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Farsalinos KE, Niaura R. E-cigarettes and Smoking Cessation in the United States According to Frequency of E-cigarette Use and Quitting Duration: Analysis of the 2016 and 2017 National Health Interview Surveys. Nicotine Tob Res 2020; 22:655-662. [PMID: 30768136 DOI: 10.1093/ntr/ntz025] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 02/12/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The purpose of this study was to examine the association between electronic cigarette (e-cigarette) use and smoking cessation among US adults. Duration of smoking cessation was taken into consideration because e-cigarette awareness and use were low in the United States before 2010. METHODS A pooled analysis of the 2016 and 2017 National Health Interview Surveys on current (N = 9935) and former smokers (N = 14 754) was performed. Adjusted prevalence ratios (aPRs), for sociodemographic factors, were calculated. FINDINGS Current e-cigarette use was reported by 10.5% (95% CI = 9.8% to 11.3%) of current smokers and 4.5% (95% CI = 4.0% to 5.0%) of former smokers. Prevalence was high in former smokers of less than 1 year (16.8%, 95% CI = 13.9% to 20.2%), 1-3 years (15.0%, 95% CI = 13.0% to 17.3%), and 4-6 years (10.5%, 95% CI = 8.6% to 12.7%), and very low in former smokers of more than 6 years (0.7%, 95% CI = 0.5% to 0.9%). Similar patterns were observed for daily e-cigarette use. Current e-cigarette use was negatively associated with being a former smoker when quit duration was ignored (aPR = 0.64, 95% CI = 0.59 to 0.69) but was positively associated with being a former smoker of less than 1 year (aPR = 1.44, 95% CI = 1.12 to 1.84) and 1-3 years (aPR = 1.21, 95% CI = 1.03 to 1.42). Daily e-cigarette use was not associated with being a former smoker when quit duration was ignored but was positively associated with being a former smoker of less than 1 year (aPR = 3.44, 95% CI = 2.63 to 4.49), 1-3 years (aPR = 2.51, 95% CI = 2.13 to 2.95), and 4-6 years (aPR = 1.84, 95% CI = 1.49 to 2.26). CONCLUSIONS Daily e-cigarette use is strongly associated with recent smoking cessation (≤6 years) among US adults. Frequency of e-cigarette use and smoking cessation duration are important parameters when analyzing the effects of e-cigarettes in population surveys. IMPLICATIONS There is controversy on whether e-cigarettes promote or prevent smoking cessation. This study presents a detailed analysis of the association between e-cigarette use and smoking cessation in the United States considering frequency of e-cigarette use and duration of smoking cessation. The latter was considered appropriate because e-cigarette awareness and use were low in the United States before 2010. Daily e-cigarette use is strongly associated with recent (≤6 years) smoking cessation in the United States. Both frequency of e-cigarette use and duration of smoking cessation are important factors in determining the effects of e-cigarettes in population studies.
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Affiliation(s)
- Konstantinos E Farsalinos
- Department of Cardiology, Onassis Cardiac Surgery Center, Kallithea, Greece.,Department of Pharmacy, University of Patras, Patras, Greece.,Department of Public and Administrative Health, National School of Public Health, Athens, Greece
| | - Raymond Niaura
- Department of Social and Behavioral Science, College of Global Public Health, New York University, New York, NY.,Department of Epidemiology, College of Global Public Health, New York University, New York, NY
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Affiliation(s)
- Konstantinos E Farsalinos
- Department of Cardiology, Onassis Cardiac Surgery Center, Sygrou 356, Kallithea 17674, Greece.,Center of Excellence in Trauma and Accidents, King Abdulaziz University, Al Ehtifalat St, Jeddah 21589, Saudi Arabia.,Department of Public and Administrative Health, National School of Public Health, L. Alexandras 196, Athens 11521, Greece
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Farsalinos KE, Barbouni A. Association between electronic cigarette use and smoking cessation in the European Union in 2017: analysis of a representative sample of 13 057 Europeans from 28 countries. Tob Control 2020; 30:71-76. [PMID: 32015151 DOI: 10.1136/tobaccocontrol-2019-055190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 10/08/2019] [Accepted: 11/01/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To examine the association between electronic cigarette (e-cigarette) use and smoking cessation in the European Union (EU) in 2017 according to e-cigarette use frequency and smoking cessation duration. DESIGN Cross-sectional survey of EU citizens, representative of the population (Special Eurobarometer 458). Weighted proportions (95% CI) and adjusted prevalence ratios (aPRs) were calculated. SETTING EU. PARTICIPANTS 13 057 EU citizens aged ≥15 years (6904 current and 6153 former smokers). RESULTS Current daily e-cigarette use was reported by 2.4% (1.8%-3.1%) of current and 3.3% (2.5%-4.2%) of former smokers (p=0.002), while former daily use was reported by 5.6% (4.7%-6.8%) and 1.9% (1.3%-2.7%), respectively (p<0.001). More than half of all former smokers had quit for >10 years. Current daily e-cigarette use was rare among former smokers of >10 years (0.2%, 0.1%-0.6%) and was more prevalent in former smokers of ≤2 and 3-5 years (12.9%, 9.1%-17.9% and 9.0%, 5.8%-13.7%, respectively). Compared with never use, current daily e-cigarette use was associated with being a former smoker of ≤2 (aPR 4.96, 95% CI 3.57 to 6.90) and 3-5 years (aPR 3.20, 95% CI 2.10 to 4.87). Former daily e-cigarette use was associated with being a former smoker of ≤2 years (aPR 1.96, 95% CI 1.21 to 3.12). Current daily e-cigarette use was negatively associated with being a former smoker of 5-10 and >10 years. CONCLUSIONS Current daily e-cigarette use in the EU in 2017 was rare among former smokers of >10 years and was positively associated with recent (≤5 years) smoking cessation. Former daily e-cigarette use was also positively associated with recent (≤2 years) smoking cessation.
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Affiliation(s)
- Konstantinos E Farsalinos
- Cardiology, Onassis Cardiac Surgery Center, Kallithea, Greece .,Department of Public and Administrative Health, National School of Public Health, Athens, Greece
| | - Anastasia Barbouni
- Department of Public and Administrative Health, National School of Public Health, Athens, Greece
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Farsalinos KE, Polosa R, Cibella F, Niaura R. Is e-cigarette use associated with coronary heart disease and myocardial infarction? Insights from the 2016 and 2017 National Health Interview Surveys. Ther Adv Chronic Dis 2019; 10:2040622319877741. [PMID: 31632622 PMCID: PMC6767743 DOI: 10.1177/2040622319877741] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 08/28/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND This study analyzed the National Health Interview Surveys (NHIS) of 2016 (n = 33,028) and 2017 (n = 26,742) to examine whether e-cigarette use is consistently associated with myocardial infarction (MI) and coronary heart disease (CHD). METHODS Surveys were examined separately and pooled. Logistic regression analysis was used, with demographics, e-cigarette use, smoking and risk factors for CHD (hypertension, hypercholesterolemia, and diabetes) being independent variables. Former smokers were subclassified according to quit duration (⩽ 6 and > 6 years). RESULTS For MI, an association was observed with some days e-cigarette (but not daily) use in the 2017 survey (OR: 2.11, 95% CI: 1.14-3.88, p = 0.017). No statistically significant association was observed in the pooled analysis (daily e-cigarette use: OR: 1.35, 95% CI: 0.80-2.27, p = 0.267). For CHD, an association was observed with daily e-cigarette use in the 2016 survey (OR: 1.89, 95% CI: 1.01-3.53, p = 0.047). From the pooled analysis, no association was found between any pattern of e-cigarette use and CHD. In single-year and pooled analysis, both MI and CHD were strongly associated with all patterns of smoking, hypertension, hypercholesterolemia, diabetes, and age. CONCLUSIONS The pooled analysis of the 2016 and 2017 NHIS showed no association between e-cigarette use and MI or CHD. The associations between established risk factors, including smoking, and both conditions were remarkably consistent. The inconsistent associations observed in single-year surveys and the cross-sectional design of the NHIS cannot substantiate any link between e-cigarette use and an elevated risk for MI or CHD. Longitudinal studies are needed to explore the effects of e-cigarette use on cardiovascular disease.
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Affiliation(s)
- Konstantinos E Farsalinos
- Onassis Cardiac Surgery Center, Sygrou 356,
Kallithea 17674, Greece Department of Pharmacy, University of Patras, Rio,
Greece National School of Public Health, Athens, Greece
| | - Riccardo Polosa
- Department of Clinical and Experimental
Medicine, University of Catania, Catania, Italy
- Center of Excellence for the acceleration of
HArm Reduction (CoEHAR), University of Catania, Catania, Italy
| | - Fabio Cibella
- National Research Council of Italy, Institute of
Biomedicine and Molecular Immunology, Palermo, Italy
| | - Raymond Niaura
- Departments of Social and Behavioral Science and
Epidemiology, College of Global Public Health, New York University, New
York, USA
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Polosa R, Urso S, Farsalinos KE. [Response to "New tobacco products, a threat for tobacco control and public health of Mexico"]. Salud Publica Mex 2019; 61:552-553. [PMID: 31430091 DOI: 10.21149/10128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Riccardo Polosa
- Department of Clinical and Experimental Medicine, University of Catania. Catania, Italy
- Center of Excellence for the Acceleration of Harm Reduction (Coehar), University of Catania. Catania, Italy
| | - Salvatore Urso
- Center of Excellence for the Acceleration of Harm Reduction (Coehar), University of Catania. Catania, Italy
| | - Konstantinos E Farsalinos
- Department of Cardiology, Onassis Cardiac Surgery Centre. Kallithea, Greece
- Department of Pharmacy, University of Patras. Patras, Greece
- National School of Public Health. Athens, Greece
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Abstract
Introduction: A recent study reported levels of metal emissions in e-cigarette (EC) aerosol. Herein we present a risk assessment analysis of the published findings using total daily exposure limits. Methods: Median and 75th percentile metal concentrations in EC aerosols were used to determine the level of daily liquid consumption (g/d) that would exceed the permissible daily exposures (PDEs) defined for inhalation medications (cadmium, chromium, copper, nickel, lead, antimony and tin). For metals not having PDEs, minimal risk levels (manganese) or risk exposure levels (aluminum, iron and zinc) were converted into total daily exposure using an inhalation volume of 20 m3 (for 24 h) and 6.7 m3 (for 8 h) respectively. Results: The lowest amount of liquid consumption exceeding safety limits was found for nickel (73 g/day for median and 17 g/day for 75th percentile levels). The consumption corresponding to the 75th percentile could be associated with realistic use, although this would represent an extreme rather than average consumption. For chromium, the respective levels were 358 and 68 g/day and for lead 338 and 135 g/day. For all other metals, liquid consumption would need to be orders of magnitude higher, reaching to 1.5 million grams for aluminum. Conclusion: EC emissions contain trace levels of metals. For almost all metals, unrealistically high levels of liquid need to be consumed in order for total daily exposure to exceed established limits.
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Affiliation(s)
- Konstantinos E Farsalinos
- a Department of Cardiology , Onassis Cardiac Surgery Center , Kallithea , Greece.,b Department of Pharmacy , University of Patras , Rio-Patras , Greece.,c National School of Public Health , Athens, Greece
| | - Brad Rodu
- d Department of Medicine School of Medicine , University of Louisville , Louisville, KY , USA
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Farsalinos KE, Yannovits N, Sarri T, Voudris V, Poulas K, Leischow SJ. Carbonyl emissions from a novel heated tobacco product (IQOS): comparison with an e-cigarette and a tobacco cigarette. Addiction 2018; 113:2099-2106. [PMID: 29920842 DOI: 10.1111/add.14365] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 04/20/2018] [Accepted: 06/13/2018] [Indexed: 01/16/2023]
Abstract
AIMS To measure carbonyl emissions from a heated tobacco product (IQOS) in comparison with an e-cigarette (Nautilus Mini) and a commercial tobacco cigarette (Marlboro Red). DESIGN Regular and menthol variants of the heated tobacco product were tested. A tank-type atomizer was tested with a tobacco-flavoured liquid at 10 and 14 W. Aerosol and smoke were collected in impingers containing 2,4-dinitrophenylhydrazine. Health Canada Intense and two more intense puffing regimens were used. SETTING Analytical laboratory in Greece. MEASUREMENTS Carbonyl levels in the aerosol and smoke. FINDINGS At the Health Canada Intense regimen, heated tobacco products emitted 5.0-6.4 μg/stick formaldehyde, 144.1-176.7 μg/stick acetaldehyde, 10.4-10.8 μg/stick acrolein, 11.0-12.8 μg/stick propionaldehyde and 1.9-2.0 μg/stick crotonaldehyde. Compared with the tobacco cigarette, levels were on average 91.6% lower for formaldehyde, 84.9% lower for acetaldehyde, 90.6% lower for acrolein, 89.0% lower for propionaldehyde and 95.3% lower for crotonaldehyde. The e-cigarette emitted 0.5-1.0 μg/12 puffs formaldehyde, 0.8-1.5 μg/12 puffs acetaldehyde and 0.3-0.4 μg/12 puffs acrolein, but no propionaldehyde and crotonaldehyde. At more intense puffing regimens, formaldehyde was increased in heated tobacco products, but levels were three-fourfold lower compared with the tobacco cigarette. Based on the findings from Health Canada Intense puffing regimen, use of 20 heated tobacco sticks would result in approximately 85% to 95% reduced carbonyl exposure compared with smoking 20 tobacco cigarettes; the respective reduction in exposure from use of 5 g e-cigarette liquid would be 97% to > 99%. CONCLUSIONS The IQOS heated tobacco product emits substantially lower levels of carbonyls than a commercial tobacco cigarette (Marlboro Red) but higher levels than a Nautilus Mini e-cigarette.
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Affiliation(s)
- Konstantinos E Farsalinos
- Department of Cardiology, Onassis Cardiac Surgery Center, Kallithea, Greece
- Department of Pharmacy, University of Patras, Rio-Patras, Greece
- National School of Public Health, Athens, Greece
| | - Nikoletta Yannovits
- Skylab-Med Laboratories of Applied Industrial Research and Analysis SA, Marousi, Greece
| | - Theoni Sarri
- Skylab-Med Laboratories of Applied Industrial Research and Analysis SA, Marousi, Greece
| | - Vassilis Voudris
- Department of Cardiology, Onassis Cardiac Surgery Center, Kallithea, Greece
| | | | - Scott J Leischow
- Arizona College of Health Solutions, Arizona State University, Phoenix, AZ, USA
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Farsalinos KE, Voudris V. Do flavouring compounds contribute to aldehyde emissions in e-cigarettes? Food Chem Toxicol 2018; 115:212-217. [DOI: 10.1016/j.fct.2018.02.059] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 02/05/2018] [Accepted: 02/27/2018] [Indexed: 11/28/2022]
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Farsalinos KE, Siakas G, Poulas K, Voudris V, Merakou K, Barbouni A. Electronic cigarette use in Greece: an analysis of a representative population sample in Attica prefecture. Harm Reduct J 2018; 15:20. [PMID: 29653578 PMCID: PMC5899338 DOI: 10.1186/s12954-018-0229-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 04/02/2018] [Indexed: 11/24/2022] Open
Abstract
Background The purpose was to assess prevalence and correlates of electronic cigarette (e-cigarette) use in Greece in 2017. Methods A cross-sectional survey of a representative sample of 4058 adults living in Attica prefecture (35% of the Greek adult population) was performed in May 2017 through telephone interviews. Prevalence and frequency of e-cigarette use were assessed according to the smoking status, and logistic regression analysis was performed to identify correlates of use. Results Current smoking was reported by 32.6% of participants. Ever e-cigarette use was reported by 54.1% (51.4–56.8%) of current smokers, 24.1% (21.7–26.5%) of former smokers and 6.5% (5.3–7.7%) of never smokers. Past experimentation was the most prevalent pattern of e-cigarette use among ever users (P < 0.001). Almost 80% of ever and 90% of current e-cigarette users were using nicotine. Extrapolated to the whole Attica population (3.1 million), there were 1 million current smokers, 848,000 ever e-cigarette users and 155,000 current e-cigarette users. The majority of current e-cigarette users (62.2%) were former smokers. Only 0.2% of never smokers were current e-cigarette users. One out of 20 participants considered e-cigarettes a lot less harmful than smoking. Being current or former smoker were the strongest correlates current e-cigarette use (OR 30.82, 95%CI 10. 21–69.33 and OR 69.33, 95%CI 23.12–207.90 respectively). Conclusions E-cigarette use in Greece is largely confined to current or former smokers, while current use and nicotine use by never smokers is extremely rare. The majority of current e-cigarette users were former smokers. Most participants overestimate the harmfulness of e-cigarettes relative to smoking. Electronic supplementary material The online version of this article (10.1186/s12954-018-0229-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Konstantinos E Farsalinos
- Onassis Cardiac Surgery Center, Sygrou 356, 17674, Kallithea, Greece. .,Department of Pharmacy, University of Patras, 26500, Rio, Greece. .,National School of Public Health, Alexandras Av. 196, 11521, Athens, Greece.
| | - Georgios Siakas
- Public Opinion Research Unit, University of Macedonia, Egnatia 156, 546 36, Thessaloniki, Greece
| | | | - Vassilis Voudris
- Onassis Cardiac Surgery Center, Sygrou 356, 17674, Kallithea, Greece
| | - Kyriakoula Merakou
- National School of Public Health, Alexandras Av. 196, 11521, Athens, Greece
| | - Anastasia Barbouni
- National School of Public Health, Alexandras Av. 196, 11521, Athens, Greece
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Farsalinos KE, Gillman G. Carbonyl Emissions in E-cigarette Aerosol: A Systematic Review and Methodological Considerations. Front Physiol 2018; 8:1119. [PMID: 29375395 PMCID: PMC5769337 DOI: 10.3389/fphys.2017.01119] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 12/18/2017] [Indexed: 11/13/2022] Open
Abstract
Carbonyl emissions from tobacco cigarettes represent a substantial health risk contributing to smoking-related morbidity and mortality. As expected, this is an important research topic for tobacco harm reduction products, in an attempt to compare the relative risk of these products compared to tobacco cigarettes. In this study, a systematic review of the literature available on PubMed was performed analyzing the studies evaluating carbonyl emissions from e-cigarettes. A total of 32 studies were identified and presented. We identified a large diversity of methodologies, with substantial discrepancies in puffing patterns, aerosol collection and analytical methods as well as reported units of measurements. Such discrepancies make comparisons difficult, and in some cases the accuracy of the findings cannot be determined. Importantly, control for the generation of dry puffs was not performed in the vast majority of studies, particularly in studies using variable power devices, which could result in testing conditions and reported carbonyl levels that have no clinical relevance or context. Some studies have been replicated, verifying the presence of dry puff conditions. Whenever realistic use conditions were ensured, carbonyl emissions from e-cigarettes were substantially lower than tobacco cigarette smoke, while newer generation (bottom-coil, cotton wick) atomizers appeared to emit minimal levels of carbonyls with questionable clinical significance in terms of health risk. However, extremely high levels of carbonyl emissions were reported in some studies, and all these studies need to be replicated because of potentially important health implications.
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Affiliation(s)
- Konstantinos E Farsalinos
- Department of Cardiology, Onassis Cardiac Surgery Center, Kallithea, Greece.,Department of Pharmacy, University of Patras, Patras, Greece.,National School of Public Health, Athens, Greece
| | - Gene Gillman
- Enthalpy Analytical, Inc., Durham, NC, United States
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Farsalinos KE, Kistler KA, Pennington A, Spyrou A, Kouretas D, Gillman G. Aldehyde levels in e-cigarette aerosol: Findings from a replication study and from use of a new-generation device. Food Chem Toxicol 2017; 111:64-70. [PMID: 29109042 DOI: 10.1016/j.fct.2017.11.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 11/01/2017] [Accepted: 11/02/2017] [Indexed: 02/08/2023]
Abstract
PURPOSE A recent study identified high aldehyde emissions from e-cigarettes (ECs), that when converted to reasonable daily human EC liquid consumption, 5 g/day, gave formaldehyde exposure equivalent to 604-3257 tobacco cigarettes. We replicated this study and also tested a new-generation atomizer under verified realistic (no dry puff) conditions. DESIGN CE4v2 atomizers were tested at 3.8 V and 4.8 V, and a Nautilus Mini atomizer was tested at 9.0 W and 13.5 W. All measurements were performed in a laboratory ISO-accredited for EC aerosol collection and aldehyde measurements. RESULTS CE4v2 generated dry puffs at both voltage settings. Formaldehyde levels were >10-fold lower, acetaldehyde 6-9-fold lower and acrolein 16-26-fold lower than reported in the previous study. Nautilus Mini did not generate dry puffs, and minimal aldehydes were emitted despite >100% higher aerosol production per puff compared to CE4v2 (formaldehyde: 16.7 and 16.5 μg/g; acetaldehyde: 9.6 and 10.3 μg/g; acrolein: 8.6 and 11.7 μg/g at 9.0 W and 13.5 W, respectively). EC liquid consumption of 5 g/day reduces aldehyde exposure by 94.4-99.8% compared to smoking 20 tobacco cigarettes. CONCLUSION Checking for dry puffs is essential for EC emission testing. Under realistic conditions, new-generation ECs emit minimal aldehydes/g liquid at both low and high power. Validated methods should be used when analyzing EC aerosol.
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Affiliation(s)
- Konstantinos E Farsalinos
- Department of Cardiology, Onassis Cardiac Surgery Center, Sygrou 356, Kallithea 17674, Greece; Department of Pharmacy, University of Patras, Rio 26500, Greece.
| | - Kurt A Kistler
- Department of Chemistry, The Pennsylvania State University Brandywine, 25 Yearsley Mill Road, Media, PA 19063, USA
| | | | - Alketa Spyrou
- Department of Cardiology, Onassis Cardiac Surgery Center, Sygrou 356, Kallithea 17674, Greece
| | - Dimitris Kouretas
- Department of Biochemistry-Biotechnology, School of Health Sciences, University of Thessaly, Viopolis, Larissa, 41500, Greece
| | - Gene Gillman
- Enthalpy Analytical, Inc., 800 Capitola Drive, Suite 1, Durham, NC 27713, USA
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Polosa R, Russell C, Nitzkin J, Farsalinos KE. A critique of the US Surgeon General's conclusions regarding e-cigarette use among youth and young adults in the United States of America. Harm Reduct J 2017; 14:61. [PMID: 28874159 PMCID: PMC5586058 DOI: 10.1186/s12954-017-0187-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 08/29/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In December 2016, the Surgeon General published a report that concluded e-cigarette use among youth and young adults is becoming a major public health concern in the United States of America. METHODS Re-analysis of key data sources on nicotine toxicity and prevalence of youth use of e-cigarettes cited in the Surgeon General report as the basis for its conclusions. RESULTS Multiple years of nationally representative surveys indicate the majority of e-cigarette use among US youth is either infrequent or experimental, and negligible among never-smoking youth. The majority of the very small proportion of US youth who use e-cigarettes on a regular basis, consume nicotine-free products. The sharpest declines in US youth smoking rates have occurred as e-cigarettes have become increasingly available. Most of the evidence presented in the Surgeon General's discussion of nicotine harm is not applicable to e-cigarette use, because it relies almost exclusively on exposure to nicotine in the cigarette smoke and not to nicotine present in e-cigarette aerosol emissions. Moreover, the referenced literature describes effects in adults, not youth, and in animal models that have little relevance to real-world e-cigarette use by youth. The Surgeon General's report is an excellent reference document for the adverse outcomes due to nicotine in combination with several other toxicants present in tobacco smoke, but fails to address the risks of nicotine decoupled from tobacco smoke constituents. The report exaggerates the toxicity of propylene glycol (PG) and vegetable glycerin (VG) by focusing on experimental conditions that do not reflect use in the real-world and provides little discussion of emerging evidence that e-cigarettes may significantly reduce harm to smokers who have completely switched. CONCLUSIONS The U.S. Surgeon General's claim that e-cigarette use among U.S. youth and young adults is an emerging public health concern does not appear to be supported by the best available evidence on the health risks of nicotine use and population survey data on prevalence of frequent e-cigarette use. Nonetheless, patterns of e-cigarettes use in youth must be constantly monitored for early detection of significant changes. The next US Surgeon General should consider the possibility that future generations of young Americans will be less likely to start smoking tobacco because of, not in spite of, the availability of e-cigarettes.
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Affiliation(s)
- Riccardo Polosa
- Centro Prevenzione e Cura del Tabagismo, Azienda Ospedaliero Universitaria "Policlinico-V. Emanuele", Catania, Italy.
- Dipartimento di Medicina Clinica e Sperimentale, Università di Catania, Catania, Italy.
- UOC di Medicina Interna e d'Urgenza, Azienda Ospedaliero Universitaria "Policlinico-V. Emanuele", Catania, Italy.
| | | | | | - Konstantinos E Farsalinos
- Department of Cardiology, Onassis Cardiac Surgery Center, Sygrou 356, 17674, Kallithea, Greece
- Department of Pharmacy, University of Patras, 17674, Rio, Greece
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Farsalinos KE, Poulas K, Voudris V, Le Houezec J. Prevalence and correlates of current daily use of electronic cigarettes in the European Union: analysis of the 2014 Eurobarometer survey. Intern Emerg Med 2017; 12:757-763. [PMID: 28260221 DOI: 10.1007/s11739-017-1643-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 02/24/2017] [Indexed: 10/20/2022]
Abstract
The study purpose was to analyze current daily and current daily nicotine-containing electronic cigarette (EC) use in the European Union (EU). Special Eurobarometer 429, a cross-sectional survey performed in a representative sample of 28 member states of the EU in November and December of 2014, was analyzed. The prevalence of current daily and current daily nicotine-containing EC use was 1.08% (95% CI 0.95-1.20%) and 1.00% (95% CI 0.88-1.12%), respectively, and was mainly observed in current and former smokers. Minimal current daily (0.08%, 95% CI 0.03-0.12%) and current daily nicotine-containing EC use (0.04%, 95% CI 0.01-0.08%) was observed among never smokers. Smoking cessation with the help of ECs was reported by 47.12% (95% CI 41.28-52.96%) of current daily and 49.14% (95% CI 43.12-55.17%) of current daily nicotine-containing EC users. Additionally, 33.18% (95% CI 27.67-38.69%) and 31.40% (95% CI 25.80-36.99%) reported reduction in smoking consumption, respectively. The strongest correlates of daily EC use were being current and former smokers. In the EU in late 2014, current daily EC use was predominantly observed in current and former smokers and was associated with high self-reported rates of smoking cessation and reduction. Current daily EC use by never smokers was extremely infrequent.
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Affiliation(s)
- Konstantinos E Farsalinos
- Onassis Cardiac Surgery Center, Sygrou 356, 17674, Kallithea, Greece.
- Department of Pharmacy, University of Patras, 26500, Rio, Greece.
| | | | - Vassilis Voudris
- Onassis Cardiac Surgery Center, Sygrou 356, 17674, Kallithea, Greece
| | - Jacques Le Houezec
- Division of Epidemiology and Public Health, UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, England, UK
- Addiction Research Unit, INSERM 1178 (Mental and Public Health), Paris, France
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Farsalinos KE, Voudris V, Spyrou A, Poulas K. E-cigarettes emit very high formaldehyde levels only in conditions that are aversive to users: A replication study under verified realistic use conditions. Food Chem Toxicol 2017; 109:90-94. [PMID: 28864295 DOI: 10.1016/j.fct.2017.08.044] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/18/2017] [Accepted: 08/28/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE In 2015, a study identified 5-15-fold higher levels of formaldehyde emissions from an old-generation e-cigarette tested at 5.0 V compared to tobacco cigarettes. We set to replicate this study using the same e-cigarette equipment and e-liquid, while checking for the generation of dry puffs. DESIGN Experienced e-cigarette users (n = 26) took 4 s puffs at different voltage settings and were asked to report the generation of dry puffs. Formaldehyde emissions were measured at both realistic and dry puff conditions. RESULTS Dry puffs were detected at ≤4.2 V by 88% of participants; thus, 4.0 V was defined as the upper limit of realistic use. Levels ranged from 3.4 (SE = 2.2) μg/10 puffs at 3.3 V to 718.2 (SE = 58.2) μg/10 puffs at 5.0 V. The levels detected at 4.0 V were 19.8 (SE = 5.6) μg/10 puffs. At 4.0 V, the daily exposure to formaldehyde from consuming 3 g of liquid with the device tested would be 32% lower compared to smoking 20 tobacco cigarettes. CONCLUSIONS The high levels of formaldehyde emissions that were reported in a previous study were caused by unrealistic use conditions that create the unpleasant taste of dry puffs to e-cigarette users and are thus avoided.
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Affiliation(s)
- Konstantinos E Farsalinos
- Department of Cardiology, Onassis Cardiac Surgery Center, Sygrou 356, Kallithea 17674, Greece; Department of Pharmacy, University of Patras, Rio-Patras 26500, Greece; National School of Public Health, Greece.
| | - Vassilis Voudris
- Department of Cardiology, Onassis Cardiac Surgery Center, Sygrou 356, Kallithea 17674, Greece
| | - Alketa Spyrou
- Department of Cardiology, Onassis Cardiac Surgery Center, Sygrou 356, Kallithea 17674, Greece
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Farsalinos KE, Yannovits N, Sarri T, Voudris V, Poulas K. Nicotine Delivery to the Aerosol of a Heat-Not-Burn Tobacco Product: Comparison With a Tobacco Cigarette and E-Cigarettes. Nicotine Tob Res 2017. [DOI: 10.1093/ntr/ntx138] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Konstantinos E Farsalinos
- Department of Cardiology, Onassis Cardiac Surgery Center, Kallithea, Greece
- Department of Pharmacy, University of Patras, Rio-Patras, Greece
| | - Nikoletta Yannovits
- Skylab-Med Laboratories of Applied Industrial Research and Analysis S.A., Marousi, Greece
| | - Theoni Sarri
- Skylab-Med Laboratories of Applied Industrial Research and Analysis S.A., Marousi, Greece
| | - Vassilis Voudris
- Department of Cardiology, Onassis Cardiac Surgery Center, Kallithea, Greece
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Farsalinos KE, Poulas K, Voudris V, Le Houezec J. E-cigarette use in the European Union: millions of smokers claim e-cigarettes helped them quit. Addiction 2017; 112:545-546. [PMID: 28168790 DOI: 10.1111/add.13722] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 12/05/2016] [Accepted: 12/05/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Konstantinos E Farsalinos
- Onassis Cardiac Surgery Center, Kallithea, Greece.,Department of Pharmacy, University of Patras, Rio, Greece
| | | | | | - Jacques Le Houezec
- UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.,Addiction Research Unit, INSERM 1178 (Mental and Public Health), Paris, France
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Farsalinos KE, Le Houezec J. Electronic cigarette experimentation in the Malaysian city of Kuantan: Was there an association with the smoking status? J Pharm Bioallied Sci 2017; 8:347-348. [PMID: 28216962 PMCID: PMC5314837 DOI: 10.4103/0975-7406.199341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Konstantinos E Farsalinos
- Department of Cardiology, Onassis Cardiac Surgery Center, Kallithea, Greece; Department of Pharmacy, University of Patras, Patras, Greece E-mail:
| | - Jacques Le Houezec
- Division of Epidemiology and Public Health, UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, England; CESP, University Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
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Farsalinos KE, Polosa R. Endothelial progenitor cell release is usually considered a beneficial effect: Problems in interpreting the acute effects of e-cigarette use. Atherosclerosis 2016; 258:162-163. [PMID: 28034508 DOI: 10.1016/j.atherosclerosis.2016.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 12/14/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Konstantinos E Farsalinos
- Department of Cardiology, Onassis Cardiac Surgery Center, Sygrou 356, Kallithea 17674, Greece; Department of Pharmacy, University of Patras, Rio 26500, Greece.
| | - Riccardo Polosa
- UOC di Medicina Interna e d'Urgenza, AOU "Policlinico-V. Emanuele", University of Catania, Catania, Italy
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Farsalinos KE, Poulas K, Voudris V, Le Houezec J. Electronic cigarette use in the European Union: analysis of a representative sample of 27 460 Europeans from 28 countries. Addiction 2016; 111:2032-2040. [PMID: 27338716 DOI: 10.1111/add.13506] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 05/02/2016] [Accepted: 06/17/2016] [Indexed: 12/31/2022]
Abstract
AIMS To assess prevalence of electronic cigarette (e-cigarette) use, reported changes in smoking status due to e-cigarette use and correlates of e-cigarette use in the European Union (EU) member states in 2014. DESIGN Cross-sectional survey of EU citizens representative of the population (Special Eurobarometer 429). SETTING All 28 Member States of the EU. PARTICIPANTS A total of 27 460 EU citizens aged ≥ 15 years (after excluding those who responded 'Do not know' to the questions about smoking status and e-cigarette use). MEASUREMENTS Descriptive analysis [%, 95% confidence interval (CI)] of e-cigarette use prevalence (current use, past use and past experimentation) according to smoking status, self-reported changes in smoking status according to patterns of e-cigarette use and logistic regression analysis to examine correlates of e-cigarette use, especially socio-demographic factors and smoking status. FINDINGS Ever e-cigarette use was reported by 31.1% (95% CI = 30.0-32.2%) of current smokers, 10.8% (95% CI = 10.0-11.7%) of former smokers and 2.3% (95% CI = 2.1-2.6%) of never smokers. Past experimentation [7.2% (95% CI = 6.9-7.5%)] was more common than current [1.8% (95% CI = 1.6-1.9%)] and past use [2.6% (95% CI = 2.4-2.8%)]. Extrapolated to the whole population, approximately 48.5 million EU citizens were ever e-cigarette users, with 76.8% using nicotine-containing e-cigarettes. An estimated 6.1 and 9.2 million EU citizens had quit and reduced smoking with the help of e-cigarettes, respectively. Initiation with e-cigarettes was reported by 0.8% (95% CI = 0.6-0.9%) of participants who reported ever use of any tobacco-related product. Only 1.3% (95% CI = 1.1-1.5%) of never smokers used nicotine-containing e-cigarettes, with 0.09% (95% CI = 0.04-0.14%) reporting daily nicotine use. Smoking cessation with the help of e-cigarettes was reported by 35.1% (95% CI = 30.7-39.5%) of current e-cigarette users, while a further 32.2% (95% CI = 29.9-36.5%) reported smoking reduction. Being current [odds ratio (OR) = 21.23, 95% CI = 18.32-24.59) or former smokers (OR = 6.49, 95% CI = 5.49-7.67) were the strongest correlates of ever e-cigarette use. CONCLUSIONS E-cigarette use in the European Union appears to be largely confined to current or former smokers, while current use and nicotine use by people who have never smoked is rare. More than one-third of current e-cigarette users polled reported smoking cessation and reduction.
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Affiliation(s)
- Konstantinos E Farsalinos
- Onassis Cardiac Surgery Center, Kallithea, Greece.,Department of Pharmacy, University of Patras, Rio, Greece
| | | | | | - Jacques Le Houezec
- UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.,Addiction Research Unit, CESP, University Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
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Farsalinos KE, Baeyens F. Harmful effects from one puff of shisha-pen vapor: methodological and interpretational problems in the risk assessment analysis. Tob Induc Dis 2016; 14:22. [PMID: 27390575 PMCID: PMC4936017 DOI: 10.1186/s12971-016-0086-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 06/06/2016] [Indexed: 11/10/2022] Open
Abstract
With this letter we express our concerns about the applicability of the proposed Margin of Exposure analysis as a method of risk assessment for propylene glycol and glycerol exposure from a shisha-pen type electronic cigarette. The studies used to determine the Margin of Exposure were evaluating the effects in humans or animals of continuous exposure to these chemicals in every single breath, whereas electronic cigarettes are used intermittently by consumers, resulting in lower and discontinuous exposure. Moreover, the authors make no clear distinction between irritation and harm, neither do they discuss the effects of exposure compared to continuous smoking.
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Affiliation(s)
- Konstantinos E Farsalinos
- Department of Cardiology, Onassis Cardiac Surgery Center, Sygrou 356, Kallithea, 17674 Greece ; Department of Pharmacy, University of Patras, Rio, 26100 Greece
| | - Frank Baeyens
- Faculty of Psychology and Educational Sciences, KU Leuven-University of Leuven, Tiensestraat 102, 3000 Leuven, Belgium
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Farsalinos KE, Yannovits N, Sarri T, Voudris V, Poulas K. Protocol proposal for, and evaluation of, consistency in nicotine delivery from the liquid to the aerosol of electronic cigarettes atomizers: regulatory implications. Addiction 2016; 111:1069-76. [PMID: 26756124 DOI: 10.1111/add.13299] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 10/27/2015] [Accepted: 01/06/2016] [Indexed: 11/27/2022]
Abstract
AIMS To propose a protocol and evaluate the consistency in nicotine delivery to the aerosol of different types of electronic cigarette (EC) atomizers, as required by regulatory authorities. DESIGN Three cartomizer and four tank-type atomizer products were tested (three samples per product). The aerosol from three 20-puff sessions from each sample was collected using a smoke machine. Three cartridges from a nicotine inhaler and three tobacco cigarettes were also tested. SETTING Analytical laboratory in Greece. MEASUREMENTS Aerosol nicotine levels were measured. Relative standard deviation (RSD, i.e. coefficient of variation) was calculated separately for each cartomizer and replacement atomizer head sample (intrasample RSD) and between different samples (intersample RSD). The percentage difference from the mean, which is used to assess the quality of medicinal nebulizers, was also calculated. FINDINGS The aerosol nicotine levels were 1.01-10.61 mg/20 puffs for ECs, 0.12-0.18 mg/20 puffs for the nicotine inhaler and 1.76-2.20 mg/cigarette for the tobacco cigarettes. The intrasample RSDs were 3.7-12.5% for ECs and 14.3% for the nicotine inhaler and 11.1% for the tobacco cigarettes. The intersample RSDs were higher in cartomizers (range: 6.9-37.8%) compared with tank systems (range: 6.4-9.3%). All tank-type atomizers and one cartomizer were within 75-125% of the mean, as dictated for medicinal nebulizers. CONCLUSIONS Electronic cigarettes that use tank-type atomizers appear to deliver nicotine in more consistent quantities (within the acceptable limits for medicinal nebulizers and similar to the nicotine inhaler) than electronic cigarettes that use cartomizers. The protocol for testing nicotine delivery consistency described in this paper could be used effectively for regulatory purposes.
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Affiliation(s)
- Konstantinos E Farsalinos
- Department of Cardiology, Onassis Cardiac Surgery Center, Sygrou, Kallithea, Greece.,Department of Pharmacy, University of Patras, Rio-Patras, Greece
| | - Nikoletta Yannovits
- Skylab-Med Laboratories of Applied Industrial Research and Analysis S.A., Amyklon, Halandri, Greece
| | - Theoni Sarri
- Skylab-Med Laboratories of Applied Industrial Research and Analysis S.A., Amyklon, Halandri, Greece
| | - Vassilis Voudris
- Department of Cardiology, Onassis Cardiac Surgery Center, Sygrou, Kallithea, Greece
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Moysidou A, Farsalinos KE, Voudris V, Merakou K, Kourea K, Barbouni A. Knowledge and Perceptions about Nicotine, Nicotine Replacement Therapies and Electronic Cigarettes among Healthcare Professionals in Greece. Int J Environ Res Public Health 2016; 13:ijerph13050514. [PMID: 27213421 PMCID: PMC4881139 DOI: 10.3390/ijerph13050514] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 05/10/2016] [Accepted: 05/12/2016] [Indexed: 12/28/2022]
Abstract
Introduction. The purpose of this study was to evaluate the knowledge and perceptions of Greek healthcare professionals about nicotine, nicotine replacement therapies and electronic cigarettes. Methods. An online survey was performed, in which physicians and nurses working in private and public healthcare sectors in Athens-Greece were asked to participate through email invitations. A knowledge score was calculated by scoring the correct answers to specific questions with 1 point. Results. A total of 262 healthcare professionals were included to the analysis. Most had daily contact with smokers in their working environment. About half of them considered that nicotine has an extremely or very important contribution to smoking-related disease. More than 30% considered nicotine replacement therapies equally or more addictive than smoking, 76.7% overestimated their smoking cessation efficacy and only 21.0% would recommend them as long-term smoking substitutes. For electronic cigarettes, 45.0% considered them equally or more addictive than smoking and 24.4% equally or more harmful than tobacco cigarettes. Additionally, 35.5% thought they involve combustion while the majority responded that nicotine in electronic cigarettes is synthetically produced. Only 14.5% knew about the pending European regulation, but 33.2% have recommended them to smokers in the past. Still, more than 40% would not recommend electronic cigarettes to smokers unwilling or unable to quit smoking with currently approved medications. Cardiologists and respiratory physicians, who are responsible for smoking cessation therapy in Greece, were even more reluctant to recommend electronic cigarettes to this subpopulation of smokers compared to all other participants. The knowledge score of the whole study sample was 7.7 (SD: 2.4) out of a maximum score of 16. Higher score was associated with specific physician specialties. Conclusions. Greek healthcare professionals appear to overestimate the adverse effects of nicotine, and many would not recommend any nicotine-containing product as a long-term smoking substitute. Additionally, they have poor knowledge about the function and characteristics of electronic cigarettes.
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Affiliation(s)
- Anastasia Moysidou
- National School of Public Health, Alexandras Av. 196, Athens 11521, Greece.
| | | | - Vassilis Voudris
- Onassis Cardiac Surgery Center, Sygrou 356, Kallithea 17674, Greece.
| | - Kyriakoula Merakou
- National School of Public Health, Alexandras Av. 196, Athens 11521, Greece.
| | - Kallirrhoe Kourea
- National School of Public Health, Alexandras Av. 196, Athens 11521, Greece.
| | - Anastasia Barbouni
- National School of Public Health, Alexandras Av. 196, Athens 11521, Greece.
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Kassim S, Farsalinos KE. E-Cigarette as a Harm Reduction Approach among Tobacco Smoking Khat Chewers: A Promising Bullet of Multiple Gains. Int J Environ Res Public Health 2016; 13:240. [PMID: 26907315 PMCID: PMC4772260 DOI: 10.3390/ijerph13020240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 02/05/2016] [Accepted: 02/15/2016] [Indexed: 12/27/2022]
Abstract
Khat chewing/use, a green leaf with amphetamine-like effects is socially integrated in the Middle East and Africa. Khat chewing is often associated with tobacco smoking and occurs in closed places, such as a family home setting where the smoke-free laws cannot be implemented. Tobacco cigarette smoking among khat chewers is a significant concern, but there is also second-hand exposure to smoke at home or in places where khat users gather. Evidence suggests that e-cigarettes represent a significantly less harmful form of nicotine intake. Evaluating the effects of e-cigarettes among khat chewers could be important in understanding the impact of e-cigarettes as a harm reduction approach, with the potential to reduce the health risk associated with smoking.
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Affiliation(s)
- Saba Kassim
- College of Dentistry, Taibah University, Al-Madinah Al-Munawwarah 43353, Saudi Arabia.
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Farsalinos KE, Daraban AM, Ünlü S, Thomas JD, Badano LP, Voigt JU. Head-to-Head Comparison of Global Longitudinal Strain Measurements among Nine Different Vendors. J Am Soc Echocardiogr 2015. [DOI: 10.1016/j.echo.2015.06.011] [Citation(s) in RCA: 431] [Impact Index Per Article: 47.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Affiliation(s)
- Clive D Bates
- Counterfactual Consulting Limited, 4 Pentney Road, London, SW120NX, UK
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Bates CD, Farsalinos KE. Research letter on e-cigarette cancer risk was so misleading it should be retracted. Addiction 2015; 110:1686-7. [PMID: 26350716 DOI: 10.1111/add.13018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 06/05/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Clive D Bates
- Counterfactual Consulting Limited, 4 Pentney Road, SW12 0NX, London, UK
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Farsalinos KE, Le Houezec J. Regulation in the face of uncertainty: the evidence on electronic nicotine delivery systems (e-cigarettes). Risk Manag Healthc Policy 2015; 8:157-67. [PMID: 26457058 PMCID: PMC4598199 DOI: 10.2147/rmhp.s62116] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Tobacco smoking is the largest single preventable cause of many chronic diseases and death. Effective treatments exist; however, few smokers use them and most try to quit by themselves. Most of the tobacco cigarette’s toxicity is related to the combustion process. Models of harm reduction applied to tobacco suggest that switching from inhalation of combustible products to a noncombustible nicotine delivery product would likely result in a vast reduction in tobacco-related death and illness. Currently available evidence raises no doubt that electronic cigarettes (e-cigs) are by far less harmful than smoking (although probably not absolutely safe) and have the potential to be the most effective tobacco harm reduction products due to their unique property of resembling smoking and providing satisfaction to the user. A lot of controversy is surrounding e-cigs and their regulation, much of which is based on the precautionary principle. Although monitoring and further research is definitely needed, the arguments used to implement severe restrictions or bans are mostly hypothetical, weakly supported by evidence, and, in some cases, derived from mispresentation or misinterpretation of the study findings. Regulators should keep in mind that the target population is smokers who want to reduce or quit their deadly tobacco consumption. To achieve this goal, smokers should be honestly informed on the relative harmfulness of the different products. E-cigs are not tobacco products and are not used as medications. For this reason, a specific regulatory scheme is needed, separate from tobacco or medicinal products regulation. Regulation should implement specific quality criteria for products, rules for the exclusion of chemicals of reasonable concern, and appropriate testing for possible contaminants. Additionally, manufacturing standards derived from the food industry should be implemented and adjusted for specific conditions related to e-cigs. Finding the appropriate balance between safety and acceptability of use by smokers will be important in achieving the maximum public health benefit. Labeling should be specified, with warnings about exposure to skin or through ingestion and discouragement of use by nonsmokers, related to the presence of nicotine. Finally, advertising and marketing should not be banned, but appropriately regulated in order to encourage use by the intended population while avoiding use by never-smokers. E-cigs should be appealing to smokers (but not to nonsmokers), while availability and pricing should be strong competitive advantages of e-cigs relative to tobacco cigarettes.
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Affiliation(s)
- Konstantinos E Farsalinos
- Department of Cardiology, Onassis Cardiac Surgery Center, Kallithea, Greece ; Department of Pharmacy, University of Patras, Patras, Greece
| | - Jacques Le Houezec
- Division of Epidemiology and Public Health, UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, England, UK ; Addiction Research Unit, INSERM 1178 (Mental and Public Health), Paris, France
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Farsalinos KE, Voudris V, Poulas K. E-cigarettes generate high levels of aldehydes only in 'dry puff' conditions. Addiction 2015; 110:1352-6. [PMID: 25996087 DOI: 10.1111/add.12942] [Citation(s) in RCA: 158] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 03/10/2015] [Accepted: 03/31/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Aldehydes are emitted by electronic cigarettes due to thermal decomposition of liquid components. Although elevated levels have been reported with new-generation high-power devices, it is unclear whether they are relevant to true exposure of users (vapers) because overheating produces an unpleasant taste, called a dry puff, which vapers learn to avoid. The aim was to evaluate aldehyde emissions at different power levels associated with normal and dry puff conditions. DESIGN Two customizable atomizers were prepared so that one (A1) had a double wick, resulting in high liquid supply and lower chance of overheating at high power levels, while the other (A2) was a conventional setup (single wick). Experienced vapers took 4-s puffs at 6.5 watts (W), 7.5 W, 9 W and 10 W power levels with both atomizers and were asked to report whether dry puffs were generated. The atomizers were then attached to a smoking machine and aerosol was trapped. SETTING Clinic office and analytical chemistry laboratory in Greece. PARTICIPANTS Seven experienced vapers. MEASUREMENTS Aldehyde levels were measured in the aerosol. FINDINGS All vapers identified dry puff conditions at 9 W and 10 W with A2. A1 did not lead to dry puffs at any power level. Minimal amounts of aldehydes per 10 puffs were found at all power levels with A1 (up to 11.3 µg for formaldehyde, 4.5 µg for acetaldehyde and 1.0 µg for acrolein) and at 6.5 W and 7.5 W with A2 (up to 3.7 µg for formaldehyde, 0.8 µg for acetaldehyde and 1.3 µg for acrolein). The levels were increased by 30 to 250 times in dry puff conditions (up to 344.6 µg for formaldehyde, 206.3 µg for acetaldehyde and 210.4 µg for acrolein, P < 0.001), while acetone was detected only in dry puff conditions (up to 22.5 µg). CONCLUSIONS Electronic cigarettes produce high levels of aldehyde only in dry puff conditions, in which the liquid overheats, causing a strong unpleasant taste that e-cigarette users detect and avoid. Under normal vaping conditions aldehyde emissions are minimal, even in new-generation high-power e-cigarettes.
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Affiliation(s)
- Konstantinos E Farsalinos
- Department of Cardiology, Onassis Cardiac Surgery Center, Sygrou, Kallithea, Greece.,Department of Pharmacy, University of Patras, Rio-Patras, Greece
| | - Vassilis Voudris
- Department of Cardiology, Onassis Cardiac Surgery Center, Sygrou, Kallithea, Greece
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Farsalinos KE, Gillman G, Poulas K, Voudris V. Tobacco-Specific Nitrosamines in Electronic Cigarettes: Comparison between Liquid and Aerosol Levels. Int J Environ Res Public Health 2015; 12:9046-53. [PMID: 26264016 PMCID: PMC4555263 DOI: 10.3390/ijerph120809046] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 07/10/2015] [Accepted: 07/10/2015] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Although electronic cigarette (EC) liquids contain low levels of tobacco-specific nitrosamines (TSNAs), studies evaluating the levels emitted to the aerosol are scarce. The purpose of this study was to compare the levels of TSNAs between liquids and generated aerosol. METHODS Three EC liquids were obtained from the market. An additional (spiked) sample was prepared by adding known amounts of standard TSNAs solutions to one of the obtained liquids. N-nitrosonornicotine (NNN), N-nitrosoanatabine (NAT), N-nitrosoanabasine (NAB) and 4-(methylnitrosamino)1-(3-pyridyl)-1-butanone (NNK) were measured. Three 100-puff sets from each liquid were trapped in filter pads and were subsequently analyzed for the presence of TSNAs. The expected levels of TSNAs (calculated based on the liquid consumption) were compared with the measured levels in the aerosol. RESULTS Only NAB was found at trace levels in two commercial liquids (1.2 and 2.3 ng/g), while the third contained 1.5 ng/g NAB and 7.7 ng/g NNN. The 100-puff sets resulted in 336-515 mg liquid consumption, with no TSNAs being detected in the aerosol. The spiked sample contained 42.0-53.9 ng/g of each of the TSNAs. All TSNAs were detected in the aerosol with the measured levels being statistically similar to the expected amounts. A significant correlation between expected and measured levels of TSNAs in the aerosol was found (r = 0.83, p < 0.001). CONCLUSION The findings of this study show that exposure of EC users to TSNAs can be accurately assessed based on the levels present in the liquid, without the need to analyze the aerosol.
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Affiliation(s)
- Konstantinos E Farsalinos
- Department of Cardiology, Onassis Cardiac Surgery Center, Sygrou 356, Kallithea 17674, Greece.
- Department of Pharmacy, University of Patras, Rio 26500, Greece.
| | - Gene Gillman
- Enthalpy Analytical, Inc., 800 Capitola Drive, Suite 1, NC 27713, USA.
| | | | - Vassilis Voudris
- Department of Cardiology, Onassis Cardiac Surgery Center, Sygrou 356, Kallithea 17674, Greece.
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Farsalinos KE, Voudris V, Poulas K. Are metals emitted from electronic cigarettes a reason for health concern? A risk-assessment analysis of currently available literature. Int J Environ Res Public Health 2015; 12:5215-32. [PMID: 25988311 PMCID: PMC4454963 DOI: 10.3390/ijerph120505215] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 04/28/2015] [Accepted: 05/07/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Studies have found that metals are emitted to the electronic cigarette (EC) aerosol. However, the potential health impact of exposure to such metals has not been adequately defined. The purpose of this study was to perform a risk assessment analysis, evaluating the exposure of electronic cigarette (EC) users to metal emissions based on findings from the published literature. METHODS Two studies were found in the literature, measuring metals emitted to the aerosol from 13 EC products. We estimated that users take on average 600 EC puffs per day, but we evaluated the daily exposure from 1200 puffs. Estimates of exposure were compared with the chronic Permissible Daily Exposure (PDE) from inhalational medications defined by the U.S. Pharmacopeia (cadmium, chromium, copper, lead and nickel), the Minimal Risk Level (MRL) defined by the Agency for Toxic Substances and Disease Registry (manganese) and the Recommended Exposure Limit (REL) defined by the National Institute of Occupational Safety and Health (aluminum, barium, iron, tin, titanium, zinc and zirconium). RESULTS The average daily exposure from 13 EC products was 2.6 to 387 times lower than the safety cut-off point of PDEs, 325 times lower than the safety limit of MRL and 665 to 77,514 times lower than the safety cut-off point of RELs. Only one of the 13 products was found to result in exposure 10% higher than PDE for one metal (cadmium) at the extreme daily use of 1200 puffs. Significant differences in emissions between products were observed. CONCLUSIONS Based on currently available data, overall exposure to metals from EC use is not expected to be of significant health concern for smokers switching to EC use, but is an unnecessary source of exposure for never-smokers. Metal analysis should be expanded to more products and exposure can be further reduced through improvements in product quality and appropriate choice of materials.
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Affiliation(s)
- Konstantinos E Farsalinos
- Department of Cardiology, Onassis Cardiac Surgery Center, Sygrou 356, Kallithea 17674, Greece.
- Department of Pharmacy, University of Patras, Rio 26500, Greece.
| | - Vassilis Voudris
- Department of Cardiology, Onassis Cardiac Surgery Center, Sygrou 356, Kallithea 17674, Greece.
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Farsalinos KE, Gillman IG, Melvin MS, Paolantonio AR, Gardow WJ, Humphries KE, Brown SE, Poulas K, Voudris V. Nicotine levels and presence of selected tobacco-derived toxins in tobacco flavoured electronic cigarette refill liquids. Int J Environ Res Public Health 2015; 12:3439-52. [PMID: 25811768 PMCID: PMC4410195 DOI: 10.3390/ijerph120403439] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 03/08/2015] [Accepted: 03/09/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Some electronic cigarette (EC) liquids of tobacco flavour contain extracts of cured tobacco leaves produced by a process of solvent extraction and steeping. These are commonly called Natural Extract of Tobacco (NET) liquids. The purpose of the study was to evaluate nicotine levels and the presence of tobacco-derived toxins in tobacco-flavoured conventional and NET liquids. METHODS Twenty-one samples (10 conventional and 11 NET liquids) were obtained from the US and Greek market. Nicotine levels were measured and compared with labelled values. The levels of tobacco-derived chemicals were compared with literature data on tobacco products. RESULTS Twelve samples had nicotine levels within 10% of the labelled value. Inconsistency ranged from -21% to 22.1%, with no difference observed between conventional and NET liquids. Tobacco-specific nitrosamines (TSNAs) were present in all samples at ng/mL levels. Nitrates were present almost exclusively in NET liquids. Acetaldehyde was present predominantly in conventional liquids while formaldehyde was detected in almost all EC liquids at trace levels. Phenols were present in trace amounts, mostly in NET liquids. Total TSNAs and nitrate, which are derived from the tobacco plant, were present at levels 200-300 times lower in 1 mL of NET liquids compared to 1 gram of tobacco products. CONCLUSIONS NET liquids contained higher levels of phenols and nitrates, but lower levels of acetaldehyde compared to conventional EC liquids. The lower levels of tobacco-derived toxins found in NET liquids compared to tobacco products indicate that the extraction process used to make these products did not transfer a significant amount of toxins to the NET. Overall, all EC liquids contained far lower (by 2-3 orders of magnitude) levels of the tobacco-derived toxins compared to tobacco products.
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Affiliation(s)
- Konstantinos E Farsalinos
- Department of Cardiology, Onassis Cardiac Surgery Center, Kallithea 17674, Greece.
- Department of Pharmacy, University of Patras, Rio 26500, Greece.
| | | | | | | | | | | | | | | | - Vassilis Voudris
- Department of Cardiology, Onassis Cardiac Surgery Center, Kallithea 17674, Greece.
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Farsalinos KE, Kistler KA, Gillman G, Voudris V. Why We Consider the NIOSH-Proposed Safety Limits for Diacetyl and Acetyl Propionyl Appropriate in the Risk Assessment of Electronic Cigarette Liquid Use: A Response to Hubbs et al. Nicotine Tob Res 2015; 17:1290-1. [PMID: 25586778 DOI: 10.1093/ntr/ntv005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 12/22/2014] [Indexed: 11/14/2022]
Affiliation(s)
| | - Kurt A Kistler
- Department of Chemistry, Pennsylvania State University Brandywine, Media, PA
| | | | - Vassilis Voudris
- Department of Cardiology, Onassis Cardiac Surgery Center, Kallithea, Greece
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Farsalinos KE, Stimson GV. Asking the wrong questions about e-cigarettes? A response to Stan Shatenstein. International Journal of Drug Policy 2014; 25:1149-50. [DOI: 10.1016/j.drugpo.2014.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
| | - Vassilis Voudris
- Department of Cardiology, Onassis Cardiac Surgery Center, Kallithea, Greece
| | - Jacques Le Houezec
- Public Health and Tobacco Dependence, Amzer Glas, Rennes, France; UK Centre for Tobacco Control Studies, University of Nottingham, Nottingham, England
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Farsalinos KE, Kistler KA, Gillman G, Voudris V. Evaluation of electronic cigarette liquids and aerosol for the presence of selected inhalation toxins. Nicotine Tob Res 2014; 17:168-74. [PMID: 25180080 DOI: 10.1093/ntr/ntu176] [Citation(s) in RCA: 220] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate sweet-flavored electronic cigarette (EC) liquids for the presence of diacetyl (DA) and acetyl propionyl (AP), which are chemicals approved for food use but are associated with respiratory disease when inhaled. METHODS In total, 159 samples were purchased from 36 manufacturers and retailers in 7 countries. Additionally, 3 liquids were prepared by dissolving a concentrated flavor sample of known DA and AP levels at 5%, 10%, and 20% concentration in a mixture of propylene glycol and glycerol. Aerosol produced by an EC was analyzed to determine the concentration of DA and AP. RESULTS DA and AP were found in 74.2% of the samples, with more samples containing DA. Similar concentrations were found in liquid and aerosol for both chemicals. The median daily exposure levels were 56 μg/day (IQR: 26-278 μg/day) for DA and 91 μg/day (IQR: 20-432 μg/day) for AP. They were slightly lower than the strict NIOSH-defined safety limits for occupational exposure and 100 and 10 times lower compared with smoking respectively; however, 47.3% of DA and 41.5% of AP-containing samples exposed consumers to levels higher than the safety limits. CONCLUSIONS DA and AP were found in a large proportion of sweet-flavored EC liquids, with many of them exposing users to higher than safety levels. Their presence in EC liquids represents an avoidable risk. Proper measures should be taken by EC liquid manufacturers and flavoring suppliers to eliminate these hazards from the products without necessarily limiting the availability of sweet flavors.
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Affiliation(s)
| | - Kurt A Kistler
- Department of Chemistry, Pennsylvania State University Brandywine, Media, PA
| | | | - Vassilis Voudris
- Department of Cardiology, Onassis Cardiac Surgery Center, Kallithea, Greece
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Farsalinos KE, Polosa R. Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: a systematic review. Ther Adv Drug Saf 2014; 5:67-86. [PMID: 25083263 DOI: 10.1177/2042098614524430] [Citation(s) in RCA: 421] [Impact Index Per Article: 42.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Electronic cigarettes are a recent development in tobacco harm reduction. They are marketed as less harmful alternatives to smoking. Awareness and use of these devices has grown exponentially in recent years, with millions of people currently using them. This systematic review appraises existing laboratory and clinical research on the potential risks from electronic cigarette use, compared with the well-established devastating effects of smoking tobacco cigarettes. Currently available evidence indicates that electronic cigarettes are by far a less harmful alternative to smoking and significant health benefits are expected in smokers who switch from tobacco to electronic cigarettes. Research will help make electronic cigarettes more effective as smoking substitutes and will better define and further reduce residual risks from use to as low as possible, by establishing appropriate quality control and standards.
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Affiliation(s)
| | - Riccardo Polosa
- Centro per la Prevenzione e Cura del Tabagismo (CPCT) and Institute of Internal Medicine, Università di Catania, Catania, Italy
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Affiliation(s)
| | - Riccardo Polosa
- Centro per la Prevenzione e Cura del Tabagismo, Institute of Internal Medicine, Azienda Policlinico-V Emanuele, Dipartimento di Biomedicina Clinica e Molecolare, Università di Catania, Catania, Italy
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Farsalinos KE, Tsiapras D, Kyrzopoulos S, Savvopoulou M, Voudris V. Acute effects of using an electronic nicotine-delivery device (electronic cigarette) on myocardial function: comparison with the effects of regular cigarettes. BMC Cardiovasc Disord 2014; 14:78. [PMID: 24958250 PMCID: PMC4077146 DOI: 10.1186/1471-2261-14-78] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 06/21/2014] [Indexed: 12/22/2022] Open
Abstract
Background Electronic cigarettes have been developed and marketed in recent years as smoking substitutes. However, no studies have evaluated their effects on the cardiovascular system. The purpose of this study was to examine the immediate effects of electronic cigarette use on left ventricular (LV) function, compared to the well-documented acute adverse effects of smoking. Methods Echocardiographic examinations were performed in 36 healthy heavy smokers (SM, age 36 ± 5 years) before and after smoking 1 cigarette and in 40 electronic cigarette users (ECIG, age 35 ± 5 years) before and after using the device with “medium-strength” nicotine concentration (11 mg/ml) for 7 minutes. Mitral flow diastolic velocities (E, A), their ratio (E/A), deceleration time (DT), isovolumetric relaxation time (IVRT) and corrected-to-heart rate IVRT (IVRTc) were measured. Mitral annulus systolic (Sm), and diastolic (Em, Am) velocities were estimated. Myocardial performance index was calculated from Doppler flow (MPI) and tissue Doppler (MPIt). Longitudinal deformation measurements of global strain (GS), systolic (SRs) and diastolic (SRe, SRa) strain rate were also performed. Results Baseline measurements were similar in both groups. In SM, IVRT and IVRTc were prolonged, Em and SRe were decreased, and both MPI and MPIt were elevated after smoking. In ECIG, no differences were observed after device use. Comparing after-use measurements, ECIG had higher Em (P = 0.032) and SRe (P = 0.022), and lower IVRTc (P = 0.011), MPI (P = 0.001) and MPIt (P = 0.019). The observed differences were significant even after adjusting for changes in heart rate and blood pressure. Conclusions Although acute smoking causes a delay in myocardial relaxation, electronic cigarette use has no immediate effects. Electronic cigarettes’ role in tobacco harm reduction should be studied intensively in order to determine whether switching to electronic cigarette use may have long-term beneficial effects on smokers’ health. Trial registration Current Controlled Trials ISRCTN16974547
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Affiliation(s)
| | - Giorgio Romagna
- Abich S.R.L. Biological and Chemical Toxicology Research Laboratory, Verbania, Italy
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Farsalinos KE, Romagna G, Voudris V. Cytotoxicity of cinnamon-flavored electronic cigarette refills: are the results truly applicable to electronic cigarette use? Toxicol In Vitro 2014; 28:1016-7. [PMID: 24780218 DOI: 10.1016/j.tiv.2014.04.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 04/17/2014] [Indexed: 10/25/2022]
Affiliation(s)
- K E Farsalinos
- Onassis Cardiac Surgery Center, Sygrou 356, Kallithea 17674, Greece.
| | - G Romagna
- ABICH S.r.l, Biological and Chemical Toxicology Research Laboratory, Via 42 Martiri, 213/B-28924 Verbania (VB), Italy.
| | - V Voudris
- Onassis Cardiac Surgery Center, Sygrou 356, Kallithea 17674, Greece.
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Farsalinos KE, Romagna G, Tsiapras D, Kyrzopoulos S, Voudris V. Characteristics, perceived side effects and benefits of electronic cigarette use: a worldwide survey of more than 19,000 consumers. Int J Environ Res Public Health 2014; 11:4356-73. [PMID: 24758891 PMCID: PMC4025024 DOI: 10.3390/ijerph110404356] [Citation(s) in RCA: 268] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 04/14/2014] [Accepted: 04/15/2014] [Indexed: 01/10/2023]
Abstract
Background: Electronic cigarette (EC) use has grown exponentially over the past few years. The purpose of this survey was to assess the characteristics and experiences of a large sample of EC users and examine the differences between those who partially and completely substituted smoking with EC use. Methods: A questionnaire was prepared, translated into 10 different languages and uploaded in an online survey tool. EC users were asked to participate irrespective of their current smoking status. Participants were divided according to their smoking status at the time of participation in two subgroups: former smokers and current smokers. Results: In total, 19,414 participants were included in the analysis, with 88 of them (0.5%) reported not being smokers at the time of EC use initiation. Complete substitution of smoking was reported by 81.0% of participants (former smokers) while current smokers had reduced smoking consumption from 20 to 4 cigarettes per day. They were using ECs for a median of 10 months. They initiated EC use with a median of 18 mg/mL nicotine-concentration liquids; 21.5% used higher than 20 mg/mL. Only 3.5% of participants were using 0-nicotine liquids at the time of the survey. Former smokers were highly dependent (Fagerström Test for Cigarette Dependence = 7) and were heavier smokers (21 cigarettes per day when smoking) compared to current smokers. The most important reasons for initiating EC use for both subgroups was to reduce the harm associated with smoking and to reduce exposure of family members to second-hand smoking. Most considered ECs as less harmful than tobacco cigarettes, while 11.0% considered them absolutely harmless. Side effects were reported by more than half of the participants (59.8%), with the most common being sore/dry mouth and throat; side effects were mild and in most cases were subsequently resolved (partially or completely). Participants experienced significant benefits in physical status and improvements in pre-existing disease conditions (including respiratory disease such as asthma and chronic obstructive lung disease). Being former smoker was independently associated with positive effects in health and improvements in disease conditions. Conclusions: The results of this worldwide survey of dedicated users indicate that ECs are mostly used to avoid the harm associated with smoking. They can be effective even in highly-dependent smokers and are used as long-term substitutes for smoking. High levels of nicotine are used at initiation; subsequently, users try to reduce nicotine consumption, with only a small minority using non-nicotine liquids. Side effects are minor and health benefits are substantial, especially for those who completely substitute smoking with EC use. Further population and interventional studies are warranted.
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Affiliation(s)
| | - Giorgio Romagna
- ABICH S.r.l, Biological and Chemical Toxicology Research Institute, Via 42 Martiri, 213, Verbania (VB) B-28924, Italy.
| | - Dimitris Tsiapras
- Onassis Cardiac Surgery Center, Sygrou 356, Kallithea 17674, Greece.
| | | | - Vassilis Voudris
- Onassis Cardiac Surgery Center, Sygrou 356, Kallithea 17674, Greece.
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Farsalinos KE, Stimson GV. Is there any legal and scientific basis for classifying electronic cigarettes as medications? Int J Drug Policy 2014; 25:340-5. [PMID: 24709413 DOI: 10.1016/j.drugpo.2014.03.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 03/05/2014] [Accepted: 03/13/2014] [Indexed: 11/17/2022]
Abstract
The rapid growth in the use of electronic cigarettes has been accompanied by substantial discussions by governments, international organisations, consumers and public health experts about how they might be regulated. In the European Union they are currently regulated under consumer legislation but new legislation will regulate them under the Tobacco Products Directive. However, several countries have sought to regulate them under medicines regulations. These claims have been successfully challenged in 6 court cases in European states. Under European legislation a product may be deemed to be a medicine by function if it is used in or administered to human beings either with a view to restoring, correcting or modifying physiological functions by exerting a pharmacological, immunological or metabolic action, or to making a medical diagnosis. It is a medicine by presentation if it is presented (e.g. by a manufacturer or distributor) as having properties for treating or preventing disease in human beings. We assess the legal and scientific basis for the claim that electronic cigarettes should be regulated as medicines. We conclude that they are neither medicine by function nor necessarily by presentation The main reason for their existence is as a harm reduction product in which the liking for and/or dependence on nicotine is maintained, and adoption of use is as a substitute for smoking and not as a smoking cessation product. In reality, they are used as consumer products providing pleasure to the user. They are not used to treat nicotine addiction or other disease, but to enable continued use of nicotine. Their use is adjusted individually by each consumer according to his or her perceived pleasure and satisfaction. Gaps in current regulation regarding safety and quality can be met by tailored regulations.
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Affiliation(s)
| | - Gerry V Stimson
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.
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Farsalinos KE, Voudris V. E-cigarette use and indoor air quality: methodological limitations: response to W. Schober et al.'s "use of electronic cigarettes (e-cigarettes) impairs indoor air quality and increases FeNO levels of e-cigarette consumers". Int J Hyg Environ Health 2014; 217:705-6. [PMID: 24656955 DOI: 10.1016/j.ijheh.2014.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 02/01/2014] [Indexed: 11/19/2022]
Affiliation(s)
| | - Vassilis Voudris
- Department of Cardiology, Onassis Cardiac Surgery Center, Kallithea 17674, Greece
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Farsalinos KE, Spyrou A, Tsimopoulou K, Stefopoulos C, Romagna G, Voudris V. Nicotine absorption from electronic cigarette use: comparison between first and new-generation devices. Sci Rep 2014; 4:4133. [PMID: 24569565 PMCID: PMC3935206 DOI: 10.1038/srep04133] [Citation(s) in RCA: 314] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 02/05/2014] [Indexed: 01/25/2023] Open
Abstract
A wide range of electronic cigarette (EC) devices, from small cigarette-like (first-generation) to new-generation high-capacity batteries with electronic circuits that provide high energy to a refillable atomizer, are available for smokers to substitute smoking. Nicotine delivery to the bloodstream is important in determining the addictiveness of ECs, but also their efficacy as smoking substitutes. In this study, plasma nicotine levels were measured in experienced users using a first- vs. new-generation EC device for 1 hour with an 18 mg/ml nicotine-containing liquid. Plasma nicotine levels were higher by 35-72% when using the new- compared to the first-generation device. Compared to smoking one tobacco cigarette, the EC devices and liquid used in this study delivered one-third to one-fourth the amount of nicotine after 5 minutes of use. New-generation EC devices were more efficient in nicotine delivery, but still delivered nicotine much slower compared to tobacco cigarettes. The use of 18 mg/ml nicotine-concentration liquid probably compromises ECs' effectiveness as smoking substitutes; this study supports the need for higher levels of nicotine-containing liquids (approximately 50 mg/ml) in order to deliver nicotine more effectively and approach the nicotine-delivery profile of tobacco cigarettes.
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Affiliation(s)
| | - Alketa Spyrou
- Onassis Cardiac Surgery Center, Sygrou 356, Kallithea 17674, Greece
| | | | | | - Giorgio Romagna
- Abich s.r.l., Biological and Chemical Toxicology Research Laboratory, Via 42 Martiri, 213/B-28924 Verbania (VB), Italy
| | - Vassilis Voudris
- Onassis Cardiac Surgery Center, Sygrou 356, Kallithea 17674, Greece
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Farsalinos KE, Romagna G, Voudris V. Authors miss the opportunity to discuss important public health implications. J Chromatogr A 2013; 1312:155-6. [PMID: 24034972 DOI: 10.1016/j.chroma.2013.07.115] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 07/28/2013] [Indexed: 11/28/2022]
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Farsalinos KE, Romagna G, Allifranchini E, Ripamonti E, Bocchietto E, Todeschi S, Tsiapras D, Kyrzopoulos S, Voudris V. Comparison of the cytotoxic potential of cigarette smoke and electronic cigarette vapour extract on cultured myocardial cells. Int J Environ Res Public Health 2013; 10:5146-62. [PMID: 24135821 PMCID: PMC3823305 DOI: 10.3390/ijerph10105146] [Citation(s) in RCA: 162] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 09/30/2013] [Accepted: 10/12/2013] [Indexed: 12/27/2022]
Abstract
BACKGROUND Electronic cigarettes (ECs) have been marketed as an alternative-to-smoking habit. Besides chemical studies of the content of EC liquids or vapour, little research has been conducted on their in vitro effects. Smoking is an important risk factor for cardiovascular disease and cigarette smoke (CS) has well-established cytotoxic effects on myocardial cells. The purpose of this study was to evaluate the cytotoxic potential of the vapour of 20 EC liquid samples and a "base" liquid sample (50% glycerol and 50% propylene glycol, with no nicotine or flavourings) on cultured myocardial cells. Included were 4 samples produced by using cured tobacco leaves in order to extract the tobacco flavour. METHODS Cytotoxicity was tested according to the ISO 10993-5 standard. By activating an EC device at 3.7 volts (6.2 watts-all samples, including the "base" liquid) and at 4.5 volts (9.2 watts-four randomly selected samples), 200 mg of liquid evaporated and was extracted in 20 mL of culture medium. Cigarette smoke (CS) extract from three tobacco cigarettes was produced according to ISO 3308 method (2 s puffs of 35 mL volume, one puff every 60 s). The extracts, undiluted (100%) and in four dilutions (50%, 25%, 12.5%, and 6.25%), were applied to myocardial cells (H9c2); percent-viability was measured after 24 h incubation. According to ISO 10993-5, viability of <70% was considered cytotoxic. RESULTS CS extract was cytotoxic at extract concentrations >6.25% (viability: 76.9 ± 2.0% at 6.25%, 38.2 ± 0.5% at 12.5%, 3.1 ± 0.2% at 25%, 5.2 ± 0.8% at 50%, and 3.9 ± 0.2% at 100% extract concentration). Three EC extracts (produced by tobacco leaves) were cytotoxic at 100% and 50% extract concentrations (viability range: 2.2%-39.1% and 7.4%-66.9% respectively) and one ("Cinnamon-Cookies" flavour) was cytotoxic at 100% concentration only (viability: 64.8 ± 2.5%). Inhibitory concentration 50 was >3 times lower in CS extract compared to the worst-performing EC vapour extract. For EC extracts produced by high-voltage and energy, viability was reduced but no sample was cytotoxic according to ISO 10993-5 definition. Vapour produced by the "base" liquid was not cytotoxic at any extract concentration. Cell survival was not associated with nicotine concentration of EC liquids. CONCLUSIONS This study indicates that some EC samples have cytotoxic properties on cultured cardiomyoblasts, associated with the production process and materials used in flavourings. However, all EC vapour extracts were significantly less cytotoxic compared to CS extract.
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Affiliation(s)
| | - Giorgio Romagna
- ABICH S.r.l, Biological and Chemical Toxicology Research Laboratory, Via 42 Martiri, 213/B-28924 Verbania (VB), Italy; E-Mails: (G.R.); (E.A.); (E.R.); (E.B.); (S.T.)
| | - Elena Allifranchini
- ABICH S.r.l, Biological and Chemical Toxicology Research Laboratory, Via 42 Martiri, 213/B-28924 Verbania (VB), Italy; E-Mails: (G.R.); (E.A.); (E.R.); (E.B.); (S.T.)
| | - Emiliano Ripamonti
- ABICH S.r.l, Biological and Chemical Toxicology Research Laboratory, Via 42 Martiri, 213/B-28924 Verbania (VB), Italy; E-Mails: (G.R.); (E.A.); (E.R.); (E.B.); (S.T.)
| | - Elena Bocchietto
- ABICH S.r.l, Biological and Chemical Toxicology Research Laboratory, Via 42 Martiri, 213/B-28924 Verbania (VB), Italy; E-Mails: (G.R.); (E.A.); (E.R.); (E.B.); (S.T.)
| | - Stefano Todeschi
- ABICH S.r.l, Biological and Chemical Toxicology Research Laboratory, Via 42 Martiri, 213/B-28924 Verbania (VB), Italy; E-Mails: (G.R.); (E.A.); (E.R.); (E.B.); (S.T.)
| | - Dimitris Tsiapras
- Onassis Cardiac Surgery Center, Sygrou 356, Kallithea 17674, Greece; E-Mails: (D.T.); (S.K.); (V.V.)
| | - Stamatis Kyrzopoulos
- Onassis Cardiac Surgery Center, Sygrou 356, Kallithea 17674, Greece; E-Mails: (D.T.); (S.K.); (V.V.)
| | - Vassilis Voudris
- Onassis Cardiac Surgery Center, Sygrou 356, Kallithea 17674, Greece; E-Mails: (D.T.); (S.K.); (V.V.)
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Farsalinos KE, Romagna G, Tsiapras D, Kyrzopoulos S, Voudris V. Evaluating nicotine levels selection and patterns of electronic cigarette use in a group of "vapers" who had achieved complete substitution of smoking. Subst Abuse 2013; 7:139-46. [PMID: 24049448 PMCID: PMC3772898 DOI: 10.4137/sart.s12756] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Electronic cigarettes (ECs) are alternative-to-smoking nicotine delivery devices; consumers (commonly called vapers) use them in order to reduce or completely substitute smoking. The European Commission has released a proposal for a new Tobacco Product Directive that might reduce availability of nicotine-containing products, including ECs. In this study, the EC use patterns in subjects who have completely substituted smoking with EC use were examined by personal interviews. The study focused on nicotine levels used in order to achieve smoking cessation, reported benefits, associated side effects, and estimation of EC dependence compared with smoking. Methods Participants were 111 subjects who had completely substituted smoking with EC use for at least 1 month. Smoking abstinence was validated by measuring blood carboxyhemoglobin levels. Nicotine levels at initiation of EC use, at time of smoking cessation, and at time of interview were recorded. Dependence potential was assessed by asking the first question of the Fagerström Test for Cigarette Dependence (time until smoking the first cigarette and until first use of EC in the morning) and questions about perceived past dependence on tobacco cigarettes and present dependence on EC. Results Forty-two percent of participants reported quitting smoking during the first month of EC use. Liquids with nicotine concentration >15 mg/mL were used by 74% of users at initiation of EC use, while 16.2% had to increase the initial nicotine levels in order to achieve complete smoking abstinence. Seventy-two participants (64.9%) reported that from the time of smoking cessation to the time of the interview (8 months median duration of EC use) they reduced the nicotine concentration they were consuming; however, only 12% of the total sample was using ≤5 mg/mL nicotine concentration at the time of the interview. Side effects were mild and temporary. The vast majority of participants reported better exercise capacity and improved olfactory and gustatory senses. Perceived EC dependenct was significantly lower compared to smoking. Conclusions Nicotine levels appear to play an important role in achieving and maintaining smoking cessation in the group of motivated subjects studied. High nicotine-containing liquids were used while few mild and temporary side effects were reported. Proposals about regulation should consider the pragmatic use patterns of ECs, especially in consumers who have completely substituted smoking.
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Farsalinos KE, Romagna G, Tsiapras D, Kyrzopoulos S, Voudris V. Evaluation of electronic cigarette use (vaping) topography and estimation of liquid consumption: implications for research protocol standards definition and for public health authorities' regulation. IJERPH 2013; 10:2500-14. [PMID: 23778060 PMCID: PMC3717749 DOI: 10.3390/ijerph10062500] [Citation(s) in RCA: 203] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Revised: 06/06/2013] [Accepted: 06/07/2013] [Indexed: 01/26/2023]
Abstract
Background: Although millions of people are using electronic cigarettes (ECs) and research on this topic has intensified in recent years, the pattern of EC use has not been systematically studied. Additionally, no comparative measure of exposure and nicotine delivery between EC and tobacco cigarette or nicotine replacement therapy (NRTs) has been established. This is important, especially in the context of the proposal for a new Tobacco Product Directive issued by the European Commission. Methods: A second generation EC device, consisting of a higher capacity battery and tank atomiser design compared to smaller cigarette-like batteries and cartomizers, and a 9 mg/mL nicotine-concentration liquid were used in this study. Eighty subjects were recruited; 45 experienced EC users and 35 smokers. EC users were video-recorded when using the device (ECIG group), while smokers were recorded when smoking (SM-S group) and when using the EC (SM-E group) in a randomized cross-over design. Puff, inhalation and exhalation duration were measured. Additionally, the amount of EC liquid consumed by experienced EC users was measured at 5 min (similar to the time needed to smoke one tobacco cigarette) and at 20 min (similar to the time needed for a nicotine inhaler to deliver 4 mg nicotine). Results: Puff duration was significantly higher in ECIG (4.2 ± 0.7 s) compared to SM-S (2.1 ± 0.4 s) and SM-E (2.3 ± 0.5 s), while inhalation time was lower (1.3 ± 0.4, 2.1 ± 0.4 and 2.1 ± 0.4 respectively). No difference was observed in exhalation duration. EC users took 13 puffs and consumed 62 ± 16 mg liquid in 5 min; they took 43 puffs and consumed 219 ± 56 mg liquid in 20 min. Nicotine delivery was estimated at 0.46 ± 0.12 mg after 5 min and 1.63 ± 0.41 mg after 20 min of use. Therefore, 20.8 mg/mL and 23.8 mg/mL nicotine-containing liquids would deliver 1 mg of nicotine in 5 min and 4 mg nicotine in 20 min, respectively. Since the ISO method significantly underestimates nicotine delivery by tobacco cigarettes, it seems that liquids with even higher than 24 mg/mL nicotine concentration would be comparable to one tobacco cigarette. Conclusions: EC use topography is significantly different compared to smoking. Four-second puffs with 20–30 s interpuff interval should be used when assessing EC effects in laboratory experiments, provided that the equipment used does not get overheated. Based on the characteristics of the device used in this study, a 20 mg/mL nicotine concentration liquid would be needed in order to deliver nicotine at amounts similar to the maximum allowable content of one tobacco cigarette (as measured by the ISO 3308 method). The results of this study do not support the statement of the European Commission Tobacco Product Directive that liquids with nicotine concentration of 4 mg/mL are comparable to NRTs in the amount of nicotine delivered to the user.
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Affiliation(s)
- Konstantinos E. Farsalinos
- Onassis Cardiac Surgery Center, Sygrou 356, Kallithea 17674, Greece; E-Mails: (D.T.); (S.K.); (V.V.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +306-977-454-837; Fax: +302-109-493-373
| | - Giorgio Romagna
- Abich s.r.l., Biological and Chemical Toxicology Research Laboratory, Via 42 Martiri, 213/B-28924 Verbania (VB), Italy; E-Mail:
| | - Dimitris Tsiapras
- Onassis Cardiac Surgery Center, Sygrou 356, Kallithea 17674, Greece; E-Mails: (D.T.); (S.K.); (V.V.)
| | - Stamatis Kyrzopoulos
- Onassis Cardiac Surgery Center, Sygrou 356, Kallithea 17674, Greece; E-Mails: (D.T.); (S.K.); (V.V.)
| | - Vassilis Voudris
- Onassis Cardiac Surgery Center, Sygrou 356, Kallithea 17674, Greece; E-Mails: (D.T.); (S.K.); (V.V.)
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Romagna G, Allifranchini E, Bocchietto E, Todeschi S, Esposito M, Farsalinos KE. Cytotoxicity evaluation of electronic cigarette vapor extract on cultured mammalian fibroblasts (ClearStream-LIFE): comparison with tobacco cigarette smoke extract. Inhal Toxicol 2013; 25:354-61. [PMID: 23742112 DOI: 10.3109/08958378.2013.793439] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
CONTEXT Electronic cigarettes (ECs) are used as alternatives to smoking; however, data on their cytotoxic potential are scarce. OBJECTIVE To evaluate the cytotoxic potential of 21 EC liquids compared to the effects of cigarette smoke (CS). METHODS Cytotoxicity was evaluated according to UNI EN ISO 10993-5 standard. By activating an EC device, 200 mg of liquid was evaporated and was extracted in 20 ml of culture medium. CS extract from one cigarette was also produced. The extracts, undiluted (100%) and in five dilutions (50%, 25%, 12.5%, 6.25% and 3.125%), were applied to cultured murine fibroblasts (3T3), and viability was measured after 24-hour incubation by 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide assay. Viability of less than 70% was considered cytotoxic. RESULTS CS extract showed cytotoxic effects at extract concentrations above 12.5% (viability: 89.1 ± 3.5% at 3.125%, 77.8 ± 1.8% at 6.25%, 72.8 ± 9.7% at 12.5%, 5.9 ± 0.9% at 25%, 9.4 ± 5.3% at 50% and 5.7 ± 0.7% at 100% extract concentration). Range of fibroblast viability for EC vapor extracts was 88.5-117.8% at 3.125%, 86.4-115.3% at 6.25%, 85.8-111.7% at 12.5%, 78.1-106.2% at 25%, 79.0-103.7% at 50% and 51.0-102.2% at 100% extract concentration. One vapor extract was cytotoxic at 100% extract concentration only (viability: 51.0 ± 2.6%). However, even for that liquid, viability was 795% higher relative to CS extract. CONCLUSIONS This study indicates that EC vapor is significantly less cytotoxic compared tobacco CS. These results should be validated by clinical studies.
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Affiliation(s)
- Giorgio Romagna
- Abich srl, biological and chemical toxicology research laboratory, Verbania (VB), Italy
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Farsalinos KE, Romagna G. Chronic idiopathic neutrophilia in a smoker, relieved after smoking cessation with the use of electronic cigarette: a case report. Clin Med Insights Case Rep 2013; 6:15-21. [PMID: 23439796 PMCID: PMC3571762 DOI: 10.4137/ccrep.s11175] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Smoking is a major risk factor for a variety of diseases. Electronic cigarettes are battery-operated devices that deliver nicotine to the lungs by evaporation of a liquid. Chronic idiopathic neutrophilia is a condition characterized by elevated white blood cell and neutrophil counts without any underlying disease; smoking has been implicated as a potential cause. CASE PRESENTATION A male Caucasian patient, born in 1977, presented in September 2005 with asymptomatic elevation of white blood cell and neutrophil count, and mildly-elevated C-reactive protein levels. He was a smoker since 1996 and was treated with 20 mg/day of simvastatin since 2003 due to hyperlipidemia. Clinical examination, and laboratory and imaging investigations ruled out any infectious, haematological, rheumatological, or endocrine conditions. He was followed-up regularly and was advised to stop smoking. He had 2 unsuccessful attempts to quit smoking; one was unassisted and the second was performed with the use of both varenicline and nicotine replacement therapy (patches). During the subsequent 6.5 years, his leukocyte and C-reactive protein levels were repeatedly elevated; the condition was consistent with chronic idiopathic neutrophilia. In February 2012, he started using electronic cigarettes and he managed to quit smoking within 10 days. After 6 months, laboratory examination showed normalized leukocyte count and C-reactive protein levels, confirmed immediately by a second laboratory and by repeated tests after 1 and 2 months. CONCLUSION Smoking cessation with the use of electronic cigarette led to reversal of chronic idiopathic neutrophilia. The daily use of electronic cigarette may help preserve the beneficial effects of smoking cessation.
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