes.

American pediatric society's 2017 John Howland award acceptance lecture: a tale of two toxicants: childhood exposure to lead and tobacco

This article summarizes the presentation of the 2017 Howland Award to Michael Weitzman, MD, at the Annual Pediatric Academic Society Meetings. It summarizes the remarkable advances in understanding the effects and pathways of exposure of the two most common and pernicious of our nation's child environmental exposures, namely lead and tobacco. It also summarizes the profound effect of the translation of these findings into prudent and effective clinical and public health policies such that exposure to both has dramatically decreased over the past 40 years due to the tenacious activities of pediatricians, other child-related professionals, government agencies at all levels, and the American Academy of Pediatrics. Research and clinical activities, although essential, were not sufficient to produce these successes, but required extensive mentoring to produce a generation of academic pediatricians capable of conducting the requisite research, and extensive advocacy by pediatricians and others to overcome the formidable inertia and outright opposition to efforts to protect our children from these exposures. Moreover, the article highlights that both of these environmental exposures have roots in social and environmental injustice and neither is solved, and that there is no safe level of exposure to either of these toxicants.

Electronic Cigarette Use in Students and Its Relation with Tobacco-Smoking: A Cross-Sectional Analysis of the i-Share Study

While young adults often try e-cigarettes, little is known about its use and the reasons for experimentation, particularly in relation with tobacco-smoking. In 2016, data were collected from 2720 French-speaking students participating in a web-based study on students' health: the internet-based Students Health Research Enterprise (i-Share) project. Univariate analyses and multivariable logistic regressions were performed to study the relationship between e-cigarette use and smoking status. Two out of five students declared having tried e-cigarettes and 3.6% were current users. Former smokers were more likely than current smokers to use e-cigarettes currently. Among those who had never smoked, 13.5% had tried e-cigarettes. Very few (0.3%) were current users, alternating e-liquids with and without nicotine. The three main reasons for trying e-cigarettes were curiosity, offer to try by someone, and attractiveness of e-liquid flavors. Among current smokers, previous attempts to quit smoking and a strong desire to stop tobacco were reported more in e-cigarette current users than in former users. In this large sample of French students, findings were consistent with the possibility that e-cigarettes might be used as smoking cessation or reduction aids by some young adults whereas other young never-smokers could be exposed to nicotine.

Dental, Dental Hygiene, and Advanced Dental Students' Use, Knowledge, and Beliefs Regarding Tobacco Products

Using cigarettes and alternative tobacco products (ATPs) is associated with negative oral health outcomes, and dental health professionals are poised to help patients quit. The aim of this study was to determine dental, dental hygiene, and advanced dental students' use, knowledge, and beliefs about cigarettes and ATPs, including perceptions about their education in tobacco dependence treatment and counseling experience. All 1,783 students enrolled in the dental, dental hygiene, and postdoctoral dental programs at the New York University College of Dentistry were invited to participate in the survey in 2016. A total of 708 students at least partially completed the survey, for a response rate of 39.7%. In the results, 146 of the students (20.1%) reported ever using cigarettes, while 253 (35.7%) reported ever using any ATP. Regarding tobacco use intervention, the students reported they had not received enough training on ATPs, were neutral about cigarettes, and were somewhat confident and not so confident counseling a cigarette smoker or ATP user, respectively. By their fourth year, 77.8% of the dental students reported they had counseled someone to stop smoking cigarettes, but only 40.7% had counseled someone to stop using ATPs. Overall, all groups of students reported feeling more confident and had received more education on interventions for cigarettes than for ATPs (p<0.001). These students reported low confidence in helping people quit tobacco and did not perceive they had received enough training on intervening with patients on use of cigarettes and ATPs. These findings call for a revised tobacco education curriculum for dental, dental hygiene, and advanced dental students, focused on building knowledge and confidence for promoting tobacco dependence treatment.

Electronic cigarette use, knowledge, and perceptions among health professional students

INTRODUCTION

Our study evaluated the electronic cigarette (e-cigarette) use, knowledge, and perceptions of health professional students enrolled in one of five colleges at a single academic health center.

METHODS

A 56-item survey was conducted to examine the use, knowledge, and perceptions of e-cigarettes among health professional students. An e-cigarette knowledge score was calculated according to correct responses to eight true-false survey items, with possible scores ranging from zero to eight points. Regressions were used to determine associations between students' enrolled college/discipline and e-cigarette knowledge scores and to identify associations between three perception domains (smoking cessation, harm reduction, and enhanced regulation) and e-cigarette use.

RESULTS

Of the 853 students responding, 24.2% reported e-cigarette ever-use. Of e-cigarette ever users, 85.5% had used within the past year, and 23.1% used e-cigarettes for smoking cessation. Participants from the colleges of public health, pharmacy, and nursing had significantly higher knowledge scores, compared to those in allied health. Knowledge scores from college of medicine participants did not differ significantly compared to scores from allied health. Perceptions of using e-cigarettes for smoking cessation, reduced harm compared to tobacco, and reduced e-cigarette regulation were significantly associated with using e-cigarettes.

DISCUSSION AND CONCLUSIONS

Self-reported ever-use of e-cigarettes among health professional students in this sample was 3.5-6 times higher than previously reported among medical and nursing students. Substantial gaps in e-cigarette knowledge exist. Enhancing health professionals' preparedness to effectively advise patients about the benefits and harms of e-cigarettes is crucial.

Tobacco toxicant exposure in cigarette smokers who use or do not use other tobacco products

BACKGROUND

Non-cigarette other tobacco products (OTP; e.g., cigarillos, little cigars) are typically used in combination with cigarettes, but limited data exists on the tobacco toxicant exposure profiles of dual cigarette-OTP (Cig-OTP) users. This study examined biomarkers of nicotine and carcinogen exposure in cigarette smokers who used or did not use OTP.

METHODS

111 Cig-OTP and 111 cigarette only (Cig Only) users who smoked equivalent cigarettes per day were matched on age (< 40, >=40), race (African American, White), and gender. Participants reported past 7-day daily use of cigarettes and OTP and provided urine for nicotine, cotinine, total nicotine equivalents (TNE) and total NNAL concentrations.

RESULTS

Cig-OTP users reported greater past 7-day tobacco use (15.9 versus 13.0 products/day, p<0.01) but had significantly lower creatinine-normalized nicotine (606 versus 1301ng/mg), cotinine (1063 versus 2125ng/mg), TNE (28 versus 57 nmol/mg) and NNAL (251 versus 343pg/mg) than Cig Only users (p<0.001).

CONCLUSIONS

Cig-OTP users had lower levels of nicotine and metabolites of a lung carcinogen relative to Cig-Only users, but concentrations of toxicants among Cig-OTP users were still at levels that place smokers at great risk from the detrimental health effects of smoking.

IMPACT

Our study finds that nicotine and carcinogen exposure in Cig-OTP users are lower compared to cigarette only users, but still likely to be associated with substantial harm. A better understanding of why toxicant levels may be lower in Cig-OTP is an important area for future study.

A Content Analysis of Unique Selling Propositions of Tobacco Print Ads

OBJECTIVES

We describe the unique selling propositions (USPs) (propositions used to convince customers to use a particular brand/product by focusing on the unique benefit) of print tobacco ads.

METHODS

A qualitative content analysis was conducted of print tobacco ads (N = 171) selected from August 2012 to August 2013 for cigarettes, moist snuff, e-cigarettes, cigars, and snus to determine the content and themes of USPs for tobacco ads.

RESULTS

Cigarette ad USP themes focused on portraying the product as attractive; moist snuff ads focused on portraying product as masculine; cigar ads focused on selling a "high end product;" and new and emerging tobacco products (e-cigarette, snus) focused on directly comparing these products to cigarettes.

CONCLUSIONS

Whereas traditional tobacco product ads used USPs focused on themes of enjoyment and pleasure (eg, attractive for cigarettes, "high end product" for cigars), new and emerging tobacco product ads offered the unique benefit (USP) of their product being a better and "safer" alternative to traditional tobacco products. Snuff's USPs focused nearly exclusively on the masculinity of their products. Our results provide targets for potential tobacco regulatory actions that could be implemented to reduce demand for tobacco products by reducing their perceived unique benefits.

Overview of Electronic Nicotine Delivery Systems: A Systematic Review

CONTEXT

Rapid developments in e-cigarettes, or electronic nicotine delivery systems (ENDS), and the evolution of the overall tobacco product marketplace warrant frequent evaluation of the published literature. The purpose of this article is to report updated findings from a comprehensive review of the published scientific literature on ENDS.

EVIDENCE ACQUISITION

The authors conducted a systematic review of published empirical research literature on ENDS through May 31, 2016, using a detailed search strategy in the PubMed electronic database, expert review, and additional targeted searches. Included studies presented empirical findings and were coded to at least one of nine topics: (1) Product Features; (2) Health Effects; (3) Consumer Perceptions; (4) Patterns of Use; (5) Potential to Induce Dependence; (6) Smoking Cessation; (7) Marketing and Communication; (8) Sales; and (9) Policies; reviews and commentaries were excluded. Data from included studies were extracted by multiple coders (October 2015 to August 2016) into a standardized form and synthesized qualitatively by topic.

EVIDENCE SYNTHESIS

There were 687 articles included in this systematic review. The majority of studies assessed patterns of ENDS use and consumer perceptions of ENDS, followed by studies examining health effects of vaping and product features.

CONCLUSIONS

Studies indicate that ENDS are increasing in use, particularly among current smokers, pose substantially less harm to smokers than cigarettes, are being used to reduce/quit smoking, and are widely available. More longitudinal studies and controlled trials are needed to evaluate the impact of ENDS on population-level tobacco use and determine the health effects of longer-term vaping.