Mercury, cadmium, and lead in cigarettes from international markets: concentrations, distributions and absorption ability of filters

Mercury (Hg), cadmium (Cd), and lead (Pb) concentrations in marketed cigarettes from South Korea, Vietnam, Japan, Indonesia, Taiwan, Thailand, the United Kingdom (UK), Belgium, Italy, Finland, and France were investigated. The cigarettes from Vietnam and Thailand had the highest trend of Hg. Meanwhile, Cd was found higher in cigarettes from Thailand, the UK, and Belgium. Pb concentrations in cigarettes from Belgium, the UK, and Korea were higher than others. The average of these heavy metals concentrated in cigarettes was in the order of Pb > Cd > Hg. Furthermore, the contents of these heavy metals in cigarette leaves were much higher than in filter and rolling paper. There was a significant positive correlation between Hg and Cd, but no correlation between Cd and Pb and between Hg and Pb. Significant positive correlations of nicotine with Hg and Cd but not Pb in the cigarette were observed. Activated carbon filters (Ce-C) absorb Cd and Pb from cigarette leaves and rolling paper indicated a higher trapping trend than cellulose acetate filter without activated carbon (Ce). The trapping ratios of Ce-C (Cd: 5.53%, Pb:5.41%) were higher than Ce (Cd:3.09%, Pb:5.49%). On the other hand, Hg had lower absorption by both types of filters (Ce:0.15%, Ce-C:0.02%). This revealed that Hg, Cd and Pb absorption ability by both filters was relatively lower to the total concentration of these metals in tobacco leaves and rolling paper. The concern was that the higher concentrations of metals such as Hg, Cd and Pb in cigarettes might exist in mainstream smoke.

Smoking and Liver Disease

Cigarette smoking is the leading cause of preventable disease and death in the United States, causing approximately 480,000 deaths per year, which is equivalent to 1 in 5 deaths being attributable to tobacco use. The adverse effects of cigarette smoking on the lungs and cardiovascular system are well described; however, the detrimental effects of smoking on the liver are not as well defined. Smoking affects the liver via 3 separate mechanisms: toxic (both direct and indirect), immunologic, and oncogenic. There is an emerging body of evidence of an association between cigarette smoking and progression of fibrosis in chronic liver diseases such as nonalcoholic fatty liver disease and primary biliary cholangitis. Smoking is associated with accelerated development of hepatocellular carcinoma in patients with chronic hepatitis B or C virus infection. Tobacco smoking adversely affects lung function, which increases physical limitations and may preclude liver transplantation. Following liver transplantation, smoking is associated with several adverse outcomes, including increased risk of de novo malignancy, vascular complications, and nongraft-associated mortality. The respiratory illness caused by the novel coronavirus disease 2019 serves as a good example of the complex interplay between the lungs and the liver. It is evident that cigarette smoking has important negative effects on a multitude of liver diseases and that patients' smoking cessation must be prioritized. The data are limited, and more research is needed to better understand how smoking affects the liver. This article summarizes what is known about the pathologic effects of cigarette smoking on common liver diseases.

Helen G, Max W. The impact of e-cigarette and cigarette prices on e-cigarette and cigarette sales in California

Although numerous studies have examined the impact of cigarette prices on cigarette demand, research examining the impact of e-cigarette and cigarette prices on e-cigarette demand is relatively limited. This study estimated the impact of e-cigarette and cigarette prices on e-cigarette and cigarette sales in California. Using the 2012-2017 Nielsen Retail Scanner Data, we constructed e-cigarette prices, cigarette prices, and per capita e-cigarette and cigarette sales by year, quarter, and Nielsen scantrack market in California. E-cigarettes were categorized as disposable or reusable. Separate fixed-effects models estimated the impact of e-cigarette and cigarette prices on per capita disposable e-cigarette, reusable e-cigarette, and cigarette sales controlling for year, quarter, market, and smoke-free air law coverage. Average prices were $5.86 per pack of 20 cigarettes, $9.80 per disposable e-cigarette, and $19.11 per reusable e-cigarette. When prices of disposable e-cigarettes, reusable e-cigarettes, and cigarettes increased by 1%, per capita sales of the products decreased by 0.37%, 0.20%, and 0.21% respectively. Cigarette prices were positively associated with per capita sales of reusable e-cigarettes, indicating reusable e-cigarettes are substitutes for cigarettes. Reusable e-cigarette prices were positively associated with per capita sales of disposable e-cigarettes, indicating disposable e-cigarettes are substitutes for reusable e-cigarettes. No statistically significant association was found between disposable/reusable e-cigarette prices and cigarette sales. Our results suggest that raising prices of disposable e-cigarettes, reusable e-cigarettes, and cigarettes such as via tobacco excise tax increases would result in reduced sales for the products. Policymakers should consider the substitution between e-cigarettes and cigarettes when designing tobacco control policies.

Factors associated with readiness to quit smoking among young adults enrolled in a Facebook-based tobacco and alcohol intervention study

INTRODUCTION

Young adults who smoke cigarettes often report heavy episodic drinking (HED) and co-use of other psychoactive substances which may complicate efforts to quit cigarette smoking. The current study examined factors associated with readiness to quit cigarette smoking among young adults who smoke and engage in HED.

METHODS

One hundred seventy-nine young adults aged 18 to 25 who reported regular cigarette smoking and past month HED enrolled in the 90-day Facebook-based Smoking Tobacco and Drinking (STAND) intervention study. Analyses compared baseline differences in patterns of cigarette smoking and alcohol and cannabis use, thoughts about abstinence, use of nicotine replacement therapy (NRT), sociodemographic characteristics, and other health behaviors between participants who were ready to quit cigarette smoking in the next 30 days and those who were not.

RESULTS

Participants were 40.2% female, 49.7% male, 10.1% non-binary, and 80.4% Non-Hispanic White. They reported on average moderate nicotine dependence (FTCD), moderate risk for alcohol use disorder (AUDIT), and occasional or regular cannabis use. Readiness to quit cigarette smoking in the next 30 days (33.5%) was positively associated with age (p = .021), NRT use in the past 30 days (p = .037) and perceived importance to also reduce alcohol use (p = .033).

CONCLUSIONS

Findings indicate that readiness to quit cigarette smoking among young adults who drink is positively associated with importance to reduce alcohol use, but not with use patterns or levels of dependence. Interventions addressing polysubstance use may be better suited to help young adults reduce or quit cigarette smoking once they signal readiness for behavior change.

Contributions of obesity and cigarette smoking to incident disability: A longitudinal analysis

Downward trends in U.S. disability levels are stagnating. Assessing the key contributors to U.S. disability incidence is critical to improving the functional status of the U.S. population. Using longitudinal, nationally representative data from waves 2003-2015 of the Panel Study of Income Dynamics (PSID), we estimated age-specific U.S. disability incidence and quantified the individual and joint contributions of obesity (contemporaneous and earlier-life; BMI ≥ 30) and cigarette smoking to disability incidence. Participants were adults ages 33-96 who participated in PSID in 1986 and at least two consecutive waves 2003-2015 (N = 3247). We conducted age-stratified logistic regressions to predict incident disability at middle and older ages (33-69 years, 70-96 years). Next, counterfactual scenarios were used to estimate the contributions of each risk factor to incident disability. Disability incidence was greater in women than men (5.8 and 4.5 cases per 100 person-years, respectively) and increased with age. Obesity and cigarette smoking jointly explained 17-38% of disability incidence; each factor contributed roughly equal amounts in all groups but older men, for whom smoking history appeared more important. Obesity and smoking appeared to explain more of disability at younger ages (women: 33.1%, 95% CI: 25.1 to 41.0%; men: 37.6%, 95% CI: 28.8 to 46.5%) than at older ages (women: 16.5%, 95% CI: 8.2 to 24.9%; men: 24.5.%, 95% CI: 12.7 to 36.3%). This study provides a benchmark for monitoring trends in U.S. disability incidence. Obesity and smoking are key contributors to disability, accounting for 17-38% of incident disability in U.S. adults.

Divergent trends in lifetime drinking and smoking between Black and White Americans diagnosed with chronic pancreatitis

BACKGROUND/OBJECTIVES

Black Americans are at increased risk of chronic pancreatitis (CP) compared to their White counterparts. We aimed to describe the race-specific smoking history and lifetime drinking in patients diagnosed with CP.

METHODS

We analyzed data on 334 Black and White CP participants of the North American Pancreatitis Study 2 Continuation and Validation Study and Ancillary Study. Lifetime drinking history and lifetime smoking history were collected through in-person interviews. Intensity, frequency, duration and current status of drinking and smoking were compared between Black and White CP participants, stratified by physician-defined alcohol etiology. In addition, drinking levels at each successive decades in life (20s, 30s, 40s) were compared by race and graphically portrayed as heat diagrams.

RESULTS

Among patients with alcoholic CP, current smoking levels were not different by race (67-70%), but a smaller proportion of Black patients reported having smoked 1 or more packs per day in the past (32%) as compared to White patients (58%, p < 0.0001). Black patients were more likely to report current consumption of alcohol (31%), as opposed to White patients (17%, p = 0.016). Black patients also reported more intense drinking at age 35 and 45 years as compared to White patients, while age at CP onset were similar between the two groups.

CONCLUSION

We found more intense drinking but less intense smoking history in Black CP patients as compared to White CP patients. Effective alcohol abstinence and smoking cessation program with sustained impact are needed in CP patients.

Popularity of natural American Spirit cigarettes is greater in U.S. cities with lower smoking prevalence

BACKGROUND

Often perceived as a safer smoke, Natural American Spirit (NAS) may find particular appeal in communities with strong non-smoking norms. We hypothesized NAS would be more popular in cities with lower smoking prevalence, with the pattern unique to NAS. We tested household income, cigarette taxes, and young adult population as alternative correlates and examined brand specificity, relative to Marlboro and Pall Mall.

METHODS

Using proprietary, city-specific sales estimates obtained from Nielsen for 30 U.S. cities over one year (9/7/18-9/9/19), we computed cigarette sales volume as standard pack units per 10,000 adult smokers for NAS and Marlboro and Pall Mall. Linear regression models examined associations between city-level sales volume and adult smoking prevalence, median household income, the sum of state/local cigarette excise taxes, and young adult population.

RESULTS

NAS sales volume averaged 44,785 packs per 10,000 adult smokers (SD = 47,676). Across 30 cities, adult smoking prevalence averaged 18.0% (SD = 4.5%), median household income averaged $53,677 (SD = $14,825), cigarette excise tax averaged $2.55 (SD = $1.63), and young adult population averaged 10.6% (SD = 2.2%). NAS sales volume was greater in cities with lower adult smoking prevalence (β = -0.39, 95% CI[-0.74, -0.03], p = 0.034), a pattern that was not observed for Marlboro or Pall Mall (ps > 0.356). Marlboro (β = -0.40, 95% CI[-0.76, -0.05], p = 0.027) and Pall Mall (β = -0.48, 95% CI[-0.82, -0.14], p = 0.008) sales volumes were higher in cities where cigarette excise taxes were lower, a pattern not observed for NAS (p = 0.224).

CONCLUSION

NAS appears to be more popular in cities with lower smoking prevalence and may deter efforts to further decrease prevalence.

The use of human induced pluripotent stem cells to screen for developmental toxicity potential indicates reduced potential for non-combusted products, when compared to cigarettes

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Effective in vitro strategies are required to predict early developmental toxicity.

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devTOX^qP is a metabolomics biomarker assay using iPSCs.

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Sample smoke/aerosol captured in bPBS, was tested up to 10% concentration.

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Cigarettes & HTP bPBS extracts were predicted as potentially developmentally toxic.

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HYB & EVP aerosols were not predicted as having developmentally toxic potential in devTOX^qP.

devTOX quickPredict (devTOX^qP) is a metabolomics biomarker-based assay that utilises human induced pluripotent stem (iPS) cells to screen for potential early stage embryonic developmental toxicity in vitro. Developmental toxicity potential is assessed based on the assay endpoint of the alteration in the ratio of key unrelated biomarkers, ornithine and cystine (o/c).

This work aimed to compare the developmental toxicity potential of tobacco-containing and tobacco-free non-combustible nicotine products to cigarette smoke. Smoke and aerosol from test articles were produced using a Vitrocell VC10 smoke/aerosol exposure system and bubbled into phosphate buffered saline (bPBS). iPS cells were exposed to concentrations of up to 10% bPBS. Assay sensitivity was assessed through a spiking study with a known developmental toxicant, all-trans-retinoic acid (ATRA), in combination with cigarette smoke extract.

The bPBS extracts of reference cigarettes (1R6F and 3R4F) and a heated tobacco product (HTP) were predicted to have the potential to induce developmental toxicity, in this screening assay. The bPBS concentration at which these extracts exceeded the developmental toxicity threshold was 0.6% (1R6F), 1.3% (3R4F), and 4.3% (HTP) added to the cell media. Effects from cigarette smoke and HTP aerosol were driven largely by cytotoxicity, with the cell viability and o/c ratio dose–response curves crossing the developmental toxicity thresholds at very similar concentrations of added bPBS. The hybrid product and all the electronic cigarette (e-cigarette) aerosols were not predicted to be potential early developmental toxicants, under the conditions of this screening assay.

Assessing how the history of e-cigarette and cigarette use are associated with the developmental course of marijuana use in a sample of United States adolescents

BACKGROUND

The purpose of this study was to determine the developmental course of marijuana use among adolescents based on their history of cigarette and e-cigarette use among a national U.S. sample of adolescents who were followed over a four year time-period.

METHODS

The data for this study used four waves of the Population Assessment of Tobacco and Health (PATH) Study provided by a panel of 12 to 17-year-olds at Wave 1 (n = 11,059) who completed each of the four annual waves of the adolescent/adult survey. We examined recent use (i.e., past 30-day) of e-cigarettes, cigarettes, and marijuana use at each of the four waves.

RESULTS

Respondents who had a history of non-concurrent dual use (AOR = 1.67, 95 % CI = 1.24, 2.24) and a history of concurrent dual use (AOR = 1.67, 95 % CI = 1.40, 1.99) had greater odds of past 30-day marijuana use when compared to respondents who had a history of past 30-day e-cigarette use only. Interaction effect models found that e-cigarette only users were at lower risk for past 30-day marijuana use at Wave 1, however, the risk of past 30-day marijuana use increased at a faster rate across the four waves for e-cigarette only users when compared to their peers who used cigarettes or a combination of cigarettes and e-cigarettes.

CONCLUSION

While concurrent and non-concurrent dual use was strongly associated with marijuana use over the study period, marijuana use increased at a faster rate across the four-year span of the study among e-cigarette only users.

Assessing the effect of nicotine dose in cigarette smoking on sleep quality

BACKGROUND

While several studies assessed the relation between cigarette smoking and sleep, there are still very few studies assessing the effect of nicotine in cigarette smoking on sleep.

AIM

This study aimed to compare higher vs lower nicotine levels in cigarette smoking on sleep quality.

METHODS

We used data from the recently released dataset for the Randomized Trial of Reduced-Nicotine Standards for Cigarettes. We included three groups in the current study: the least nicotine concentration (i.e., 0.4 mg/g), a moderate nicotine concentration (i.e., 5.2 mg/g), and the highest nicotine concentration (i.e., 15.8 mg/g). For each participant, we included data regarding baseline and the last follow up at 6 weeks, where we compared insomnia, sleep problems, and awakening at night, in addition to different depression and affect scores.

RESULTS

A total of 360 patients were included in this study, with a mean age of 42.4 (±13.4) years. For the three nicotine groups (i.e., 0.4 mg/g, 5.2 mg/g, and 15.8 mg/g), we included 119 (33%), 122 (34%), and 119 (33%) participants. Among the high-nicotine-dose group, the number of participants who had worsened sleep was significantly higher than the number of those who had improved sleep (p = 0.01) after 6 weeks of consumption, where 37 (31%) had worsened sleep score after 6 weeks while only 19 (16%) had improved score compared with baseline.

CONCLUSION

While previous studies established a relation either between cigarette smoking and sleep or between nicotine patches and sleep, the present study is the first to establish that higher nicotine doses in cigarettes were associated with more sleep disturbances.

Widening disparities in cigarette smoking by race/ethnicity across education level in the United States

Reducing tobacco use is an important public health objective. It is the largest preventable cause of death and disease, yet inequalities remain. This study examines combined educational and racial/ethnic disparities in the United States related to cigarette smoking for the three largest racial/ethnic groups (African Americans, Hispanics/Latinos, and non-Hispanic Whites). Data included nine Tobacco Use Supplements to the Current Population Surveys (TUS-CPS) conducted in the United States from 1992/1993-2018 for four smoking metrics: ever smoking rates, current smoking rates, consumption (cigarettes per day), and quit ratios. Across all TUS-CPS samples, there were 9.5% African Americans, 8.8% Hispanics/Latinos, and 81.8% non-Hispanic Whites who completed surveys. Findings revealed that lower educational attainment was associated with increased ever and current smoking prevalence over time across all racial/ethnic groups, and education-level disparities within each race/ethnicity widened over time. Disparities in ever and current smoking rates between the lowest and highest categories of educational attainment (less than a high school education vs. completion of college) were larger for African Americans and non-Hispanic Whites than Hispanics/Latinos. Non-Hispanic Whites had the highest cigarette consumption across all education levels over time. College graduates had the highest quit ratios for all racial/ethnic groups from 1992 to 2018, with quit ratios significantly increasing for Hispanics/Latinos and non-Hispanic Whites, but not African Americans. In conclusion, educational disparities in smoking have worsened over time, especially among African Americans and Hispanics/Latinos. Targeted tobacco control efforts could help reduce these disparities to meet public health objectives, although racial/ethnic disparities may persist regardless of educational attainment.

Dependence on e-cigarettes and cigarettes in a cross-sectional study of US adults

BACKGROUND AND AIMS

Cigarette smoking often results in nicotine dependence. With use of electronic cigarettes as an alternative source of nicotine, it is important to assess dependence associated with e-cigarette use. This study assesses dependence among current and former adult e-cigarette users on cigarettes and e-cigarettes, compared with dependence on cigarettes.

DESIGN

Cross-sectional data from the Population Assessment of Tobacco and Health (PATH) study from 2013-2016. Psychometrically assessed dependence was compared for cigarettes and e-cigarettes among current and former exclusive and dual users of the products and among e-cigarette users who had and had not recently stopped smoking. Setting A population-based representative sample of US adults. Participants Participants were 13 311 US adults (18+) in Waves 1-3 of PATH reporting current established smoking, current use of e-cigarettes, or stopping use of either product in the past year who were administered dependence assessments for cigarettes and/or e-cigarettes. Measurements A 16-item scale assessing tobacco dependence (on a 1-5 scale), previously validated for assessment and comparison of dependence on varied tobacco products, including cigarettes and e-cigarettes, with a variation assessing residual dependence among users who stopped in the past year. Findings Among current users, dependence on e-cigarettes was significantly lower than dependence on cigarettes, in within-subjects comparisons among dual users of both e-cigarettes and cigarettes (1.58 [SE = 0.05] vs. 2.76 [0.04]), P < 0.0001), and in separate groups of e-cigarette users and cigarette smokers (1.95 [0.05] vs. 2.52 [0.02], P < 0.0001), and among both daily and non-daily users of each product. Among former users, residual symptoms were significantly lower for e-cigarettes than cigarettes, both among former dual users (1.23 [0.07] vs. 1.41 [0.06], P < 0.001) and among users of one product (1.28 [0.03] vs. 1.53 [0.03], P < 0.0001). The highest level of e-cigarette dependence was among e-cigarette users who had stopped smoking (2.17 [0.08]). Conclusion Use of e-cigarettes appears to be consistently associated with lower nicotine dependence than cigarette smoking.

Trends and predictors of exclusive e-cigarette use, exclusive smoking and dual use among youth in Canada

BACKGROUND

Few studies have examined predictors of exclusive e-cigarette use, exclusive smoking and dual use among youth. We investigated whether frequency of e-cigarette use and cigarette smoking predicted involvement in different usage groups after a 1- and 2-year follow-up among a sample of Canadian youth.

METHODS

A longitudinal sample of youth who participated in three waves of COMPASS [Wave 1 (W₁) 2015/16, Wave 2 (W₂) 2016-17, Wave 3 (W₃) 2017/18] was identified (N = 5,704). Multinomial logistic regression was used to examine whether frequency of e-cigarette use and cigarette smoking at W₁ predicted involvement in different usage groups at W₂ and W₃. Similarly, we examined whether changes in frequency of e-cigarette use and cigarette smoking between W₁ and W₂ predicted involvement in different usage groups at W₃.

RESULTS

E-cigarette users reporting use on 4 or more days per month at W₁ had greater odds of dual use at W₂, compared to non-users (aOR = 11.22, p < 0.0001). Those who reduced their frequency of e-cigarette use between W₁ and W₂ had lower odds of exclusive e-cigarette use and dual use at W₃ (aOR = 0.18 and 0.17 respectively; both p < 0.05). Those who increased their frequency of cigarette smoking between W₁ and W₂ had higher odds of exclusive smoking and dual use at W₃ (aOR = 22.65 and aOR = 9.92 respectively; both p < 0.0001).

DISCUSSION

Reductions in frequency of e-cigarette use appeared to have a protective effect of reducing exclusive e-cigarette use and dual use at follow-up. Increases in frequency of cigarette smoking were a significant predictor of exclusive smoking and dual use.

Unpacking the Non-Hispanic Other Category: Differences in Patterns of Tobacco Product Use Among Youth and Adults in the United States, 2009-2018

Studies investigating patterns of tobacco use by race often aggregate non-Black and non-Hispanic racial minorities into the "Other" category, masking important differences. Pooling 10 years (2009-2018) of National Survey on Drug Use and Health data (n = 52,424), we estimated the prevalence and proportion of individual tobacco product use and patterns of single, dual, and polytobacco use overall and by sex for youth (12-17) and adult (18 +) non-Hispanic Asian, American Indian/Alaska Native (AI/AN), Native Hawaiian/other Pacific Islander (NH/PI), and multiracial respondents. Cigarette prevalence was highest among AI/AN youth (8.6%) and adults (37.3%). For youth and adults, the AI/AN subgroup had the highest prevalence of single (9.2% youth, 35.8% adults) and dual (2.8% youth, 6.6% adults) use, followed by multiracial respondents. Furthermore, among tobacco users, AI/AN and multiracial youth and adults had the highest proportions of dual and poly use compared to other races. Appropriate tobacco prevention and cessation interventions should consider variation in tobacco use among non-Hispanic "Other" subgroups.

Dataset on cigarette smokers in six South African townships

A total of 2453 smokers were interviewed in townships over two rounds of data collection. Townships are low-income, urban areas characterised by overpopulation, poor service delivery, crime, and poor socioeconomic outcomes. Township residents typically live in poverty. Data were collected from six townships in four of South Africa's nine provinces, namely Gauteng (Eldorado Park and Ivory Park), Western Cape (Khayelitsha and Mitchell's Plain), Free State (Thabong) and KwaZulu-Natal (Umlazi). These townships were chosen to represent both the geographical and racial spread of low socioeconomic areas in South Africa. Round 1 data (n = 1260) were collected from October to November 2017, and round 2 data (n = 1193) were collected from July to August 2018. The sample includes two of South Africa's four population groups: African and mixed race (locally referred to as “Coloured”, which describes people of mixed Khoisan, Malay, European, and black African ancestry). Since few Whites and Asians live in townships, they were not sampled. Households were selected via a random walk through each township. One smoker per household was interviewed (if a household contained at least one available smoker). We aimed to interview 200 adult smokers (aged 18+ years) per township per round. If a household had more than one smoker, a random selection determined which smoker to interview. Respondents were asked about their most recent cigarette purchase, specifically packaging type (single stick, pack, or carton), number of items purchased, brand, type of outlet where the cigarettes were bought, and the total amount paid for cigarettes. Respondents were also asked about other tobacco use in the household, and about their perceptions regarding illegal cigarettes. Socioeconomic and demographic information was collected at the individual and household level. The data has been used to estimate illicit trade (https://tobaccocontrol.bmj.com/content/early/2020/03/10/tobaccocontrol-2019–055136.info), and to analyse the determinants of smoking intensity (https://www.sciencedirect.com/science/article/pii/S2211335520300590).

Pesticides residues in tobacco smoke: risk assessment study

Pesticides are not only used on food but also on non-food crops, such as tobacco, to control a range of unwanted animal, plant, and microbial, fungal pests. The residue levels in tobacco leaves are expected to decline up to harvest, during drying, and when the leaves are further processed. Additional pesticides may also be applied to the finished product and residue levels may remain present even when the tobacco is burned. Human exposure to pesticide residues on tobacco occurs when residues remaining in cigarette smoke are inhaled. Based on this assumption, the objectives of this research were (i) to determine the level of pesticides residues in harvested tobacco leaves and (ii) to assess the risk of human exposure to these residues in tobacco smoke. Pesticide residues were detected in all analysed tobacco samples. These detected residues represent ten different active ingredients (AI), three of these AIs (thiodicarb, alachlor, and endosulfan) are no longer allowed in Europe. A 54.7% of these residues were quantifiable. Furthermore, it was found that with the use of solid-phase extraction sorbent (SPE) as adsorbent and n-hexane as solvent, higher recoveries of the pesticide residues in the tobacco smoke from the amount spiked can be obtained. It was also found that cigarette filters help to reduce the intake of residues of pesticides that may be present in cigarettes. Finally, the study concluded that both active smoking and passive smoking populations are exposed to pesticide residues in the tobacco smoke.

High school sport participation and substance use: A cross-sectional analysis of students from the COMPASS study

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Over half the sample did not participate in any school sports.

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32% of youth reported use of one or more substances.

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Intramurals were negatively associated with cannabis and cigarette use.

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Varsity sports were associated with lower odds of cigarette use.

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Varsity sports were associated with increased odds of binge drinking and e-cigarette use.

Introduction

The objective of this study was to examine the association between participation in school sports and substance use behaviors in both male and female high school students.

Methods

The current study used cross-sectional data from 60,601 students from Year 6 (2017–2018) of the COMPASS study. Students reported their school physical activity participation (none, intramurals only, varsity only, both) and past 30-day substance use (binge drinking, cannabis use, cigarette use, e-cigarette use). Hierarchical logistic regression models predicted the odds of substance use, by sex.

Results

55% of students did not participate in any school sports and 32% reported substance use. Intramurals were negatively associated with cannabis use and cigarette use among all students and e-cigarette use among females. Varsity sports were associated with lower odds of cigarette use among all students and cannabis use among males. In contrast, participating in varsity sports was associated with increased odds of binge drinking and e-cigarette use among all students. Participating in both intramurals and varsity sports was associated with increased odds of binge drinking and e-cigarette use but with decreased odds of cannabis use and cigarette use.

Conclusions

Intramurals were found to be protective against cannabis use and cigarette use among all students and e-cigarette use among females. Although varsity sports were protective against cannabis and cigarette use, they were found to be a risk factor for binge drinking and e-cigarette use. Substance use prevention efforts should be a focus among school varsity sports teams, especially for binge drinking and e-cigarette use.

Patients' perspectives on smoking and inflammatory bowel disease: An online survey in collaboration with European Federation of Crohn's and Ulcerative Colitis Associations

BACKGROUND

Smoking has detrimental effects on Crohn’s disease (CD) activity while data on ulcerative colitis (UC) are conflicting. Little is known about the use and impact of alternative smoking products in inflammatory bowel diseases (IBD).

AIM

To understand the patients’ perceptions of the impact of smoking on their IBD and to assess differences between CD and UC patients.

METHODS

The questionnaire was developed by Philip Morris Products SA in cooperation with European Federation of Crohn's and Ulcerative Colitis Associations. The final survey questionnaire consisted of 41 questions divided in 8 categories: (1) Subject screener; (2) Smoking history; (3) Background information; (4) IBD disease background; (5) Current disease status; (6) Current therapeutics and medications; and (7) Current nicotine/cigarettes use and awareness of the impacts of smoking on IBD. The questionnaire was submitted online from 4^th November 2019 to 11th March 2020 through the European Federation of Crohn's and Ulcerative Colitis Associations website to IBD patients who were current smokers or had a history of smoking.

RESULTS

In total 1050 IBD patients speaking nine languages participated to the survey. Among them, 807 (76.9%) patients declared to have ever smoked or consumed an alternative smoking product, with a higher proportion of current cigarette smokers among CD patients (CD: 63.1% vs UC: 54.1%, P = 0.012). About two-thirds of the participants declared to have ever stopped cigarette smoking and restarted (67.0%), with a significantly higher proportion among UC patients compared to CD patients (73.1% vs 62.0%, P = 0.001). We also found significant differences between CD and UC patients in the awareness of the health consequences of smoking in their disease and in the perceived impact of smoking on disease activity, for both cigarettes and alternative smoking products.

CONCLUSION

This survey found significant differences between CD and UC patients in both awareness and perception of the impact of smoking on their disease. Further efforts should be done to encourage smoking cessation for all IBD patients, including UC patients.

Acute and chronic vascular effects of inhaled crotonaldehyde in mice: Role of TRPA1

Although crotonaldehyde (CR) is an abundant α,β-unsaturated aldehyde in mainstream cigarette smoke (MCS), the cardiovascular toxicity of inhaled CR is largely unexplored. Thus, male C57BL/6 J mice were exposed acutely (1 h, 6 h, and 4d) and chronically (12 weeks) to CR (at levels relevant to MCS; 1 and 3 ppm), and cardiovascular and systemic outcomes were measured in vivo and in vitro. Diastolic blood pressure was decreased (hypotension) by both acute and chronic CR exposure. Vascular toxicity of inhaled CR was quantified in isolated aorta in response to agonists of contraction (phenylephrine, PE) and relaxation (acetylcholine, ACh; sodium nitroprusside, SNP). Although no change in contractility was observed, ACh-induced relaxations were augmented after both acute and chronic CR exposures whereas SNP-induced relaxation was enhanced only following 3 ppm CR exposure. Because CR is a known agonist of the transient receptor potential ankyrin 1 (TRPA1) channel, male TRPA1-null mice were exposed to air or CR (4d, 1 ppm) and aortic function assessed in vitro. CR exposure had no effect on TRPA1-null aortic function indicating a role of TRPA1 in CR effects in C57BL/6 J mice. Notably, CR exposure (4d, 1 ppm) had no effect on aortic function in female C57BL/6 J mice. This study shows that CR inhalation exposure induces real-time and persistent vascular changes that promote hypotension-a known risk factor for stroke. Because of continued widespread exposures of humans to combustion-derived CR (environmental and tobacco products), CR may be an important cardiovascular disease risk factor.

[Smoking and Breastfeeding - CNGOF-SFT Expert Report and Guidelines on the management for Smoking Management During Pregnancy]

INTRODUCTION

The consequences of smoking have been studied more during pregnancy than during breastfeeding. There is a passage of nicotine and other substances in breast milk and some modifications of milk composition. The objectives of this chapter are to study the benefits of breastfeeding in women who smoke, and the adaptation of smoking, medication and behavioral habits in case of incomplete withdrawal to better guide women.

METHODS

The Medline database, the Cochrane Library and foreign guidelines from 1999 to 2019 have been consulted.

RESULTS

The conservation of the benefit of breastfeeding in smokers with regard to the prevention of respiratory infections, infantile colic, cognitive deficits, obesity, sudden infant death, is not known to date. It is therefore not recommended to include smoking status in the choice of feeding mode for the newborn (professional agreement). However, since breastfeeding is a factor associated with a reduction in smoking and/or withdrawal (NP2), it is recommended to promote breastfeeding in non-weaned women in order to limit smoking (grade B). The use of nicotine replacement therapy is possible during breastfeeding (professional agreement). In the absence of data, bupropion (Zyban®) and varenicline (Champix®) are not recommended for women who are breastfeeding (professional agreement). A free interval between smoking and breastfeeding reduces the concentration of nicotine in milk (NP4). For non-weaned women who are breastfeeding, it is therefore recommended not to smoke just before breastfeeding (professional agreement).

CONCLUSION

The results indicate that breastfeeding is possible in smokers, although less often initiated by them. If the conservation of its benefits for the child is not demonstrated to date, breastfeeding allows the mother to limit smoking.

Multiple Sclerosis and Smoking

Multiple sclerosis (MS) is a common, severe neurological disease that affects millions of people worldwide. Nevertheless, the actual cause of MS remains unknown. Smoking has been studied with respect to MS development and progression. The objectives of this review were to examine the relationship between smoking and MS and to understand the possible molecular mechanisms underlying the association. PubMed was searched for articles related to the study topic published between 2012 and 2020 using the search terms "multiple sclerosis," "smoking," "risk factors," "cigarettes," and "molecular mechanisms." Studies show a significant relationship between smoking and the risk of MS. Furthermore, smoking has been linked to the progression of MS at the patient and population levels. However, the underlying mechanism remains to be explored in further studies; researchers still disagree on how the relationship between smoking and MS arises in different populations. Evidence from randomized controlled trials, systematic reviews, and epidemiological studies shows that smokers have a higher risk of developing MS and experiencing related adverse symptoms and complications.

Type of e-liquid vaped, poly-nicotine use and nicotine dependence symptoms in young adult e-cigarette users: a descriptive study

BACKGROUND

Data are lacking on type of e-liquid vaped among e-cigarette users. Further, few studies assess all sources of nicotine used by e-cigarette users to assess whether poly-nicotine use relates to nicotine dependence (ND). The objectives were to describe young adult e-cigarette users by: (i) type of e-liquid vaped; (ii) poly-nicotine use; (iii) ND symptoms; and (iv) attempts to quit conventional cigarettes.

METHODS

Data were available in cycle 23 of a longitudinal investigation on the natural course of cigarette smoking and ND. A total of 775 young adults (44% male; mean (SD) age 30.5(1.0)) completed mailed self-report questionnaires in 2017-20.

RESULTS

Of 775 participants, 149 (19.2%) reported past-year e-cigarette use. Overall, 55.0% of e-cigarette users had used cannabis-containing e-liquid (31.5% vaped cannabis e-liquid exclusively); 50.4% used nicotine-containing e-liquid (23.5% vaped nicotine e-liquid exclusively); and 39.9% used e-liquid without nicotine (8.7% vaped e-liquid without nicotine exclusively). Most e-cigarette users (82.6%) used other nicotine-containing products including conventional cigarettes (72.5%); 60.8% reported ND symptoms, rising to 79.4% among those who vaped nicotine-containing e-liquid. Finally, 29.0% tried to quit conventional cigarettes using e-cigarettes in the past-year, but only 16.7% found them helpful.

CONCLUSIONS

E-cigarettes now appear to appeal to a broader market than smokers who want to quit. More than half of young adult e-cigarette users vaped cannabis-containing e-liquid in the past year while only one-quarter had used e-cigarettes to assist with cessation. Most e-cigarette users used multiple nicotine-containing substances (including combustible cigarettes) which were associated with reports of ND symptoms.

The Role of Anxiety in Smoking Onset, Severity, and Cessation-Related Outcomes: a Review of Recent Literature

PURPOSE OF REVIEW

Anxiety is one of the most common mental health conditions globally and co-occurs with smoking at a markedly high rate. The present review offers a narrative overview of the most recent research on the role of anxiety in smoking onset, maintenance, and cessation-related outcomes. Additionally, given the rise in electronic cigarette use, we review the emerging literature on the influence of anxiety on e-cigarette use.

RECENT FINDINGS

Evidence across studies varied as to the role of anxiety or anxiety symptoms in smoking behavior. The most consistent findings suggested that those with anxiety are more likely to be a smoker, supporting a high rate of co-occurrence across these conditions. Less consistent evidence was observed for the association between anxiety and onset, indicators of severity, and cessation outcomes. Although there is robust evidence for an association between smoking and anxiety, there were considerable discrepancies for the precise role of anxiety in smoking onset, severity, and cessation outcomes. Future work utilizing more sophisticated methodologies is needed to identify causal relations as well as putative moderators and mediators of the anxiety-smoking relation.

The impact of a comprehensive tobacco product flavor ban in San Francisco among young adults

OBJECTIVE

Flavors play an important role in the initiation and use of tobacco products. The FDA, states, and cities have been implementing or considering banning flavored e-cigarettes or any flavored tobacco products. This study empirically assessed the impact of one of the first comprehensive bans of all flavored tobacco products other than tobacco-flavored e-cigarettes among young adults in San Francisco, California.

METHODS

Using Amazon Mechanical Turk, a sample of San Francisco residents aged 18-34 who previously used tobacco products (N = 247) were surveyed about their tobacco use both before and after the ban. Descriptive statistics and regression models were applied.

RESULTS

The prevalence of overall flavored tobacco use decreased from 81% and 85% to 69% and 76% for 18-24 years and 25-34 years old, respectively. The prevalence of flavored e-cigarettes decreased from 57% and 56% to 45% and 48% for 18-24 years and 25-34 years old, respectively. The prevalence of cigars uses reduced as well. However, cigarette smoking increased, although not statistically significant among 25-34 years old. 66% of participants did not support the ban and 65% believed the ban had not been enforced completely. Most users reported being able to obtain flavored tobacco products in multiple ways despite the ban.

CONCLUSIONS

These findings suggest that comprehensive local flavor bans, by themselves, cannot sharply reduce the availability or use of flavored tobacco products among residents. Nevertheless, local bans can still significantly reduce overall e-cigarette use and cigar smoking but may increase cigarette smoking.