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St Helen G, Shahid M, Chu S, Benowitz NL. Impact of e-liquid flavors on e-cigarette vaping behavior. Drug Alcohol Depend 2018; 189:42-48. [PMID: 29879680 PMCID: PMC6211798 DOI: 10.1016/j.drugalcdep.2018.04.032] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 04/18/2018] [Accepted: 04/21/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The primary objective of this pilot study was to describe the impact of e-cigarette liquid flavors on experienced e-cigarette users' vaping behavior. METHODS 11 males and 3 females participated in a 3-day inpatient crossover study using e-cigarettes with strawberry, tobacco, and their usual brand e-liquid. Nicotine levels were nominally 18 mg/mL in the strawberry and tobacco e-liquids and ranged between 3-18 mg/mL in the usual brands. On each day, participants had access to the study e-cigarette (KangerTech mini ProTank 3, 1.5 Ohms, 3.7 V) and the assigned e-liquid during a 90-minute videotaped ad libitum session. RESULTS Average puff duration was significantly longer when using the strawberry e-liquid (3.2 ± 1.3 s, mean ± SD) compared to the tobacco e-liquid (2.8 ± 1.1 s) but the average number of puffs was not significantly different (strawberry, 73 ± 35; tobacco, 69 ± 46). Compared to the strawberry- and tobacco-flavored e-liquids, average puff duration was significantly longer (4.3 ± 1.6 s) and the average number of puffs was significantly higher (106 ± 67 puffs) when participants used their usual brand of e-liquid. Participants generally puffed more frequently in small groups of puffs (1-5 puffs) with the strawberry compared to the tobacco e-liquid and more frequently in larger groups (>10 puffs) with their usual brand. The strength of the relationship between vaping topography and nicotine intake and exposure were not consistent across e-liquids. CONCLUSION Vaping behavior changes across e-liquids and influences nicotine intake. Research is needed to understand the mechanisms that underlie these behavioral changes, including e-liquid pH and related sensory effects, subjective liking, and nicotine effects.
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Affiliation(s)
- Gideon St Helen
- Division of Clinical Pharmacology and Experimental Therapeutics, Department of Medicine, University of California, San Francisco, CA, United States; Center for Tobacco Control Research and Education, University of California, San Francisco, CA, United States; UCSF Tobacco Center of Regulatory Science (TCORS), United States.
| | - Marian Shahid
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, United States
| | - Sherman Chu
- Division of Clinical Pharmacology and Experimental Therapeutics, Department of Medicine, University of California, San Francisco, CA, United States
| | - Neal L Benowitz
- Division of Clinical Pharmacology and Experimental Therapeutics, Department of Medicine, University of California, San Francisco, CA, United States; Center for Tobacco Control Research and Education, University of California, San Francisco, CA, United States; UCSF Tobacco Center of Regulatory Science (TCORS), United States; Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, United States
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102
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Vansickel AR, Edmiston JS, Liang Q, Duhon C, Connell C, Bennett D, Sarkar M. Characterization of puff topography of a prototype electronic cigarette in adult exclusive cigarette smokers and adult exclusive electronic cigarette users. Regul Toxicol Pharmacol 2018; 98:250-256. [PMID: 30053435 DOI: 10.1016/j.yrtph.2018.07.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 07/21/2018] [Accepted: 07/23/2018] [Indexed: 11/30/2022]
Abstract
Puff topography is an important measure of how consumers use e-vapor products. The purpose of this study was to evaluate the feasibility of using SODIM Smoking Puff Analyzer Mobile Device (SPA/M) to measure puff topography during use of a prototype e-cigarette (e-cig) in exclusive cigarette smokers (CS) and e-cig users (EC) under ad lib conditions in a clinic. Adult CS (n = 13) and EC (EC; n = 10) completed a 7-hr use session with the e-cig (2% tobacco-derived nicotine by weight, cartridge based system approximately the size of a king size cigarette). E-liquid usage was determined from cartridge weight. CS also smoked a single cigarette with the SPA/M. The SPA/M reliably recorded puff parameters throughout the study period, with CS puffs averaging 47.9 ± 18.2 ml volume, 2.3 ± 0.8 s duration, and 21.5 ± 4.6 ml/s flow rate. EC puffs averaged 53.4 ± 19.2 ml volume, 3.0 ± 1.3 s duration, and 19.6 ± 5.0 flow rate. CS average e-liquid use was 292 ± 214 mg and EC averaged 415 ± 305 mg over 7 h. When compared to a single use of their own brand cigarettes, CS took longer (2.3 ± 0.8 vs.1.7 ± 0.4 s) puffs with similar puff volume (47.9 ± 18.2 vs. 44.1 ± 10.5 ml) from the e-cig prototype. The puff duration, flow rate and peak flow were significantly lower (p < 0.05) with the e-cigs compared to cigarettes. Experienced EC and CS appeared to use the e-cig prototype differently, which is consistent with the literature. The SPA/M could be a useful tool in assessing e-cig use behavior for regulatory purposes.
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Affiliation(s)
- Andrea Rae Vansickel
- Altria Client Services LLC, Center for Research and Technology, 601 E. Jackson Street, Richmond, VA, USA
| | - Jeffery S Edmiston
- Altria Client Services LLC, Center for Research and Technology, 601 E. Jackson Street, Richmond, VA, USA
| | - Qiwei Liang
- Altria Client Services LLC, Center for Research and Technology, 601 E. Jackson Street, Richmond, VA, USA
| | - Cheryl Duhon
- Altria Client Services LLC, Center for Research and Technology, 601 E. Jackson Street, Richmond, VA, USA
| | - Chris Connell
- Altria Client Services LLC, Center for Research and Technology, 601 E. Jackson Street, Richmond, VA, USA
| | - David Bennett
- Altria Client Services LLC, Center for Research and Technology, 601 E. Jackson Street, Richmond, VA, USA
| | - Mohamadi Sarkar
- Altria Client Services LLC, Center for Research and Technology, 601 E. Jackson Street, Richmond, VA, USA.
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Differential Effects of E-Cigarette on Microvascular Endothelial Function, Arterial Stiffness and Oxidative Stress: A Randomized Crossover Trial. Sci Rep 2018; 8:10378. [PMID: 29991814 PMCID: PMC6039507 DOI: 10.1038/s41598-018-28723-0] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 06/27/2018] [Indexed: 11/30/2022] Open
Abstract
Propylene glycol and glycerol are electronic cigarettes vehicles allowing liquid vaporization and nicotine transport. The respective effects of these different constituents on the cardiovascular system are unknown. We assessed the differential effects of vehicles (propylene glycol and glycerol) and nicotine on microcirculatory function, arterial stiffness, hemodynamic parameters and oxidative stress. Twenty-five tobacco smokers were exposed to vaping with and without nicotine, and sham vaping, in a randomized, single blind, 3-period crossover design study. Neither sham-vaping nor vaping in the absence of nicotine resulted in modifications of cardiovascular parameters or oxidative stress. In contrast, vaping with nicotine: 1) impaired acetylcholine mediated vasodilation (mean ± standard error mean) (area under curve, perfusion unit (PU), 3385 ± 27PU to 2271 ± 27PU, p < 0.0001); 2) increased indices of arterial stiffness, namely augmentation index corrected for heart rhythm (−3.5 ± 1.5% to 1.9 ± 2.3%; p = 0.013) and pulse wave velocity (4.9 ± 0.1 m.s−1 to 5.3 ± 0.1 m.s−1; p < 0.0001); 3) increased systolic and diastolic blood pressures as well as heart rate (all p < 0.0001) and finally; 4) raised plasma myeloperoxidase (median [interquartile range]) (13.6 ng.ml−1 [10–17.7] to 18.9 ng.ml−1 [12.2–54.4], p = 0.005). Our findings demonstrated that high temperature e-cigarette vehicle vaporization does not alter micro- and macro-vascular function, and oxidative stress, and that these effects are solely attributable to nicotine.
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Spindle TR, Talih S, Hiler MM, Karaoghlanian N, Halquist MS, Breland AB, Shihadeh A, Eissenberg T. Effects of electronic cigarette liquid solvents propylene glycol and vegetable glycerin on user nicotine delivery, heart rate, subjective effects, and puff topography. Drug Alcohol Depend 2018; 188:193-199. [PMID: 29778773 PMCID: PMC7193252 DOI: 10.1016/j.drugalcdep.2018.03.042] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/18/2018] [Accepted: 03/23/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Electronic cigarettes (ECIGs) are a class of tobacco products that produce different effects (e.g., nicotine delivery), depending on the device, liquid, and behavioral factors. However, the influence of the two primary ECIG liquid solvents, propylene glycol (PG) and vegetable glycerin (VG), on ECIG acute effects is unknown. METHODS Thirty ECIG-experienced, ≥12-h nicotine- abstinent participants completed four conditions consisting of two ECIG-use bouts (10 puffs, 30 s interpuff-interval) differing only by liquid PG:VG ratio (2PG:98VG, 20PG:80VG, 55PG:45VG, 100PG). Device power (7.3 W) and liquid nicotine concentration (18 mg/ml) remained constant. Nicotine delivery, subjective effects, heart rate (HR), and puff topography were assessed. RESULTS In the 100PG condition, participants took shorter and smaller puffs but obtained significantly more nicotine relative to the two VG-based conditions. Total nicotine exposure (i.e., area under the curve) was also significantly higher during use of the two PG-based liquids. However, participants reported that the 100 PG liquid was significantly less "pleasant" and "satisfying" relative to the other liquids (all ps < .05). Increases in HR and decreases in abstinence symptoms (e.g., "craving") did not differ across conditions. CONCLUSIONS PG:VG ratio influenced nicotine delivery, some subjective effects, and puff topography. Lower overall product satisfaction associated with the 100PG liquid suggests factors other than nicotine delivery (e.g., aerosol visibility) may play a role in maintaining ECIG use. Regulating ECIG acute effects such as nicotine delivery and subjective effects may require simultaneous attention to liquid PG:VG ratio as well as device, liquid, and behavioral factors known to influence these outcomes.
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Affiliation(s)
- Tory R Spindle
- Department of Psychology, Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, United States
| | - Soha Talih
- Department of Psychology, Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, United States; Department of Mechanical Engineering, American University of Beirut, Beirut, Lebanon
| | - Marzena M Hiler
- Department of Psychology, Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, United States
| | - Nareg Karaoghlanian
- Department of Psychology, Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, United States; Department of Mechanical Engineering, American University of Beirut, Beirut, Lebanon
| | - Matthew S Halquist
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA, United States
| | - Alison B Breland
- Department of Psychology, Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, United States
| | - Alan Shihadeh
- Department of Psychology, Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, United States; Department of Mechanical Engineering, American University of Beirut, Beirut, Lebanon
| | - Thomas Eissenberg
- Department of Psychology, Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, United States.
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Bowker K, Orton S, Cooper S, Naughton F, Whitemore R, Lewis S, Bauld L, Sinclair L, Coleman T, Dickinson A, Ussher M. Views on and experiences of electronic cigarettes: a qualitative study of women who are pregnant or have recently given birth. BMC Pregnancy Childbirth 2018; 18:233. [PMID: 29902987 PMCID: PMC6003107 DOI: 10.1186/s12884-018-1856-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 05/25/2018] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Electronic cigarettes (ECs) are increasingly used for reducing or stopping smoking, with some studies showing positive outcomes. However, little is known about views on ECs during pregnancy or postpartum and previous studies have nearly all been conducted in the US and have methodological limitations, such as not distinguishing between smokers and ex/non-smokers. A greater understanding of this topic will help to inform both clinicians and EC interventions. We elicited views and experiences of ECs among UK pregnant or recently pregnant women. METHODS We conducted semi-structured telephone interviews, using topic guides, with pregnant or recently pregnant women, who were current or recent ex-smokers. To ensure broad views of ECs were obtained, recruitment was from several geographical locations and via various avenues of recruitment. This included stop smoking services, antenatal and health visitor clinics, a pregnancy website and an informal network. Participants were 15 pregnant and 15 postpartum women, including nine current EC users, 11 ex-users, and 10 never-users. Five women who were interviewed in pregnancy were later interviewed in postpartum to explore if their views had changed. Audio data was transcribed verbatim and framework analysis was applied. RESULTS Five main themes emerged: motivations for use (e.g., for stopping or reducing smoking), social stigma (e.g., avoiding use in public, preferring 'discrete' NRT), using the EC (e.g., mostly used at home); consumer aspects (e.g., limited advice available), and harm perceptions (e.g., viewed as less harmful than smoking; concerns about safety and addiction). CONCLUSIONS ECs were viewed positively by some pregnant and postpartum women and seen as less harmful than smoking and useful as aids for reducing and stopping smoking. However, due to perceived social stigma, some women feel uncomfortable using ECs in public, especially during pregnancy, and had concerns about safety and nicotine dependence. Health professionals and designers of EC interventions need to provide women with up-to-date and consistent information and advice about safety and dependence, as well as considering the influence of social stigma.
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Affiliation(s)
- Katharine Bowker
- NIHR School for Primary Care Research and UK Centre for Tobacco and Alcohol Studies, Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, NG7 2RD UK
| | - Sophie Orton
- NIHR School for Primary Care Research and UK Centre for Tobacco and Alcohol Studies, Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, NG7 2RD UK
| | - Sue Cooper
- NIHR School for Primary Care Research and UK Centre for Tobacco and Alcohol Studies, Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, NG7 2RD UK
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Edith Cavell Building, Norwich, NR4 7TJ UK
| | - Rachel Whitemore
- NIHR School for Primary Care Research and UK Centre for Tobacco and Alcohol Studies, Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, NG7 2RD UK
| | - Sarah Lewis
- Division of Epidemiology and Public Health and UK Centre for Tobacco and Alcohol Studies and, University of Nottingham, Clinical Sciences Building 2, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB UK
| | - Linda Bauld
- Institute for Social Marketing and UK Centre for Tobacco and Alcohol Studies, University of Stirling, Stirling, FK9 4LA UK
| | - Lesley Sinclair
- Institute for Social Marketing and UK Centre for Tobacco and Alcohol Studies, University of Stirling, Stirling, FK9 4LA UK
| | - Tim Coleman
- NIHR School for Primary Care Research and UK Centre for Tobacco and Alcohol Studies, Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, NG7 2RD UK
| | - Anne Dickinson
- NIHR School for Primary Care Research and UK Centre for Tobacco and Alcohol Studies, Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, NG7 2RD UK
| | - Michael Ussher
- Institute for Social Marketing and UK Centre for Tobacco and Alcohol Studies, University of Stirling, Stirling, FK9 4LA UK
- Population Health Research Institute, St George’s, University of London, London, SW17 0RE UK
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106
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Guerrero-Cignarella A, Luna Diaz LV, Balestrini K, Holt G, Mirsaeidi M, Calderon-Candelario R, Whitney P, Salathe M, Campos MA. Differences in vaping topography in relation to adherence to exclusive electronic cigarette use in veterans. PLoS One 2018; 13:e0195896. [PMID: 29694428 PMCID: PMC5919012 DOI: 10.1371/journal.pone.0195896] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 03/26/2018] [Indexed: 11/18/2022] Open
Abstract
Background Understanding vaping patterns of electronic cigarette (EC) use is important to understand the real-life exposure to EC vapor. Long term information on vaping topography in relation to tobacco cigarette (TC) smoking cessation success has not been explored. Methods Observational non-blinded study where active TC smokers were asked to replace TC with EC over 4 weeks (replacement phase, RP) followed by exclusive EC use for an additional 12 weeks (maintenance phase, MP). TC use and EC compliance was monitored weekly. Subjects were classified as success or failure whether or not they completed the protocol. Vaping information was stored and downloaded directly from the EC device and averaged per calendar day for analysis. Results From 25 subjects that followed the protocol, sixteen succeeded in completing the RP and 8 the MP (32%). No significant differences in baseline characteristics were noted between subjects in the success and failure groups including markers of nicotine addiction, plasma cotinine levels or smoking history. Success subjects showed significantly longer puff duration (seconds per vape) and total overall vapor exposure (number of vapes x average vape duration or vape-seconds) in both study phases. Furthermore, subjects in the success group continued to increase the number of vapes, device voltage and wattage significantly as they transitioned into the MP. After an initial drop, subjects in the success group were able to regain plasma cotinine levels comparable to their TC use while subjects in the failure group could not. Cotinine levels significantly correlated with the average number of daily vapes and vapes-seconds, but not with other vaping parameters. Conclusion The topography of smokers who adhere to exclusive EC use reflects a progressive and dynamic device adaptation over weeks to maintain baseline cotinine levels. The higher inhaled volume over time should be considered when addressing the potential toxic effects of EC and the variable EC adherence when addressing public health policies regarding their use.
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Affiliation(s)
- Andrea Guerrero-Cignarella
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States of America
- Miami Veterans Affairs Medical Center, Miami, Florida, United States of America
| | - Landy V. Luna Diaz
- Miami Veterans Affairs Medical Center, Miami, Florida, United States of America
| | - Kira Balestrini
- Miami Veterans Affairs Medical Center, Miami, Florida, United States of America
| | - Gregory Holt
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States of America
- Miami Veterans Affairs Medical Center, Miami, Florida, United States of America
| | - Mehdi Mirsaeidi
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States of America
- Miami Veterans Affairs Medical Center, Miami, Florida, United States of America
| | - Rafael Calderon-Candelario
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States of America
- Miami Veterans Affairs Medical Center, Miami, Florida, United States of America
| | - Philip Whitney
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Matthias Salathe
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Michael A. Campos
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States of America
- Miami Veterans Affairs Medical Center, Miami, Florida, United States of America
- * E-mail:
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McNeill A, Robson D. A man before his time: Russell's insights into nicotine, smoking, treatment and curbing the smoking problem. Addiction 2018; 113:759-763. [PMID: 29139190 DOI: 10.1111/add.14043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 08/21/2017] [Accepted: 09/25/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND AIMS This narrative review aimed to provide a brief overview of five key research 'classics' produced by the innovative and radical thought leader, Professor Michael Anthony Hamilton Russell (1932-2009), drawing upon his other work wherever feasible. METHODS Narrative review. From more than 250 publications, we selected papers we considered seminal texts, published in 1971, 1976, 1978, 1979 and 1991. RESULTS Russell was among the first researchers to explain that smoking was a dependence disorder caused by the drug nicotine decades before this was recognized formally. He therefore saw quickly the importance of delivering nicotine in a less harmful format as a way of controlling nicotine withdrawal when stopping smoking, first studying nicotine gum. In addition to pharmacotherapies, Russell's research also explored the role of behavioural support, particularly the role of general practitioners (GPs), alone as well as supported by specialist clinics; this research underpinned initiatives in England to reimburse doctors for giving advice to smokers, and to provide a national network of smoking cessation services. Research on nicotine uptake from other delivery systems and routes led Russell to theorize that the speed and dose of delivery impacted upon the effectiveness of a product to act as a substitute for smoking. He commented on the addictiveness of the high nicotine boli delivered in quick succession when smoking cigarettes and argued that alternative recreational nicotine delivery systems would need to be promoted actively to smokers in order for them to compete with cigarettes, a forerunner for contemporary debates on electronic cigarettes. CONCLUSIONS The legacy of Russell's landmark research is seen in present-day nicotine science, policy and discourse.
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Affiliation(s)
- Ann McNeill
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, London, UK.,UK Centre for Tobacco & Alcohol Studies, UK
| | - Debbie Robson
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, London, UK.,UK Centre for Tobacco & Alcohol Studies, UK
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108
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Baldassarri SR, Hillmer AT, Anderson JM, Jatlow P, Nabulsi N, Labaree D, Cosgrove KP, O’Malley SS, Eissenberg T, Krishnan-Sarin S, Esterlis I. Use of Electronic Cigarettes Leads to Significant Beta2-Nicotinic Acetylcholine Receptor Occupancy: Evidence From a PET Imaging Study. Nicotine Tob Res 2018; 20:425-433. [PMID: 28460123 PMCID: PMC5896427 DOI: 10.1093/ntr/ntx091] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 04/21/2017] [Indexed: 12/13/2022]
Abstract
Background Electronic cigarettes (ECs) can influence nicotine addiction by delivering aerosolized nicotine. We investigated if nicotine from ECs is delivered to the brain β2*-nicotinic acetylcholine receptors (β2*-nAChR) and how this relates to the behavioral effects and nicotine delivery from cigarettes. Methods Seven nicotine users participated in positron emission tomography (PET) studies with (-)-[18F]Flubatine before and after nicotine challenge with 0, 8, and 36 mg/ml nicotine in a 3.3 Volt, 1.5 Ohm EC or a standard tobacco cigarette. Craving was evaluated before and after product use. Results Average β2*-nAChR occupancy was higher after 36 mg/ml EC challenge compared to 8 mg/ml EC at trend level. Average β2*-nAChR occupancy after tobacco cigarette smoking was 68 ± 18% and was not different compared with 8 mg/ml (64 ± 17%,) or 36 mg/ml (84 ± 3%) nicotine in EC users. Area under the curve (AUC) of blood nicotine level was higher in the cigarette smoking group compared with the 8mg/ml group (p = 0.03), but similar compared with the 36 mg/ml EC (p = 0.29). Drug craving was reduced after use of the tobacco cigarette, 8 mg/ml EC, and 36 mg/ml EC. Conclusions In this novel investigation of EC effects at β2*-nAChRs, we show that average β2*-nAChR occupancy was higher after 36 mg/ml EC challenge compared with 8 mg/ml EC. Receptor occupancy and arterial blood nicotine levels after cigarette smoking were similar to 36 mg/ml EC use under controlled conditions. These findings suggest that the ECs studied here have abuse liability and may provide an adequate alternative nicotine delivery system for cigarette smokers. Implications This is the first study to directly determine the neurologic effects of electronic cigarettes on human brain beta-2 nicotinic acetylcholine receptors using PET neuroimaging with (-)-[18F]Flubatine, a novel radiotracer. Our findings suggest that the e-cigarettes studied here have abuse liability and may provide an adequate alternative nicotine delivery system for cigarette smokers.
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Affiliation(s)
- Stephen R Baldassarri
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT
| | - Ansel T Hillmer
- PET center, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | | | - Peter Jatlow
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT
| | - Nabeel Nabulsi
- PET center, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT
| | - David Labaree
- PET center, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT
| | - Kelly P Cosgrove
- PET center, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | | | - Thomas Eissenberg
- Department of Psychology (Health Program) and Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA
| | | | - Irina Esterlis
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
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Haswell LE, Corke S, Verrastro I, Baxter A, Banerjee A, Adamson J, Jaunky T, Proctor C, Gaça M, Minet E. In vitro RNA-seq-based toxicogenomics assessment shows reduced biological effect of tobacco heating products when compared to cigarette smoke. Sci Rep 2018; 8:1145. [PMID: 29402904 PMCID: PMC5799303 DOI: 10.1038/s41598-018-19627-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 01/05/2018] [Indexed: 12/11/2022] Open
Abstract
The battery of regulatory tests used to evaluate the risk of novel tobacco products such as heated tobacco products (THPs) presents some limitations including a bias towards the apical endpoint tested, and limited information on the mode of action. This is driving a paradigm shift to more holistic systems biology approaches. In this study, we used RNA-sequencing to compare the transcriptomic perturbations following acute exposure of a 3D airway tissue to the aerosols from two commercial THPs and a reference 3R4F cigarette. 2809 RNAs were differentially expressed for the 3R4F treatment and 115 and 2 RNAs for the two THPs (pFDR < 0.05, FC > 1.5), respectively. The relationship between the identified RNA features and gene ontologies were mapped showing a strong association with stress response, xenobiotics metabolism, and COPD-related terms for 3R4F. In contrast, fewer ontologies were found enriched for the THPs aerosols. "Response to wounding" was a common COPD-related term over-represented for the two THPs but at a reduced significance. Quantification of a cytokine panel post-exposure confirmed a pro-inflammatory effect of cigarette smoke but not for THPs. In conclusion, THPs have a reduced impact on gene expression compared to 3R4F.
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Affiliation(s)
- Linsey E Haswell
- British American Tobacco R&D Centre, Regents Park Road, Southampton, SO15 8TL, UK
| | - Sarah Corke
- British American Tobacco R&D Centre, Regents Park Road, Southampton, SO15 8TL, UK
| | - Ivan Verrastro
- British American Tobacco R&D Centre, Regents Park Road, Southampton, SO15 8TL, UK
| | - Andrew Baxter
- British American Tobacco R&D Centre, Regents Park Road, Southampton, SO15 8TL, UK
| | - Anisha Banerjee
- British American Tobacco R&D Centre, Regents Park Road, Southampton, SO15 8TL, UK
| | - Jason Adamson
- British American Tobacco R&D Centre, Regents Park Road, Southampton, SO15 8TL, UK
| | - Tomasz Jaunky
- British American Tobacco R&D Centre, Regents Park Road, Southampton, SO15 8TL, UK
| | - Christopher Proctor
- British American Tobacco R&D Centre, Regents Park Road, Southampton, SO15 8TL, UK
| | - Marianna Gaça
- British American Tobacco R&D Centre, Regents Park Road, Southampton, SO15 8TL, UK
| | - Emmanuel Minet
- British American Tobacco R&D Centre, Regents Park Road, Southampton, SO15 8TL, UK.
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110
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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: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [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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111
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Goldenson NI, Leventhal AM, Stone MD, McConnell RS, Barrington-Trimis JL. Associations of Electronic Cigarette Nicotine Concentration With Subsequent Cigarette Smoking and Vaping Levels in Adolescents. JAMA Pediatr 2017; 171:1192-1199. [PMID: 29059261 PMCID: PMC5779618 DOI: 10.1001/jamapediatrics.2017.3209] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Research indicates that electronic cigarette (e-cigarette) use (vaping) among adolescents is associated with the initiation and progression of combustible cigarette smoking. The reasons for this association are unknown. OBJECTIVE To evaluate whether use of e-cigarettes with higher nicotine concentrations is associated with subsequent increases in the frequency and intensity of combustible cigarette smoking and vaping. DESIGN, SETTING, AND PARTICIPANTS In this prospective cohort study involving students from 10 high schools in the Los Angeles, California, metropolitan area, surveys were administered during 10th grade in the spring (baseline) and 11th grade in the fall (6-month follow-up) of 2015 to students who reported using e-cigarettes within the past 30 days and the nicotine concentration level they used at baseline. EXPOSURES Self-report of baseline e-cigarette nicotine concentration of none (0 mg/mL), low (1-5 mg/mL), medium (6-17 mg/mL), or high (≥18 mg/mL) typically used during the past 30 days. MAIN OUTCOMES AND MEASURES Frequency of combustible cigarette smoking and e-cigarette use within the past 30 days (0 days [none], 1-2 days [infrequent], or ≥3 days [frequent]) and daily intensity of smoking and vaping (number of cigarettes smoked per day, number of vaping episodes per day, and number of puffs per vaping episode) at the 6-month follow-up. RESULTS The analytic sample included 181 students (96 boys [53.0%] and 85 girls [47.0%]; mean [SD] age, 16.1 [0.4] years). Each successive increase in nicotine concentration (none to low, low to medium, and medium to high) vaped was associated with a 2.26 (95% CI, 1.28-3.98) increase in the odds of frequent (vs no) smoking and a 1.65 (95% CI, 1.09-2.51) increase in the odds of frequent (vs no) vaping at follow-up after adjustment for baseline frequency of smoking and vaping and other relevant covariates. Use of e-cigarettes with high (vs no) nicotine concentration was associated with a greater number of cigarettes smoked per day at follow-up (adjusted rate ratio [RR], 7.03; 95% CI, 6.11-7.95). An association with a significantly greater number of vaping episodes per day was found with use of low (adjusted RR, 3.32; 95% CI, 2.61-4.03), medium (adjusted RR, 3.32; 95% CI, 2.54-4.10), and high (adjusted RR, 2.44; 95% CI, 1.63-3.24) nicotine concentrations (vs no nicotine) at baseline. Similar results were found for the number of puffs per vaping episode for low (adjusted RR, 2.05; 95% CI, 1.41-2.70), medium (adjusted RR, 3.39; 95% CI, 2.66-4.11), and high (adjusted RR, 2.23; 95% CI, 1.42-3.03) nicotine concentrations. CONCLUSIONS AND RELEVANCE The results of this study provide preliminary evidence that use of e-cigarettes with higher nicotine concentrations by youths may increase subsequent frequency and intensity of smoking and vaping.
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Affiliation(s)
- Nicholas I. Goldenson
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Adam M. Leventhal
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA,Department of Psychology, University of Southern California, Los Angeles, CA,Corresponding author: Adam M. Leventhal, University of Southern California Keck School of Medicine, 2001 N Soto Street, 3rd Floor 302-C, Los Angeles, CA 90032, Tel: 323-442-2359; Fax: 323-442-2359;
| | - Matthew D. Stone
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Rob S. McConnell
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
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112
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Mantey DS, Cooper MR, Loukas A, Perry CL. E-cigarette Use and Cigarette Smoking Cessation among Texas College Students. Am J Health Behav 2017; 41:750-759. [PMID: 29025503 DOI: 10.5993/ajhb.41.6.9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES We examined the relationships between e-cigarette use and subsequent cigarette smoking behaviors at 6- and 12-month follow-ups among young adults. METHODS Participants were 18-29 year-old current and former cigarette smokers (N = 627) at 24 Texas colleges, participating in a 3-wave study. Multi-level, multivariable logistic regression models, accounting for school clustering, examined the impact of self-reported use of e-cigarettes on cigarette smoking status at 6- and 12-month follow-ups. Two mutually-exclusive groups of e-cigarette users were examined: those that used for cigarette smoking cessation and those that used for reasons other than cessation. Baseline covariates included socio-demographics, past quit attempts, nicotine dependence, cigarettes per day, and other tobacco use. RESULTS Use of e-cigarettes for cigarette smoking cessation was associated with increased odds of cigarette smoking cessation at 6- and 12-month follow-ups, while using e-cigarettes for other reasons was not, when adjusting for covariates. CONCLUSIONS Use of e-cigarettes for cigarette smoking cessation may reduce cigarette smoking rates in young adult college students. Additional research is needed examining e-cigarettes as a complement to evidence-based cessation resources that are associated with cigarette smoking cessation among young adults.
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Affiliation(s)
- Dale S. Mantey
- Tobacco Center of Regulatory Science on Youth and Young Adults, University of Texas School of Public Health, Austin, TX
| | - Maria R. Cooper
- Tobacco Center of Regulatory Science on Youth and Young Adults, University of Texas School of Public Health, Austin, TX
| | | | - Cheryl L. Perry
- Professor and Regional Dean, University of Texas School of Public Health, Austin, TX
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113
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Ramôa CP, Eissenberg T, Sahingur SE. Increasing popularity of waterpipe tobacco smoking and electronic cigarette use: Implications for oral healthcare. J Periodontal Res 2017; 52:813-823. [PMID: 28393367 PMCID: PMC5585021 DOI: 10.1111/jre.12458] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2017] [Indexed: 01/02/2023]
Abstract
Cigarette smoking increases the risk of developing several systemic conditions including cancer, cardiovascular and pulmonary diseases. Cigarette smoking is also detrimental to oral health as it increases the incidence and severity of oral cancer, periodontal diseases and peri-implantitis, as well as impacting negatively on the dental patients' response to therapy. Therefore, consideration of smoking behavior and recommendation of smoking cessation are important parts of dental treatment planning. However, cigarettes are no longer the most popular form of tobacco use among adolescents in the United States and globally. In recent years, tobacco smoking using a waterpipe ("hookah," "shisha") and use of electronic cigarettes (ECIGs) has increased significantly. Thus, dental clinicians likely will treat more patients who are waterpipe and/or ECIG users. Yet, the literature on the health effects of waterpipe and ECIGs use is sparse. Both waterpipe and ECIGs deliver the dependence-producing drug nicotine. Waterpipe tobacco smoking has been associated with periodontitis, dry socket, premalignant lesions, and oral and esophageal cancer. The health effects of long-term ECIG use are unknown. The purpose of this review is to inform healthcare professionals about waterpipes and ECIGs, highlight emerging evidence on the biological effects of these increasingly popular tobacco products, and introduce perspectives for dental patient management and future research.
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Affiliation(s)
| | | | - Sinem Esra Sahingur
- Department of Periodontics, Virginia Commonwealth University
- Philips Institute for Oral Health Research, Virginia Commonwealth University
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114
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Hiler M, Breland A, Spindle T, Maloney S, Lipato T, Karaoghlanian N, Shihadeh A, Lopez A, Ramôa C, Eissenberg T. Electronic cigarette user plasma nicotine concentration, puff topography, heart rate, and subjective effects: Influence of liquid nicotine concentration and user experience. Exp Clin Psychopharmacol 2017; 25:380-392. [PMID: 29048187 PMCID: PMC5657238 DOI: 10.1037/pha0000140] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Electronic cigarette (ECIG) nicotine delivery and other effects may depend on liquid nicotine concentration and user experience. This study is the first to systematically examine the influence of ECIG liquid nicotine concentration and user experience on nicotine delivery, heart rate, puff topography, and subjective effects. Thirty-three ECIG-experienced individuals and 31 ECIG-naïve cigarette smokers completed 4 laboratory conditions consisting of 2, 10-puff bouts (30-sec interpuff interval) with a 3.3-V ECIG battery attached to a 1.5-Ω "cartomizer" (7.3 W) filled with 1 ml ECIG liquid. Conditions differed by liquid nicotine concentration: 0, 8, 18, or 36 mg/ml. Participants' plasma nicotine concentration was directly related to liquid nicotine concentration and dependent on user experience, with significantly higher mean plasma nicotine increases observed in ECIG-experienced individuals relative to ECIG-naïve smokers in each active nicotine condition. When using 36 mg/ml, mean plasma nicotine increase for ECIG-experienced individuals was 17.9 ng/ml (SD = 17.2) and 6.9 (SD = 7.1; p < .05) for ECIG-naïve individuals. Between-group differences were likely due to longer puffs taken by experienced ECIG users: collapsed across condition, mean puff duration was 5.6 sec (SD = 3.0) for ECIG-experienced and 2.9 (SD = 1.5) for ECIG-naïve individuals. ECIG use also suppressed nicotine/tobacco abstinence symptoms in both groups; the magnitude of abstinence symptom suppression depended on liquid nicotine concentration and user experience. These and other recent results suggest that policies intended to limit ECIG nicotine delivery will need to account for factors in addition to liquid nicotine concentration (e.g., device power and user behavior). (PsycINFO Database Record
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Affiliation(s)
- Marzena Hiler
- Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Alison Breland
- Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Tory Spindle
- Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Sarah Maloney
- Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Thokozeni Lipato
- Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, VA,Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA
| | - Nareg Karaoghlanian
- Department of Mechanical Engineering, American University of Beirut, Beirut, Lebanon
| | - Alan Shihadeh
- Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, VA,Department of Mechanical Engineering, American University of Beirut, Beirut, Lebanon
| | - Alexa Lopez
- Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Carolina Ramôa
- Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Thomas Eissenberg
- Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, VA,Department of Mechanical Engineering, American University of Beirut, Beirut, Lebanon
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115
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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] [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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116
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St Helen G, Dempsey DA, Havel CM, Jacob P, Benowitz NL. Impact of e-liquid flavors on nicotine intake and pharmacology of e-cigarettes. Drug Alcohol Depend 2017; 178:391-398. [PMID: 28704768 PMCID: PMC5565733 DOI: 10.1016/j.drugalcdep.2017.05.042] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 05/24/2017] [Accepted: 05/26/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To describe the effect of e-liquid flavors on nicotine intake and pharmacology of e-cigarettes. METHODS 11 males and 3 females participated in a 3-day inpatient crossover study with strawberry, tobacco, and their usual flavor e-liquid. Nicotine levels were nominally 18mg/mL in the strawberry (pH 8.29) and tobacco (pH 9.10) e-liquids and ranged between 3-18mg/mL in the usual brands (mean pH 6.80). Each day consisted of a 15-puff session followed by 4h of abstinence, then 90min of ad libitum use. Subjects used a KangerTech mini ProTank 3. RESULTS After 15 puffs, the amount of nicotine inhaled and systemically retained were not significantly different between the strawberry and tobacco e-liquids but plasma AUC(0→180) was significantly higher with the strawberry e-liquid. While not significantly different, Cmax was 22% higher and various early time point AUCs to measure rate of rise of nicotine in blood ranged between 17 and 23% higher with the strawberry e-liquid compared to the tobacco e-liquid. During ad libitum use, systemic exposure to nicotine (AUC(0→90)) was the same for the tobacco and usual brand e-liquids but were both significantly lower than after using the strawberry e-liquid. The usual flavors were more liked and satisfying than the strawberry and tobacco e-liquids. CONCLUSION Flavors influence nicotine exposure through flavor liking, may affect rate of nicotine absorption possibly through pH effects, and contribute to heart rate acceleration and subjective effects of e-cigarettes. E-cigarette users titrate their nicotine exposure but the extent of titration may vary across flavors.
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Affiliation(s)
- Gideon St Helen
- Division of Clinical Pharmacology and Experimental Therapeutics, Department of Medicine, University of California, San Francisco, CA, USA; Center for Tobacco Control Research and Education, University of California, San Francisco, CA, USA; Tobacco Center of Regulatory Science (TCORS), University of California, San Francisco, CA, USA.
| | - Delia A Dempsey
- Division of Clinical Pharmacology and Experimental Therapeutics, Department of Medicine, University of California, San Francisco, CA, USA
| | - Christopher M Havel
- Division of Clinical Pharmacology and Experimental Therapeutics, Department of Medicine, University of California, San Francisco, CA, USA
| | - Peyton Jacob
- Division of Clinical Pharmacology and Experimental Therapeutics, Department of Medicine, University of California, San Francisco, CA, USA; Center for Tobacco Control Research and Education, University of California, San Francisco, CA, USA; Tobacco Center of Regulatory Science (TCORS), University of California, San Francisco, CA, USA
| | - Neal L Benowitz
- Division of Clinical Pharmacology and Experimental Therapeutics, Department of Medicine, University of California, San Francisco, CA, USA; Center for Tobacco Control Research and Education, University of California, San Francisco, CA, USA; Tobacco Center of Regulatory Science (TCORS), University of California, San Francisco, CA, USA; Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, USA
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117
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Cho JH. The association between electronic-cigarette use and self-reported oral symptoms including cracked or broken teeth and tongue and/or inside-cheek pain among adolescents: A cross-sectional study. PLoS One 2017; 12:e0180506. [PMID: 28700729 PMCID: PMC5507461 DOI: 10.1371/journal.pone.0180506] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 06/18/2017] [Indexed: 12/26/2022] Open
Abstract
Background Little is known about oral health related to electronic-cigarette (EC) use, even though EC use is increasing rapidly. The aim of this study is to assess the relationship between EC use and oral health, including ‘gingival pain and/or bleeding’, ‘tongue and/or inside-cheek pain’, and ‘cracked or broken teeth’ among adolescents. Methods A total of 65,528 students in 2016 were included in this cross-sectional study. Results For EC use, 0.5% (n = 297) students were daily users, 1.9% (n = 1259) were ‘1 to 29 days past month users’, and 5.9% (n = 3848) were former users. Overall, 18.5% students reported they had experienced ‘gingival pain and/or bleeding’, 11.0% reported ‘tongue and/or inside-cheek pain’, and 11.4% reported a ‘cracked or broken tooth’ within the past 12 months. When comparing ‘daily EC users’, ‘1 to 29 days past month EC users’, and ‘former EC users’ with ‘never EC users’, the adjusted ORs for ‘cracked or broken tooth’ were 1.65 (95% CI: 1.19–2.27), 1.26 (95% CI: 1.06–1.51), and 1.16 (95% CI: 1.04–1.30), respectively. Comparing ‘daily EC users’ with ‘never EC users’, the adjusted OR for ‘tongue and/or inside-cheek pain’ was 1.54 (1.05–2.26). However, EC use among adolescents was not associated with ‘gingival pain and/or bleeding’ when adjusted for the potential confounders. Conclusions Based on the results, the odds of cracked or broken teeth among daily, ‘1 to 29 days past month’, and former EC users were significantly higher than those among never EC users. The odds of tongue and/or inside-cheek pain among daily EC users were significantly higher than those among never EC users. In conclusion, the results suggest that daily EC use among adolescents may be a risk factor for cracked or broken teeth and tongue and/or inside-cheek pain.
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Affiliation(s)
- Jun Ho Cho
- Department of Public Health Administration, Hanyang Women’s University, Seoul, Republic of Korea
- * E-mail:
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118
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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] [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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119
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Zucchet A, Schmaltz G. Electronic cigarettes—A review of the physiological health effects. Facets (Ott) 2017. [DOI: 10.1139/facets-2017-0014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Electronic cigarettes (ECs) are devices that are used recreationally or as smoking cessation tools, and have become increasingly popular in recent years. We conducted a review of the available literature to determine the health effects caused by the use of these devices. A heating element in the EC aerosolizes a solution of propylene glycol, glycerol, nicotine (optional), and flavouring (optional). These compounds are generally harmless on their own. However, upon heating, they produce various carcinogens and irritants. We found that concentrations of these toxicants vary significantly depending on the type of EC device, the type of EC liquid, and the smoking behaviour of the user. Exposure to these vapours can cause inflammation and oxidative damage to in vitro and in vivo cells. EC aerosol can also potentially affect organ systems and especially cardiovascular and lung function. We concluded that EC use causes acute effects on health but not as severe as those of conventional cigarettes (CCs). These devices could, therefore, be of use for smokers of CCs wishing to quit. However, as EC aerosol introduces new toxicants not found in CCs, long-term studies are needed to investigate possible chronic effects associated with EC use.
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Affiliation(s)
- Alyssa Zucchet
- Department of Biology, University of the Fraser Valley, Abbotsford, BC V2S 7M8, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Grégory Schmaltz
- Department of Biology, University of the Fraser Valley, Abbotsford, BC V2S 7M8, Canada
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120
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Mantey DS, Harrell MB, Case K, Crook B, Kelder SH, Perry CL. Subjective experiences at first use of cigarette, e-cigarettes, hookah, and cigar products among Texas adolescents. Drug Alcohol Depend 2017; 173:10-16. [PMID: 28182981 PMCID: PMC5432196 DOI: 10.1016/j.drugalcdep.2016.12.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 12/06/2016] [Accepted: 12/10/2016] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Subjective experiences ("SEs") at first cigarette use have been thoroughly examined; however, limited research has examined SEs at first use of non-cigarette products. This study addresses this gap in the literature. METHODS Cross-sectional data from 6th, 8th and 10th grade students in four metropolitan areas of Texas (n=3907/N=461,069). Nausea, coughing, relaxation, rush/buzz, and dizziness at first use were assessed for cigarettes, e-cigarettes, hookah, and cigar products. Chi-square analyses examined differences in the prevalence of first use SEs by product. Weighted multiple logistic regression analyses examined the association of SEs and current product use. Covariates were grade, gender, race/ethnicity, and current other tobacco product use. RESULTS Exploratory factor analysis of SEs determined differing factor structures across tobacco products. For example, the following items loaded onto the positive SE factor: 1) relaxation, rush, and dizziness for cigarettes, and 2) relaxation and rush for e-cigarettes, hookah, and cigar products. Prevalence of negative SEs (coughing and nausea) were higher for cigarette and cigar products compared to e-cigarettes and hookah. Positive SEs for cigarettes were associated with increased odds of current cigarette use (AOR=1.51); similarly positive SEs for cigars were associated with increased odds of current cigar use (AOR=2.11). Feeling nauseous at first use of cigars was associated with decreased odds of current cigar use (AOR=0.18). No SEs were associated with current e-cigarette or hookah use. CONCLUSIONS Subjective experiences at first use differ by tobacco product. Longitudinal studies are needed to examine temporal relationships between SEs at first use and sustained tobacco use.
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Affiliation(s)
- Dale S Mantey
- University of Texas School of Public Health, 1616 Guadalupe St., Suite 6.300, Austin, Texas 78701, USA.
| | - Melissa B Harrell
- University of Texas School of Public Health, 1616 Guadalupe St., Suite 6.300, Austin, Texas 78701, USA
| | - Kathleen Case
- University of Texas School of Public Health, 1616 Guadalupe St., Suite 6.300, Austin, Texas 78701, USA
| | - Brittani Crook
- Center for Health Communication Affiliated Fellow, Moody College of Communication, University of Texas at Austin,300 W. Dean Keeton St., Austin, TX 78712, USA
| | - Steven H Kelder
- University of Texas School of Public Health, 1616 Guadalupe St., Suite 6.300, Austin, Texas 78701, USA
| | - Cheryl L Perry
- University of Texas School of Public Health, 1616 Guadalupe St., Suite 6.300, Austin, Texas 78701, USA
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121
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Glasser AM, Collins L, Pearson JL, Abudayyeh H, Niaura RS, Abrams DB, Villanti AC. Overview of Electronic Nicotine Delivery Systems: A Systematic Review. Am J Prev Med 2017; 52:e33-e66. [PMID: 27914771 PMCID: PMC5253272 DOI: 10.1016/j.amepre.2016.10.036] [Citation(s) in RCA: 320] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 10/07/2016] [Accepted: 10/26/2016] [Indexed: 12/20/2022]
Abstract
CONTEXT Rapid developments in e-cigarettes, or electronic nicotine delivery systems (ENDS), and the evolution of the overall tobacco product marketplace warrant frequent evaluation of the published literature. The purpose of this article is to report updated findings from a comprehensive review of the published scientific literature on ENDS. EVIDENCE ACQUISITION The authors conducted a systematic review of published empirical research literature on ENDS through May 31, 2016, using a detailed search strategy in the PubMed electronic database, expert review, and additional targeted searches. Included studies presented empirical findings and were coded to at least one of nine topics: (1) Product Features; (2) Health Effects; (3) Consumer Perceptions; (4) Patterns of Use; (5) Potential to Induce Dependence; (6) Smoking Cessation; (7) Marketing and Communication; (8) Sales; and (9) Policies; reviews and commentaries were excluded. Data from included studies were extracted by multiple coders (October 2015 to August 2016) into a standardized form and synthesized qualitatively by topic. EVIDENCE SYNTHESIS There were 687 articles included in this systematic review. The majority of studies assessed patterns of ENDS use and consumer perceptions of ENDS, followed by studies examining health effects of vaping and product features. CONCLUSIONS Studies indicate that ENDS are increasing in use, particularly among current smokers, pose substantially less harm to smokers than cigarettes, are being used to reduce/quit smoking, and are widely available. More longitudinal studies and controlled trials are needed to evaluate the impact of ENDS on population-level tobacco use and determine the health effects of longer-term vaping.
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Affiliation(s)
- Allison M Glasser
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia.
| | - Lauren Collins
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Jennifer L Pearson
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Haneen Abudayyeh
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Raymond S Niaura
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - David B Abrams
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - Andrea C Villanti
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Hajek P, Przulj D, Phillips A, Anderson R, McRobbie H. Nicotine delivery to users from cigarettes and from different types of e-cigarettes. Psychopharmacology (Berl) 2017; 234:773-779. [PMID: 28070620 PMCID: PMC5306435 DOI: 10.1007/s00213-016-4512-6] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 12/12/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Delivering nicotine in the way smokers seek is likely to be the key factor in e-cigarette (EC) success in replacing cigarettes. We examined to what degree different types of EC mimic nicotine intake from cigarettes. METHODS Twelve participants ('dual users' of EC and cigarettes) used their own brand cigarette and nine different EC brands. Blood samples were taken at baseline and at 2-min intervals for 10 min and again at 30 min. RESULTS Eleven smokers provided usable data. None of the EC matched cigarettes in nicotine delivery (C max = 17.9 ng/ml, T max = 4 min and AUC0->30 = 315 ng/ml/min). The EC with 48 mg/ml nicotine generated the closest PK profile (C max = 13.6 ng/ml, T max = 4 min, AUC0->30 = 245 ng/ml/min), followed by a third generation EC using 20 mg/ml nicotine (C max = 11.9 ng/ml, T max = 6 min, AUC0->30 = 232 ng/ml/min), followed by the tank system using 20 mg/ml nicotine (C max = 9.9 ng/ml, T max = 6 min, AUC0->30 = 201 ng/ml/min). Cig-a-like PK values were similar, ranging from C max 7.5 to 9.7 ng/ml, T max 4-6 min, and AUC0->30 144 to 173 ng/ml/min. Moderate differences in e-liquid nicotine concentrations had little effect on nicotine delivery, e.g. the EC with 24 mg/ml cartridge had the same PK profile as ECs with 16 mg/ml cartridges. Using similar strength e-liquid, the tank EC provided significantly more nicotine than cig-a-like ECs. CONCLUSIONS EC brands we tested do not deliver nicotine as efficiently as cigarettes, but newer EC products deliver nicotine more efficiently than cig-a-like brands. Moderate variations in nicotine content of e-liquid have little effect on nicotine delivery. Smokers who are finding cig-a-like EC unsatisfactory should be advised to try more advanced systems.
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Affiliation(s)
- Peter Hajek
- Health and Lifestyle Research Unit, Queen Mary University of London, 2 Stayner’s Road, London, E1 4AH UK
| | - Dunja Przulj
- Health and Lifestyle Research Unit, Queen Mary University of London, 2 Stayner’s Road, London, E1 4AH UK
| | - Anna Phillips
- Health and Lifestyle Research Unit, Queen Mary University of London, 2 Stayner's Road, London, E1 4AH, UK.
| | - Rebecca Anderson
- Health and Lifestyle Research Unit, Queen Mary University of London, 2 Stayner’s Road, London, E1 4AH UK
| | - Hayden McRobbie
- Health and Lifestyle Research Unit, Queen Mary University of London, 2 Stayner’s Road, London, E1 4AH UK
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123
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Cox S, Kośmider L, McRobbie H, Goniewicz M, Kimber C, Doig M, Dawkins L. E-cigarette puffing patterns associated with high and low nicotine e-liquid strength: effects on toxicant and carcinogen exposure. BMC Public Health 2016; 16:999. [PMID: 27650300 PMCID: PMC5028920 DOI: 10.1186/s12889-016-3653-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 09/09/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Contrary to intuition, use of lower strength nicotine e-liquids might not offer reduced health risk if compensatory puffing behaviour occurs. Compensatory puffing (e.g. more frequent, longer puffs) or user behaviour (increasing the wattage) can lead to higher temperatures at which glycerine and propylene glycol (solvents used in e-liquids) undergo decomposition to carbonyl compounds, including the carcinogens formaldehyde and acetaldehyde. This study aims to document puffing patterns and user behaviour associated with using high and low strength nicotine e-liquid and associated toxicant/carcinogen exposure in experienced e-cigarette users (known as vapers herein). METHODS/DESIGN A counterbalanced repeated measures design. PARTICIPANTS Non-tobacco smoking vapers; have used an e-cigarette for ≥3 months; currently using nicotine strength e-liquid ≥12mg/mL and a second or third generation device. INTERVENTION This study will measure puffing patterns in vapers whilst they use high and low strength nicotine e-liquid under fixed and user-defined settings, each for a week. The 4 counterbalanced conditions are: i) low strength (6mg/mL), fixed settings; ii) low strength user-defined settings; iii) high strength (18mg/mL) fixed settings; iv) high strength user-defined settings. Biomarkers of exposure to toxicants and carcinogens will be measured in urine. In the second phase of this study, toxicant yields will be measured in aerosol generated using a smoking machine operated to replicate the puffing behaviours of each participant. PRIMARY OUTCOMES i) Puffing patterns (mean puff number, puff duration, inter-puff interval and mL of liquid consumed) and user behaviour (changes to device settings: voltage and air-flow) associated with using high and low strength nicotine e-liquid. ii) Toxicant/carcinogen exposure associated with the puffing patterns/device settings used by our participants. SECONDARY OUTCOMES i) Subjective effects. ii) comparisons with toxicant exposure from tobacco smoke (using documented evidence) and with recommended safety limits. SAMPLE SIZE Twenty participants. DISCUSSION The findings will have important implications for public health messaging regarding the relative risks and subjective effects associated with using high and low strength nicotine e-liquid, and for policy makers regarding regulations on nicotine concentrations in e-liquids.
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Affiliation(s)
- Sharon Cox
- London South Bank University, Division of Psychology, School of Applied Sciences, 103 Borough Rd, London, UK
| | - Leon Kośmider
- Institute of Occupational Medicine and Environmental Health, Koscielna 13 Street, Sosnowiec, Poland
| | - Hayden McRobbie
- Queen Mary University of London, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Charterhouse Square, London, UK
| | - Maciej Goniewicz
- Roswell Park Cancer Institute, Department of Health Behavior, Elm and Carlton Streets, Buffalo, NY 14263 USA
| | - Catherine Kimber
- University of East London, School of Psychology, Waters Lane, London, UK
| | - Mira Doig
- ABS Laboratories Ltd, BioPark, Broadwater Road, Welwyn Garden City, Hertforshire AL7 3AX UK
| | - Lynne Dawkins
- London South Bank University, Division of Psychology, School of Applied Sciences, 103 Borough Rd, London, UK
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