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Erku DA, Kisely S, Morphett K, Steadman KJ, Gartner CE. Framing and scientific uncertainty in nicotine vaping product regulation: An examination of competing narratives among health and medical organisations in the UK, Australia and New Zealand. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 78:102699. [PMID: 32086156 DOI: 10.1016/j.drugpo.2020.102699] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 02/04/2020] [Accepted: 02/07/2020] [Indexed: 01/05/2023]
Abstract
AIMS To compare the policy positions of health and medical organisations across Australia, New Zealand, and the UK as they relate to sale and supply of nicotine vaping products (NVPs) and evaluate factors that have informed the differences in policy recommendations among these countries. METHODS We used mixed methods to analyse data from position or policy statements published by health and medical organisations regarding NVPs (n = 30) and consultation documents submitted to government committees regarding policy options for the regulation of NVPs (n = 26). Quality assessment of included documents was conducted using the six-item Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Text and Opinion Papers, and findings were presented narratively. Qualitative data were coded using NVivo 12 software and analysed using thematic analysis. RESULTS An overwhelming majority of health bodies, charities and government agencies in the UK and New Zealand portrayed NVPs as a life-saving harm reduction tool. In contrast, concerns about addicting non-smoking youth to nicotine, a perceived lack of clear and convincing evidence of safety and efficacy and the potential to undermine tobacco control progress continues to define attitudes and recommendations towards NVPs among Australian health and medical organisations. Although the profoundly divided views among stakeholders seem to arise from empirical uncertainties and disagreements over the level and credibility of evidence, the source of most of these disagreements can be traced back to the fundamental and irreconcilable differences in the framing of the NVP debate, and varied tolerability of risk trade-offs associated with NVPs. CONCLUSION Progress in resolving the controversy surrounding NVP policy requires stakeholders to be frame-reflective and engage in a meaningful dialogue of risk trade-offs, as well as both intended and unintended consequences of proposed policies.
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Affiliation(s)
- Daniel A Erku
- School of Pharmacy, The University of Queensland, 20 Cornwall Street, Woolloongabba 4102, Queensland, Australia.
| | - Steve Kisely
- School of Medicine, University of Queensland, Herston Road, Herston 4006, Queensland, Australia
| | - Kylie Morphett
- School of Public Health, The University of Queensland, Herston Road, Herston 4006, Queensland, Australia
| | - Kathryn J Steadman
- School of Pharmacy, The University of Queensland, 20 Cornwall Street, Woolloongabba 4102, Queensland, Australia
| | - Coral E Gartner
- School of Public Health, The University of Queensland, Herston Road, Herston 4006, Queensland, Australia; Queensland Alliance for Environmental Health Sciences, The University of Queensland, 20 Cornwall Street, Woolloongabba 4102, Queensland, Australia
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Frati G, Carnevale R, Nocella C, Peruzzi M, Marullo AGM, De Falco E, Chimenti I, Cammisotto V, Valenti V, Cavarretta E, Carrizzo A, Versaci F, Vitali M, Protano C, Roever L, Giordano A, Sciarretta S, Biondi-Zoccai G. Profiling the Acute Effects of Modified Risk Products: Evidence from the SUR-VAPES (Sapienza University of Rome-Vascular Assessment of Proatherosclerotic Effects of Smoking) Cluster Study. Curr Atheroscler Rep 2020; 22:8. [PMID: 32034541 DOI: 10.1007/s11883-020-0824-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Giacomo Frati
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 74, 04100, Latina, Italy.
- IRCCS NEUROMED, Pozzilli, Italy.
| | - Roberto Carnevale
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 74, 04100, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Cristina Nocella
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 74, 04100, Latina, Italy
| | - Mariangela Peruzzi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 74, 04100, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Antonino G M Marullo
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 74, 04100, Latina, Italy
| | - Elena De Falco
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 74, 04100, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Isotta Chimenti
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 74, 04100, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Vittoria Cammisotto
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 74, 04100, Latina, Italy
| | | | - Elena Cavarretta
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 74, 04100, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | | | | | - Matteo Vitali
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy
| | - Carmela Protano
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy
| | - Leonardo Roever
- Department of Clinical Research, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - Arturo Giordano
- Interventional Cardiology Unit, Pineta Grande Hospital, Castel Volturno, Italy
| | - Sebastiano Sciarretta
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 74, 04100, Latina, Italy
- IRCCS NEUROMED, Pozzilli, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 74, 04100, Latina, Italy.
- Mediterranea Cardiocentro, Naples, Italy.
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Sidani JE, Colditz JB, Barrett EL, Chu KH, James AE, Primack BA. JUUL on Twitter: Analyzing Tweets About Use of a New Nicotine Delivery System. THE JOURNAL OF SCHOOL HEALTH 2020; 90:135-142. [PMID: 31828791 PMCID: PMC7034811 DOI: 10.1111/josh.12858] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/21/2019] [Accepted: 05/11/2019] [Indexed: 05/14/2023]
Abstract
BACKGROUND Initial reports suggest that JUUL, a popular e-cigarette, is being used in schools and other locations in which cigarette smoking is illegal or discouraged. However, there is little scholarly research documenting this. We aimed to make a systematic analysis of JUUL use themes and sentiment on Twitter. METHODS Data were collected from Twitter's Filtered Streams Application Programming Interface from April 12, 2018 to May 10, 2018. This yielded 67,934 tweets, from which a random sample of 2% was selected for coding. The final dataset included 1209 tweets. Inter-rater reliability ranged κ = 0.64-0.85. RESULTS The majority (71.5%) of tweets expressed positive sentiment toward JUUL. JUUL use in places where cigarette smoking is illegal or discouraged appeared in 111 tweets (9.2%); approximately one-third of these tweets referring to using the device in school. Nearly 20% of tweets mentioned using the device at home and/or directly in front of responsible adults. CONCLUSIONS This study confirms anecdotal reports of JUUL use in places where cigarette smoking is illegal or discouraged. Positive sentiment about use of JUUL suggests that the product is being normalized among young people. It may be valuable for educators to discuss the addictive nature of nicotine delivered through JUUL with younger populations.
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Affiliation(s)
- Jaime E Sidani
- Center for Research on Media, Technology, and Health, University of Pittsburgh School of Medicine, 230 McKee Place, Suite 600, Pittsburgh, PA, 15213
| | - Jason B Colditz
- Center for Research on Media, Technology, and Health, University of Pittsburgh School of Medicine, 230 McKee Place, Suite 600, Pittsburgh, PA, 15213
| | - Erica L Barrett
- Center for Research on Media, Technology, and Health, University of Pittsburgh School of Medicine, 230 McKee Place, Suite 600, Pittsburgh, PA, 15213
| | - Kar-Hai Chu
- Center for Research on Media, Technology, and Health, University of Pittsburgh School of Medicine, 230 McKee Place, Suite 600, Pittsburgh, PA, 15213
| | - A Everette James
- Health Policy Institute, University of Pittsburgh School of Public Health, 130 De Soto Street, Pittsburgh, PA, 15261
| | - Brian A Primack
- University of Arkansas College of Education and Health Professions, 1 University of Arkansas, Fayetteville, AR, 72701
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Association of E-Cigarette Use With Respiratory Disease Among Adults: A Longitudinal Analysis. Am J Prev Med 2020; 58:182-190. [PMID: 31859175 PMCID: PMC6981012 DOI: 10.1016/j.amepre.2019.07.028] [Citation(s) in RCA: 171] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 07/23/2019] [Accepted: 07/24/2019] [Indexed: 01/09/2023]
Abstract
INTRODUCTION E-cigarettes deliver an aerosol of nicotine by heating a liquid and are promoted as an alternative to combustible tobacco. This study determines the longitudinal associations between e-cigarette use and respiratory disease controlling for combustible tobacco use. METHODS This was a longitudinal analysis of the adult Population Assessment of Tobacco and Health Waves 1, 2, and 3. Multivariable logistic regression was performed to determine the associations between e-cigarette use and respiratory disease, controlling for combustible tobacco smoking, demographic, and clinical variables. Data were collected in 2013-2016 and analyzed in 2018-2019. RESULTS Among people who did not report respiratory disease (chronic obstructive pulmonary disease, chronic bronchitis, emphysema, or asthma) at Wave 1, the longitudinal analysis revealed statistically significant associations between former e-cigarette use (AOR=1.31, 95% CI=1.07, 1.60) and current e-cigarette use (AOR=1.29, 95% CI=1.03, 1.61) at Wave 1 and having incident respiratory disease at Waves 2 or 3, controlling for combustible tobacco smoking, demographic, and clinical variables. Current combustible tobacco smoking (AOR=2.56, 95% CI=1.92, 3.41) was also significantly associated with having respiratory disease at Waves 2 or 3. Odds of developing respiratory disease for a current dual user (e-cigarette and all combustible tobacco) were 3.30 compared with a never smoker who never used e-cigarettes. Analysis controlling for cigarette smoking alone yielded similar results. CONCLUSIONS Use of e-cigarettes is an independent risk factor for respiratory disease in addition to combustible tobacco smoking. Dual use, the most common use pattern, is riskier than using either product alone.
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206
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Bozier J, Chivers EK, Chapman DG, Larcombe AN, Bastian NA, Masso-Silva JA, Byun MK, McDonald CF, Crotty Alexander LE, Ween MP. The Evolving Landscape of e-Cigarettes: A Systematic Review of Recent Evidence. Chest 2020; 157:1362-1390. [PMID: 32006591 DOI: 10.1016/j.chest.2019.12.042] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/15/2019] [Accepted: 12/16/2019] [Indexed: 01/12/2023] Open
Abstract
Smoking continues to be a burden to economies and health-care systems across the world. One proposed solution to the problem has been e-cigarettes; however, because they are a relatively new product in the market, little is known about their potential health impacts. Furthermore, e-cigarettes continue to evolve at a rapid rate, making it necessary to regularly review and summarize available studies. Although e-cigarettes are marketed as a smoking cessation tool by some manufacturers, the reality is that many nonsmokers, including youth, are using them. This review focuses on two major demographic groups (smokers and nonsmokers) and evaluates the most recent data (early 2017 to mid 2019) regarding the potential health effects of e-cigarettes. We assessed peer-reviewed studies on the health impacts of e-cigarettes, with a particular focus on common questions asked by policy makers, clinicians, and scientists: (1) What are the effects of e-cigarettes compared with air/not smoking?; (2) Is there any direct evidence of harm or benefit to humans?; (3) Is there a risk from secondhand exposure?; (4) What are the risks and/or benefits of e-cigarettes compared with tobacco cigarette use?; (5) Are there risks or benefits to specific populations (eg, people with COPD or asthma, pregnant women [and their offspring])?; (6) What are the effects of flavoring chemicals?; (7) What are the effects of including nicotine in e-liquids?; (8) How often is nicotine concentration labeling incorrect?; and (9) What are the risks when e-cigarettes explode?
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Affiliation(s)
- Jack Bozier
- School of Life Sciences, University of Technology Sydney, Sydney, NSW, Australia; Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | | | - David G Chapman
- School of Life Sciences, University of Technology Sydney, Sydney, NSW, Australia; Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Alexander N Larcombe
- Telethon Kids Institute, Perth, WA, Australia; School of Public Health, Curtin University, Perth, WA, Australia
| | - Nicole A Bastian
- Discipline of Obstetrics and Gynaecology, School of Medicine, Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - Jorge A Masso-Silva
- Department of Medicine, Division of Pulmonary Critical Care & Sleep, University of California San Diego, San Diego, CA
| | - Min Kwang Byun
- Department of Medicine, Division of Pulmonary Critical Care & Sleep, University of California San Diego, San Diego, CA; Division of Pulmonology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Christine F McDonald
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia; Institute for Breathing and Sleep, Heidelberg, VIC, Australia; School of Medicine, University of Melbourne, VIC, Australia
| | - Laura E Crotty Alexander
- Department of Medicine, Division of Pulmonary Critical Care & Sleep, University of California San Diego, San Diego, CA; Pulmonary Critical Care Section, Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Miranda P Ween
- School of Medicine, University of Adelaide, Adelaide, SA, Australia; Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia.
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Klein WMP, Rothman AJ, Suls J. Bridging Behavioral Science with Cancer Prevention and Control: Contributions of an NCI Working Group (2009-2019). Cancer Prev Res (Phila) 2020; 13:337-342. [PMID: 31969345 DOI: 10.1158/1940-6207.capr-19-0484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/12/2019] [Accepted: 01/16/2020] [Indexed: 11/16/2022]
Abstract
Human behavior plays a central role in cancer-related morbidity and mortality. Much behavior is, in turn, attributable to several core biological, cognitive, emotional, motivational, and interpersonal processes. Understanding the systematic and interactive impact of these processes can inform efforts to address cancer-relevant outcomes such as tobacco use, reliance on cancer misinformation, engagement in genetic testing, adherence to treatment, and acceptance of palliative care. Here, we review efforts of the NCI-supported Cognitive, Affective, and Social Processes in Health Research working group. Since 2009, this group has endeavored to advance the integration of basic behavioral science with cancer prevention and control by addressing topics such as the degree to which behavioral interventions alter cognitions underlying behavior, how technological innovations might facilitate behavioral measurement and intervention in areas such as smoking cessation, whether decision science principles might be applied to genetic testing decisions, how the cognitive effects of chemotherapy impair self-regulation, and the extent to which emotional factors drive palliative care decisions. The group has initiated numerous activities to build capacity for research in these areas including state-of-the-science meetings, written syntheses, conference symposia, and training workshops. We conclude with reflections about future needs as well as how to sustain such integrative efforts.
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208
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Chen T, Gentry S, Qiu D, Deng Y, Notley C, Cheng G, Song F. Online Information on Electronic Cigarettes: Comparative Study of Relevant Websites From Baidu and Google Search Engines. J Med Internet Res 2020; 22:e14725. [PMID: 32012069 PMCID: PMC7007591 DOI: 10.2196/14725] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 10/16/2019] [Accepted: 12/19/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Online information on electronic cigarettes (e-cigarettes) may influence people's perception and use of e-cigarettes. Websites with information on e-cigarettes in the Chinese language have not been systematically assessed. OBJECTIVE The aim of this study was to assess and compare the types and credibility of Web-based information on e-cigarettes identified from Google (in English) and Baidu (in Chinese) search engines. METHODS We used the keywords vaping or e-cigarettes to conduct a search on Google and the equivalent Chinese characters for Baidu. The first 50 unique and relevant websites from each of the two search engines were included in this analysis. The main characteristics of the websites, credibility of the websites, and claims made on the included websites were systematically assessed and compared. RESULTS Compared with websites on Google, more websites on Baidu were owned by manufacturers or retailers (15/50, 30% vs 33/50, 66%; P<.001). None of the Baidu websites, compared to 24% (12/50) of Google websites, were provided by public or health professional institutions. The Baidu websites were more likely to contain e-cigarette advertising (P<.001) and less likely to provide information on health education (P<.001). The overall credibility of the included Baidu websites was lower than that of the Google websites (P<.001). An age restriction warning was shown on all advertising websites from Google (15/15) but only on 10 of the 33 (30%) advertising websites from Baidu (P<.001). Conflicting or unclear health and social claims were common on the included websites. CONCLUSIONS Although conflicting or unclear claims on e-cigarettes were common on websites from both Baidu and Google search engines, there was a lack of online information from public health authorities in China. Unbiased information and evidence-based recommendations on e-cigarettes should be provided by public health authorities to help the public make informed decisions regarding the use of e-cigarettes.
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Affiliation(s)
- Ting Chen
- School of Public Health, Hubei Provincial Key Laboratory of Occupational Hazard Identification & Control, Wuhan University of Science & Technology, Wuhan, China
| | - Sarah Gentry
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Dechao Qiu
- School of Public Health, Hubei Provincial Key Laboratory of Occupational Hazard Identification & Control, Wuhan University of Science & Technology, Wuhan, China
| | - Yan Deng
- School of Public Health, Hubei Provincial Key Laboratory of Occupational Hazard Identification & Control, Wuhan University of Science & Technology, Wuhan, China
| | - Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Guangwen Cheng
- School of Public Health, Hubei Provincial Key Laboratory of Occupational Hazard Identification & Control, Wuhan University of Science & Technology, Wuhan, China
| | - Fujian Song
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
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Stallings-Smith S, Ballantyne T. Ever Use of E-Cigarettes Among Adults in the United States: A Cross-Sectional Study of Sociodemographic Factors. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2020; 56:46958019864479. [PMID: 31328601 PMCID: PMC6647205 DOI: 10.1177/0046958019864479] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
E-cigarette use among adolescents is well-documented, but less is known about adult users of e-cigarettes. The purpose of this study was to examine associations between sociodemographic factors and e-cigarette use in a nationally representative sample of adults in the United States. Cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) for years 2015-2016 were analyzed to assess e-cigarette use among 5989 adults aged ≥18 years. Multivariable logistic regression was conducted to examine associations between the sociodemographic exposures of age, sex, race, marital status, education level, employment status, and poverty-income ratio and the outcome of e-cigarette use. The weighted prevalence of ever use of e-cigarettes was 20%. Compared with adults aged ≥55 years, odds of e-cigarette use were 4.77 times (95% confidence interval [CI] = 3.63-6.27) higher among ages 18 to 34 years and 2.16 times (95% CI = 1.49-3.14) higher among ages 35 to 54 years. Higher odds of e-cigarette use were observed among widowed/divorced/separated participants compared with those who were married/living with a partner, among participants with less than high school (odds ratio [OR] = 1.47; 95% CI = 1.08-2.00) or high school/general educational development (GED) education (OR=1.41; 95% CI = 1.12-1.77) compared with those with college degrees/some college, and among those with incomes below the poverty level (OR=1.31; 95% CI = 1.01-1.69) compared with above the poverty level. For non-smokers of conventional cigarettes, higher odds of e-cigarette use were observed among males compared with females, Mexican Americans/Other Hispanics compared with non-Hispanic whites, and non-working participants compared with those who were working. Overall findings indicate that individuals who are widowed/divorced/separated, individuals with lower education, and with incomes below the poverty level are likely to report ever use of e-cigarettes. As increasing evidence demonstrates negative health consequences, e-cigarette initiation may ultimately contribute to additional smoking-related health inequalities even among non-smokers of conventional cigarettes.
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Warner KE, Mendez D. E-cigarettes: Comparing the Possible Risks of Increasing Smoking Initiation with the Potential Benefits of Increasing Smoking Cessation. Nicotine Tob Res 2020; 21:41-47. [PMID: 29617887 DOI: 10.1093/ntr/nty062] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/28/2018] [Indexed: 02/05/2023]
Abstract
Introduction The public health community is divided regarding electronic cigarettes. Skeptics emphasize potential vaping-induced increases in smoking among children and possible health hazards for adults. Enthusiasts consider e-cigarettes much less dangerous than smoking and believe they increase adult smoking cessation. We compare potential health benefits and costs to put these two perspectives in context. Methods Using a dynamic model that tracks the US adult population's smoking status and smoking-related deaths over time, we simulate the effects of vaping-induced smoking initiation and cessation on life-years saved or lost to the year 2070. The base case assumes that vaping annually increases smoking initiation by 2% and smoking cessation by 10%. Sensitivity analyses raise the initiation rate increase to 6% while decreasing the cessation rate increase to 5%. Sensitivity analyses also test vaping's reducing the health benefits of quitting smoking by 10%. Results With base-case assumptions, the population gains almost 3.3 million life-years by 2070. If all people who quit smoking by vaping lose 10% of the benefit of quitting smoking, the net life-year gain falls to 2.4 million. Under worst-case assumptions, in which vaping increases smoking initiation by 6% and cessation by 5%, and vaping-induced quitters lose 10% of the health benefits, the population gains over 580000 life-years. Conclusion Potential life-years gained as a result of vaping-induced smoking cessation are projected to exceed potential life-years lost due to vaping-induced smoking initiation. These results hold over a wide range of plausible parameters. Implications Our analysis strongly suggests that the upside health benefit associated with e-cigarettes, in terms of their potential to increase adult smoking cessation, exceeds their downside risk to health as a result of their possibly increasing the number of youthful smoking initiators. Public messaging and policy should continue to strive to reduce young people's exposure to all nicotine and tobacco products. But, they should not do so at the expense of limiting such products' potential to help adult smokers to quit.
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Affiliation(s)
- Kenneth E Warner
- Department of Health Management and Policy School of Public Health, University of Michigan, Washington Heights, Ann Arbor, MI, USA
| | - David Mendez
- Department of Health Management and Policy School of Public Health, University of Michigan, Washington Heights, Ann Arbor, MI, USA
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212
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Munafò MR, West R. E-cigarette research needs to adopt open science practices to improve quality. Addiction 2020; 115:3-4. [PMID: 31301681 DOI: 10.1111/add.14749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/25/2019] [Accepted: 07/08/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Marcus R Munafò
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Robert West
- Department of Behavioural Science and Health, University College London, London, UK
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Kale D, Pickering A, Cooper A. Examining the Psychometric Properties of the CEAC (Comparing e-Cigarette and Cigarette) Questionnaire and Its Usefulness as a Predictor of e-Cigarette Use. Subst Use Misuse 2020; 55:147-155. [PMID: 31474172 DOI: 10.1080/10826084.2019.1657897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Electronic cigarette (e-cigarette) use continues to rise, while there is conflicting evidence about the health effects of its use. As such, research is needed to better determine risks factors for e-cigarette use. Accumulating evidence suggests that attitudes toward e-cigarette use could be a potential risk factor for e-cigarette use. Objectives: This study sought to examine the psychometric properties of the Comparing E-cigarette And Cigarette questionnaire (CEAC), and to replicate a structural model of the relationship between impulsive-related personality traits and e-cigarette use mediated by positive attitudes toward e-cigarettes. Methods: Participants were 525 adults (mean age = 33.42, SD = 11.27) who completed the CEAC and UPPS-P (trait impulsivity) questionnaires online. Results: Confirmatory factor analysis of the CEAC replicated the a priori factor structure of the questionnaire reasonably well (χ2(df = 32) =172.85, CFI = 0.94, TLI = 0.91, RMSEA = 0.09 (0.08-0.11, 90% Confidence Interval, SRMR = 0.06). Structural path analysis showed that deficits in conscientiousness was significantly negatively related to e-cigarette attitudes (β = -0.20, p = .01), while urgency (β = 0.19, p = .018) showed a significant positive relationship to e-cigarette attitudes. E-cigarette users showed significantly more positive attitudes toward e-cigarettes than nonusers (β = 0.59, p < .001). No significant direct effects were found between impulsivity-related traits and e-cigarette use. Conclusions: The present study suggests that impulsivity-related traits and attitudes toward e-cigarettes are likely to be important risk factors for e-cigarette use. Future prospective and experimental studies should test if the causal model described in this study predicts risk for e-cigarette use, and whether this model could therefore be used to guide strategies for reducing risk for e-cigarette use.
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A Comparison of Flavorless Electronic Cigarette-Generated Aerosol and Conventional Cigarette Smoke on the Planktonic Growth of Common Oral Commensal Streptococci. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16245004. [PMID: 31835369 PMCID: PMC6949915 DOI: 10.3390/ijerph16245004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/05/2019] [Accepted: 12/06/2019] [Indexed: 02/07/2023]
Abstract
Background: Smoking is the number one predictor for the development of periodontal disease. Consequently, electronic cigarette (ECIG) use has prompted investigations into the health-related risks induced by ECIG-generated aerosol on oral commensal bacteria as compared to cigarette smoke. Since E-liquid contains fewer constituents than smoke, we hypothesize that growth media containing E-liquid or aerosol has less impact on oral commensal streptococci than cigarette smoke. Methods: Eight-hour growth curves were generated for three strains of streptococci following exposure of growth media to nicotine alone (0.05, 0.1, 0.2 mg/mL), E-liquid ± nicotine (2.3, 4.7, 7.0 µL/mL), ECIG-generated aerosol ± nicotine (25, 50, 75 puffs), or cigarette smoke (2, 5, 10, 25, 50, 75 puffs). Nicotine and E-liquid were added to the media at concentrations equivalent to vaporized amounts of 25, 50, or 75 puffs. Absorbance readings were taken at 0, 2, 4, 6, and 8 h of bacterial growth. Results: Both E-liquid and aerosol (±nicotine) had little to no effect on eight-hour streptococcal growth. In contrast, five puffs of smoke inhibited streptococcal growth. Conclusions: Smoke-treated growth media, but not E-liquid or ECIG-generated aerosol, inhibits the growth of oral commensal streptococci. A possible implication is that aerosol may induce less periodontitis than smoke.
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215
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Liu J, Siegel L, Gibson LA, Kim Y, Binns S, Emery S, Hornik RC. Toward an Aggregate, Implicit, and Dynamic Model of Norm Formation: Capturing Large-Scale Media Representations of Dynamic Descriptive Norms Through Automated and Crowdsourced Content Analysis. THE JOURNAL OF COMMUNICATION 2019; 69:563-588. [PMID: 31956275 PMCID: PMC6954383 DOI: 10.1093/joc/jqz033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 08/07/2019] [Accepted: 08/10/2019] [Indexed: 05/03/2023]
Abstract
Media content can shape people's descriptive norm perceptions by presenting either population-level prevalence information or descriptions of individuals' behaviors. Supervised machine learning and crowdsourcing can be combined to answer new, theoretical questions about the ways in which normative perceptions form and evolve through repeated, incidental exposure to normative mentions emanating from the media environment. Applying these methods, this study describes tobacco and e-cigarette norm prevalence and trends over 37 months through an examination of a census of 135,764 long-form media texts, 12,262 popular YouTube videos, and 75,322,911 tweets. Long-form texts mentioned tobacco population norms (4-5%) proportionately less often than e-cigarette population norms (20%). Individual use norms were common across sources, particularly YouTube (tobacco long-form: 34%; Twitter: 33%; YouTube: 88%; e-cigarette long form: 17%; Twitter: 16%; YouTube: 96%). The capacity to capture aggregated prevalence and temporal dynamics of normative media content permits asking population-level media effects questions that would otherwise be infeasible to address.
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Affiliation(s)
- Jiaying Liu
- Department of Communication Studies, University of Georgia, Athens, GA 30602, USA
| | - Leeann Siegel
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Laura A Gibson
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA 19104, USA
- Perelman School of Medicine, University of Penns ylvania, Philadelphia, PA 19104, USA
| | - Yoonsang Kim
- Social Data Collaboratory, NORC at the University of Chicago, Chicago, IL 60603, USA
| | - Steven Binns
- Social Data Collaboratory, NORC at the University of Chicago, Chicago, IL 60603, USA
| | - Sherry Emery
- Social Data Collaboratory, NORC at the University of Chicago, Chicago, IL 60603, USA
| | - Robert C Hornik
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA 19104, USA
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216
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Corpuz KA, Dela Cruz MRI. Rates of Current Tobacco and Electronic Smoking Device Use Among Filipinos in Hawai'i. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2019; 78:359-364. [PMID: 31886467 PMCID: PMC6911778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Tobacco use continues to damage the health of Filipinos. In Hawai'i, Filipinos have the second highest rate of smoking among adults and they are the fastest growing minority population. Electronic smoking devices are becoming popular and accessible. This study explored attitudes and practices of Filipinos in Hawai'i who use electronic smoking devices (ESDs), as well their knowledge of the effect of smoking and/or vaping on health and their awareness and motivations use smoking cessation programs. A convenience sample of 178 Filipinos who reported that they smoked and/or vaped responded to the online survey from January to March 2018. Reasons for starting to use ESDs included liking the different flavors (43%), being curious about vaping (38%), and viewing vaping as healthier than cigarettes (30%). Among respondents, 12% said they would like to quit smoking and 11% wanted to quit vaping, and very few felt that smoking and/or vaping behaviors impacted their health. They also demonstrated limited knowledge of cessation methods and products. Tobacco and vaping cessation programs for the Filipino community in Hawai'i are much needed because this population is at risk of developing smoking-related diseases.
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Affiliation(s)
- Kathleen A. Corpuz
- Kathleen A. Corpuz BA; Department of Asian American Studies and Community Health Sciences, University of California, Los Angeles;
| | - May Rose I. Dela Cruz
- Office of Public Health Sciences, University of Hawai‘i at Manoa, Honolulu, HI (MRIDC)
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217
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Maziak W. E-cigarettes: harm reduction or rehabilitation of the tobacco industry? Int J Public Health 2019; 65:159-161. [PMID: 31786625 DOI: 10.1007/s00038-019-01316-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 10/30/2019] [Accepted: 11/21/2019] [Indexed: 10/25/2022] Open
Affiliation(s)
- Wasim Maziak
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, 33199, USA.
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218
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AlQahtany FS, Algahtani FH, Alshebly MM, Madkhaly FM, Ghandour MK, Almalki JH, AlOtaibi WS, Salim A, Mendoza FC. Association between cigarette & shisha smoking and the severity of polycythemia: A cross sectional study. Saudi J Biol Sci 2019; 27:460-464. [PMID: 31889871 PMCID: PMC6933157 DOI: 10.1016/j.sjbs.2019.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/11/2019] [Accepted: 11/12/2019] [Indexed: 11/20/2022] Open
Abstract
Tobacco cigarette smoking is assumed to be a key reason of death all over the world. Smoking had both severe as well long-lasting effects on hematological constraints. As per the data available from World Health Organization, every year nearly 5 million individuals die around the world due to the diseases triggered by smoking. Cigarette smoking is linked with an elevated risk of cardiovascular diseases. To examine the association between shisha or cigarette smoking and the severity of polycythemia, present study is a cross-sectional organized at King Saud University Medical City during the period from October 2017 to April 2018. Participants were patients who have hemoglobin level above 160 g/L on multiple reading in KSUMC between May 2015-February 2018. The sample size (227 patients) was computed on single proportion formula, Data were collected through questionnaires and from medical record of the patients. A pilot study was conducted to evaluate the validity of the questionnaire. A statistical analysis was performed using SPSS 21.0 version. A p-value of ≤ 0.05 considered as statistically significant. Out of 227 study subjects, 86 (37.8%) were smokers, (61.6%) were cigarette smokers while (29%), shisha smokers. Total (9.3%) were smoking both cigarette and Shisha. 29% patients had high normal hemoglobin between the ranges of (160-168 g/L), 17.6% patients had pre-polycythemic hemoglobin between the range of (169-171 g/L) and 53% patients were having polycythemic hemoglobin (>172 g/L). The hemoglobin level in non-smokers was 168.74 g/L, hemoglobin level in cigarette smokers was170.7 g/L, hemoglobin level in shisha smokers was 171.4 g/L while hemoglobin level in those who smokes both cigarette and shisha was 175 g/L. Smoking has adverse effects on hemoglobin. Shisha or cigarette Smoking is associated with increase in the hemoglobin levels and the severity of polycythemia. The findings may help in raising the awareness of tobacco smokers.
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Affiliation(s)
- Fatmah S. AlQahtany
- Department of Pathology, Hematopathology Unit, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
- Corresponding author.
| | - Farjah H. Algahtani
- Department of Medicine, Division of Oncology/Hematology, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Mashael M. Alshebly
- Department of Obstetrics and Gynecology, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Fatimah M. Madkhaly
- Hematopathology Resident, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Mohammed K. Ghandour
- College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Jawhara H. Almalki
- College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Wadha S. AlOtaibi
- College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Asrar Salim
- College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Farrah C. Mendoza
- College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
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219
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Chyderiotis S, Spilka S, Beck F. [Use of electronic cigarette in France among adolescents aged 17: Results from the ESCAPAD 2017 survey]. Bull Cancer 2019; 106:1132-1143. [PMID: 31732122 DOI: 10.1016/j.bulcan.2019.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/07/2019] [Accepted: 06/20/2019] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The use of electronic cigarettes has become relatively popular in France since 2010, including among adolescents. However, its use in relation to smoking and other factors is not well understood today. METHODS The data come from the ESCAPAD 2017 survey, a nationally representative cross-sectional survey taking place at a 1-day session of civic and military information compulsory for all French nationals around 17 (39,115 respondents). Descriptive analyses and multivariate regressions were undertaken to describe the recent use of e-cigarette at 17 and its associated factors. RESULTS e-cigarettes were experimented by 52.4 % of 17 year-olds, and used by 16.8 % in the preceding month, 1.9 % daily. Most recent users were also daily smokers (62.5 %), and only 7.6 % had never experimented cigarettes before. Among those who experimented with both products, only 13.3 % tried e-cigarettes before cigarettes. The associated uses of other products were the most striking factors: daily smoking (relative risk [RR]=2.73), ever use of hookah (RR=2.31), cannabis use in the last year (RR=1.60), regular alcohol drinking (RR=1.20) and ever use of another illicit drug (RR=1.11). Recent vapers that were also daily smokers had a more pronounced sociodemographic profile and a higher level of other drugs consumptions than recent vapers only. DISCUSSION Although a majority of French adolescents experiment with vaping, they are fewer to use it regularly and its current use is frequently associated with daily smoking. Future trends and the relationship between smoking and vaping among adolescents will have to be further investigated, including the motivations of its use.
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Affiliation(s)
- Sandra Chyderiotis
- Université Paris-Sud, Université Paris-Saclay, CESP, faculté de médecine, faculté de médecine UVSQ, Inserm, 92541 Villejuif, France; Observatoire français des drogues et des toxicomanies (OFDT), 69, rue de Varenne, 75007 Paris, France.
| | - Stanislas Spilka
- Université Paris-Sud, Université Paris-Saclay, CESP, faculté de médecine, faculté de médecine UVSQ, Inserm, 92541 Villejuif, France; Observatoire français des drogues et des toxicomanies (OFDT), 69, rue de Varenne, 75007 Paris, France
| | - François Beck
- Université Paris-Sud, Université Paris-Saclay, CESP, faculté de médecine, faculté de médecine UVSQ, Inserm, 92541 Villejuif, France; Institut national de la statistique et des études économiques, 88, avenue Verdier, CS 70058, 92541 Montrouge cedex, France
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220
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Pericot-Valverde I, Elliott RJ, Priest JS, Barret T, Yoon JH, Miller CC, Okoli CTC, Haliwa I, Ades PA, Gaalema DE. Patterns of tobacco use among smokers prior to hospitalization for an acute cardiac event: Use of combusted and non-combusted products. Prev Med 2019; 128:105757. [PMID: 31254538 PMCID: PMC7248643 DOI: 10.1016/j.ypmed.2019.105757] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/30/2019] [Accepted: 06/21/2019] [Indexed: 10/26/2022]
Abstract
Use of tobacco products before or after a cardiac event increases risk of morbidity and mortality. Unlike cigarette smoking, which is generally screened in the healthcare system, identifying the use of other tobacco products remains virtually unexplored. This study aimed at characterizing the use of other non-combusted tobacco products in addition to combusted products among cardiac patients and identifying a profile of patients who are more likely to use non-combusted products. Patients (N = 168) hospitalized for a coronary event who reported being current cigarette smokers completed a survey querying sociodemographics, cardiac diagnoses, use of other tobacco products, and perceptions towards these products. Classification and regression tree (CART) analysis was used to identify which interrelationships of participants characteristics led to profiles of smoking cardiac patients more likely to also be using non-combusted tobacco products. Results showed that non-combusted tobacco product use ranged from 0% to 47% depending on patient characteristic combinations. Younger age and lower perception that cigarette smoking is responsible for their cardiac condition were the strongest predictive factors for use of non-combusted products. Tobacco product use among cardiac patients extends beyond combusted products (13.7% non-combusted product use), and consequently, screening in health care settings should be expanded to encompass other tobacco product use. This study also characterizes patients likely to be using non-combusted products in addition to combusted, a group at high-risk due to their multiple product use, but also a group that may be amenable to harm reduction approaches and evidence-based tobacco treatment strategies.
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Affiliation(s)
- Irene Pericot-Valverde
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America; Departments of Psychiatry, University of Vermont, Burlington, VT, United States of America; School of Health Research, Clemson University, Greenville, SC, United States of America.
| | - Rebecca J Elliott
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America; Departments of Psychiatry, University of Vermont, Burlington, VT, United States of America
| | - Jeff S Priest
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America; Biostatistical Unit, University of Vermont, Burlington, VT, United States of America
| | - Trace Barret
- Division of Cardiology, University of Vermont, Burlington, VT, United States of America
| | - Jin H Yoon
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science at Houston, Houston, TX, United States of America
| | - Charles C Miller
- Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science at Houston, Houston, TX, United States of America
| | - Chizimuzo T C Okoli
- College of Nursing, University of Kentucky, Lexington, KY, United States of America
| | - Ilana Haliwa
- Department of Behavioral Neuroscience, West Virginia University, Morgantown, WV, United States of America
| | - Philip A Ades
- Division of Cardiology, University of Vermont, Burlington, VT, United States of America
| | - Diann E Gaalema
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America; Departments of Psychiatry, University of Vermont, Burlington, VT, United States of America
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221
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Pike JR, Tan N, Miller S, Cappelli C, Xie B, Stacy AW. The Effect of E-cigarette Commercials on Youth Smoking: A Prospective Study. Am J Health Behav 2019; 43:1103-1118. [PMID: 31662169 PMCID: PMC6824286 DOI: 10.5993/ajhb.43.6.8] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: In this study, we assessed whether commercials for electronic cigarettes (e-cigarettes) influence the use of e-cigarettes, cigarettes, and cigars among high-risk youth in southern California. Methods: We recruited students (N = 1060) from 29 alternative high schools into a prospective cohort study. We used multilevel Poisson regression models to examine whether exposure to e-cigarette commercials and perceptions of their appeal predicted increased use of e-cigarettes, cigarettes, and cigars one year later. We also tested the potential moderating effect of gender and ethnicity. Results: Models with and without covariates suggest that exposure to e-cigarette commercials is a statistically significant predictor of increased use of e-cigarettes. When gender was added to the models as a moderator, the relationships between commercial exposure and future use of e-cigarettes and cigars were found to be stronger among females. Unadjusted and adjusted models also indicated that students with favorable perceptions of e-cigarette commercials reported greater use of e-cigarettes, cigarettes, and cigars one year later. Conclusions: E-cigarette commercials may play an important role in persuading high-risk youth to use nicotine and tobacco products. Extending the Broadcast Advertising Ban of 1971 to include a broader range of products may be critical to preventing future generations from becoming addicted to nicotine.
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Affiliation(s)
- James Russell Pike
- James Russell Pike, School of Community and Global Health, Claremont Graduate University, Claremont, CA;,
| | - Nasya Tan
- Nasya Tan, School of Community and Global Health, Claremont Graduate University, Claremont, CA
| | - Stephen Miller
- Stephen Miller, School of Community and Global Health, Claremont Graduate University, Claremont, CA
| | - Christopher Cappelli
- Christopher Cappelli, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Bin Xie
- Bin Xie, School of Community and Global Health, Claremont Graduate University, Claremont, CA
| | - Alan W Stacy
- Alan W Stacy, School of Community and Global Health, Claremont Graduate University, Claremont, CA
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222
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Lin J, Zhu K, Hoang PK, Soliván-Ortiz AM, Larsen SL, Irwin SP, Schneid TR, Shriver CD, Lee S. Electronic Cigarette Use and Related Factors among Active Duty Service Members in the U.S. Military. Mil Med 2019; 185:418-427. [DOI: 10.1093/milmed/usz267] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Electronic cigarettes (e-cigarettes) are increasingly used in the U.S.A. by young people. As young adults serve as the primary recruiting pool for military, active duty service members in military may be susceptible to using e-cigarettes. However, factors related to e-cigarette use in military population have rarely been studied. We aimed to identify factors associated with e-cigarette use and factors related to duration of use among active duty service members.
Materials and Methods
Subjects (N = 2,467) from Fort Bragg Army Base, North Carolina and Lackland Air Force Base, Texas completed a self-administered questionnaire during July 2015 to May 2016 time frame. The questionnaire collected data on demographic and military characteristics, tobacco use (including e-cigarette use) and other information. Stepwise logistic regression was performed to identify significant factors associated with e-cigarette use. Stepwise linear regression was performed to identify factors associated with duration of use.
Results
A total of 356 (14.4%) study participants reported ever use of e-cigarettes. There was no significant difference in prevalence of use between the two military installations (15.6% at Fort Bragg vs. 13.2% at Lackland, P = 0.097). Increased use of e-cigarettes was associated with young age (20–24 years old) (OR = 1.98, 95% CI = 1.22–3.22), enlisted military rank (E1–E4: OR = 2.45, 95% CI = 1.36–4.40; E5–E9: OR = 1.88, 95% CI = 1.10–3.21), low perception of harm (OR = 5.18, 95% CI = 3.65–7.34), former (OR = 9.12, 95% CI = 6.29–13.22) and current (OR = 13.24, 95% CI = 9.22–19.02) cigarette smoking, and former smokeless tobacco use (OR = 2.07, 95% CI = 1.33–3.22), former (OR = 2.62, 95% CI = 1.42–4.85) and current (OR = 2.82, 95% CI = 1.82–4.37) cigar or pipe smoking. However, serving mainly in combat unit during deployment was associated with decreased odds of use (OR = 0.57, 95% CI = 0.34–0.97). Among e-cigarette users, the number of years using e-cigarettes was significantly longer among the participants with lower perception of harm than those with higher perception of harm (0.82 vs. 0.22, P < 0.001), and the duration was longer among subjects who used e-cigarette with nicotine than those without nicotine (0.79 vs. 0.49, P = 0.003). Finally, reasons for use differed markedly by cigarette smoking status. Never smokers used e-cigarette for the taste or flavor, while cigarette smokers used e-cigarette to help quit tobacco or reduce tobacco use.
Conclusion
Young age, lower military ranks, other tobacco use, and low perception of harm were associated with increased odds of using e-cigarettes, while serving in combat unit was associated with decreased odds of use in active duty service members. Low harm perception and using nicotine-containing e-cigarettes were associated with long duration of use. The reasons for using e-cigarettes differed by cigarette smoking status. Our study provides clues for future hypothesis-driven studies.
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Affiliation(s)
- Jie Lin
- Murtha Cancer Center Research Program, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817
| | - Kangmin Zhu
- Murtha Cancer Center Research Program, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
| | - Paula K Hoang
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
| | - Aida M Soliván-Ortiz
- Postgraduate Dental College, Uniformed Services University of the Health Sciences, San Antonio, TX 78236
| | - Stacy L Larsen
- Postgraduate Dental College, Uniformed Services University of the Health Sciences, Fort Bragg, NC 28310
| | - Scott P Irwin
- Postgraduate Dental College, Uniformed Services University of the Health Sciences, San Antonio, TX 78236
| | - Thomas R Schneid
- Postgraduate Dental College, Uniformed Services University of the Health Sciences, Fort Sam Houston, TX 78234
| | - Craig D Shriver
- Murtha Cancer Center Research Program, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
| | - Sukhyung Lee
- Murtha Cancer Center Research Program, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
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223
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Tang MS, Wu XR, Lee HW, Xia Y, Deng FM, Moreira AL, Chen LC, Huang WC, Lepor H. Electronic-cigarette smoke induces lung adenocarcinoma and bladder urothelial hyperplasia in mice. Proc Natl Acad Sci U S A 2019; 116:21727-21731. [PMID: 31591243 PMCID: PMC6815158 DOI: 10.1073/pnas.1911321116] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Electronic-cigarettes (E-cigs) are marketed as a safe alternative to tobacco to deliver the stimulant nicotine, and their use is gaining in popularity, particularly among the younger population. We recently showed that mice exposed to short-term (12 wk) E-cig smoke (ECS) sustained extensive DNA damage in lungs, heart, and bladder mucosa and diminished DNA repair in lungs. Nicotine and its nitrosation product, nicotine-derived nitrosamine ketone, cause the same deleterious effects in human lung epithelial and bladder urothelial cells. These findings raise the possibility that ECS is a lung and bladder carcinogen in addition to nicotine. Given the fact that E-cig use has become popular in the past decade, epidemiological data on the relationship between ECS and human cancer may not be known for a decade to come. In this study, the carcinogenicity of ECS was tested in mice. We found that mice exposed to ECS for 54 wk developed lung adenocarcinomas (9 of 40 mice, 22.5%) and bladder urothelial hyperplasia (23 of 40 mice, 57.5%). These lesions were extremely rare in mice exposed to vehicle control or filtered air. Current observations that ECS induces lung adenocarcinomas and bladder urothelial hyperplasia, combined with our previous findings that ECS induces DNA damage in the lungs and bladder and inhibits DNA repair in lung tissues, implicate ECS as a lung and potential bladder carcinogen in mice. While it is well established that tobacco smoke poses a huge threat to human health, whether ECS poses any threat to humans is not yet known and warrants careful investigation.
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Affiliation(s)
- Moon-Shong Tang
- Department of Environmental Medicine, New York University School of Medicine, New York, NY 10010;
- Department of Medicine, New York University School of Medicine, New York, NY 10010
- Department of Pathology, New York University School of Medicine, New York, NY 10010
| | - Xue-Ru Wu
- Department of Pathology, New York University School of Medicine, New York, NY 10010
- Department of Urology, New York University School of Medicine, New York, NY 10010
| | - Hyun-Wook Lee
- Department of Environmental Medicine, New York University School of Medicine, New York, NY 10010
| | - Yong Xia
- Department of Urology, New York University School of Medicine, New York, NY 10010
| | - Fang-Ming Deng
- Department of Pathology, New York University School of Medicine, New York, NY 10010
| | - Andre L Moreira
- Department of Pathology, New York University School of Medicine, New York, NY 10010
| | - Lung-Chi Chen
- Department of Environmental Medicine, New York University School of Medicine, New York, NY 10010
| | - William C Huang
- Department of Urology, New York University School of Medicine, New York, NY 10010
| | - Herbert Lepor
- Department of Urology, New York University School of Medicine, New York, NY 10010
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Breland A, McCubbin A, Ashford K. Electronic nicotine delivery systems and pregnancy: Recent research on perceptions, cessation, and toxicant delivery. Birth Defects Res 2019; 111:1284-1293. [PMID: 31364280 PMCID: PMC7121906 DOI: 10.1002/bdr2.1561] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 01/09/2023]
Abstract
Electronic nicotine delivery systems (ENDS), which includes e-cigarettes (ECIGs), are a rapidly-expanding class of products that heat a liquid (which may or may not contain nicotine) to produce an aerosol. The variation of ECIG components is extensive as are their effects on users. Epidemiological data show that while both adults and youth use ECIGs, use among youth has increased dramatically in recent years. Other epidemiological data show that women of reproductive age and some pregnant women are also using ECIGs. The goal of this article is to provide readers with background information about ECIGs, with a focus on recent findings about ECIG use in pregnancy and potential implications. Among pregnant women, correlates of ECIG use include current cigarette smoking, among other factors. Regarding pregnant women's perceptions of ECIG use in pregnancy, two themes emerge from the literature: many pregnant women perceive ECIGs to be safer than conventional cigarettes, and that ECIGs can aid with smoking cessation. In contrast to these perceptions, there is little concrete evidence that ECIGs help smokers quit. In addition, there are concerns about ECIG nicotine and other toxicant delivery. Nicotine is a toxicant of particular concern for pregnant women, as nicotine is known to harm a developing fetus. There are many limitations to existing research, and the literature is scant in this area. Further, new "pod mod"-style ECIGs such as JUUL present new challenges. Overall, with limited evidence of their effectiveness, and concerns about developmental toxicology, the authors do not recommend that pregnant women use ECIGs.
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Affiliation(s)
- Alison Breland
- Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Andrea McCubbin
- Perinatal Research and Wellness Center, College of Nursing, University of Kentucky, Lexington, Kentucky
| | - Kristin Ashford
- Perinatal Research and Wellness Center, College of Nursing, University of Kentucky, Lexington, Kentucky
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225
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Modeling drug exposure in rodents using e-cigarettes and other electronic nicotine delivery systems. J Neurosci Methods 2019; 330:108458. [PMID: 31614162 DOI: 10.1016/j.jneumeth.2019.108458] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 10/05/2019] [Accepted: 10/06/2019] [Indexed: 12/25/2022]
Abstract
Smoking tobacco products is the leading cause of preventable death worldwide. Coordinated efforts have successfully reduced tobacco cigarette smoking in the United States; however, electronic cigarettes (e-cigarette) and other electronic nicotine delivery systems (ENDS) recently have replaced traditional cigarettes for many users. While the clinical risks associated with long-term ENDS use remain unclear, advancements in preclinical rodent models will enhance our understanding of their overall health effects. This review examines the peripheral and central effects of ENDS-mediated exposure to nicotine and other drugs of abuse in rodents and evaluates current techniques for implementing ENDS in preclinical research.
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Palmer AM, Brandon TH. Nicotine or expectancies? Using the balanced-placebo design to test immediate outcomes of vaping. Addict Behav 2019; 97:90-96. [PMID: 31174168 DOI: 10.1016/j.addbeh.2019.04.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/23/2019] [Accepted: 04/25/2019] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Electronic (e-)cigarette use has increased in popularity, especially among those attempting to quit smoking. Previous studies evaluating the therapeutic efficacy of e-cigarettes have suggested that non-pharmacologic factors, such as expectancies about nicotine effects, may influence the experienced effects of e-cigarettes. METHOD The independent and synergistic influences of drug and expectancies were parsed using a balanced-placebo design, whereby 128 participants (52 dual users) were provided an e-cigarette that either contained nicotine or non-nicotine solution, while told that it did or did not contain nicotine. We hypothesized main effects of nicotine content on physiological, objective outcomes (attention, appetite, aversion, respiratory tract sensations), and main effects of the instructions on more subjective, psychosocial outcomes (affect, reward, satisfaction). Sex was included as a moderator. RESULTS Results showed that nicotine increased sustained attention, and more so among females. Nicotine delivery was associated with aversion among females, but not males. Among those who were both told and did not receive nicotine, higher enjoyment of respiratory tract sensations was reported. Nicotine with complementary instructions produced the highest reward ratings; additionally, nicotine was rewarding to males but not females. DISCUSSION Findings demonstrated that both nicotine content and non-pharmacologic factors impact acute outcome effects of e-cigarettes, with moderation by sex in some cases. Results are relevant to the interpretation of clinical trials of e-cigarettes and suggest a more nuanced view of reinforcement pathways.
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Abstract
Electronic cigarettes (e-cigarettes) are alternative, non-combustible tobacco products that generate an inhalable aerosol containing nicotine, flavors, propylene glycol, and vegetable glycerin. Vaping is now a multibillion dollar industry that appeals to current smokers, former smokers, and young people who have never smoked. E-cigarettes reached the market without either extensive preclinical toxicology testing or long term safety trials that would be required of conventional therapeutics or medical devices. Their effectiveness as a smoking cessation intervention, their impact at a population level, and whether they are less harmful than combustible tobacco products are highly controversial. Here, we review the evidence on the effects of e-cigarettes on respiratory health. Studies show measurable adverse biologic effects on organ and cellular health in humans, in animals, and in vitro. The effects of e-cigarettes have similarities to and important differences from those of cigarettes. Decades of chronic smoking are needed for development of lung diseases such as lung cancer or chronic obstructive pulmonary disease, so the population effects of e-cigarette use may not be apparent until the middle of this century. We conclude that current knowledge of these effects is insufficient to determine whether the respiratory health effects of e-cigarette are less than those of combustible tobacco products.
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Affiliation(s)
- Jeffrey E Gotts
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Sven-Eric Jordt
- Department of Anesthesiology, Duke University, Durham, NC, USA
- Yale Center for the Study of Tobacco Products and Addiction, Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Rob McConnell
- Department of Preventive Medicine, University of Southern California, CA, USA
| | - Robert Tarran
- Marsico Lung Institute, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
- Department of Cell Biology and Physiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
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228
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Warner KE. How to Think-Not Feel-about Tobacco Harm Reduction. Nicotine Tob Res 2019; 21:1299-1309. [PMID: 29718475 DOI: 10.1093/ntr/nty084] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 04/27/2018] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The debate over tobacco harm reduction (THR) has divided the tobacco control community into two camps, one expressing serious reservations about THR whereas the other believes that reduced-risk products like e-cigarettes will disrupt the cigarette market. The often emotional debate would benefit from dispassionate data-based evaluation of evidence. METHODS After briefly discussing harm reduction in public health and specifically in tobacco control, this paper identifies major issues concerning e-cigarettes and reviews relevant evidence. Issues include: e-cigarettes' risks compared to cigarette smoking; the effect of vaping on youth smoking; vaping's impact on adult smoking cessation; the net long-term public health implications of vaping; and differences in views on policy issues. The intent is to provide a broad overview of issues and evidence, directing readers to more detailed reviews of specific issues. FINDINGS Principal findings include the following: (1) while longitudinal studies suggest that vaping increases never-smoking young people's odds of trying smoking, national survey data indicate that adolescents' 30-day smoking prevalence decreased at an unprecedented rate precisely whereas vaping increased. Use of all other tobacco products also declined. (2) Recent population-level studies add evidence that vaping is increasing adult smoking cessation. (3) Vaping is likely to make a positive contribution to public health. CONCLUSIONS THR can be a complement to, not a substitute for, evidenced-based tobacco control interventions. Tobacco control professionals need to focus on objective assessment of and discussion about the potential costs and benefits of THR. IMPLICATIONS Participants on both sides of the divisive THR debate need to examine the complicated issues and evidence more objectively. This entails considering both the potential benefits and costs associated with reduced-risk products like e-cigarettes. Furthermore, it requires examining different kinds of evidence when considering specific issues. For example, those concerned by longitudinal study findings that vaping increases students' trial of cigarettes should consider US national survey evidence that youth smoking has decreased at an unprecedented rate. A review of the major issues suggests that the potential of vaping to assist adult smokers to quit outweighs the potential negatives.
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Affiliation(s)
- Kenneth E Warner
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI
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229
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Johnson L, Ma Y, Fisher SL, Ramsey AT, Chen LS, Hartz SM, Culverhouse RC, Grucza RA, Saccone NL, Baker TB, Bierut LJ. E-cigarette Usage Is Associated With Increased Past-12-Month Quit Attempts and Successful Smoking Cessation in Two US Population-Based Surveys. Nicotine Tob Res 2019; 21:1331-1338. [PMID: 30304476 PMCID: PMC6751520 DOI: 10.1093/ntr/nty211] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 10/04/2018] [Indexed: 11/13/2022]
Abstract
INTRODUCTION We examined past-12-month quit attempts and smoking cessation from 2006 to 2016 while accounting for demographic shifts in the US population. In addition, we sought to understand whether the current use of electronic cigarettes was associated with a change in past-12-month quit attempts and successful smoking cessation at the population level. METHODS We analyzed data from 25- to 44-year-olds from the National Health Interview Survey (NHIS) from 2006 to 2016 (N = 26,354) and the Tobacco Use Supplement to the Current Population Survey (TUS-CPS) in 2006-2007, 2010-2011, and 2014-2015 (N = 33,627). Data on e-cigarette use were available in the 2014-2016 NHIS and 2014-2015 TUS-CPS surveys. RESULTS Past-12-month quit attempts and smoking cessation increased in recent years compared with 2006. Current e-cigarette use was associated with higher quit attempts (adjusted odds ratio [aOR] = 2.29, 95% confidence interval [CI] = 1.87 to 2.81, p < .001) and greater smoking cessation (aOR = 1.64, 95% CI = 1.21 to 2.21, p = .001) in the NHIS. Multivariable logistic regression of the TUS-CPS data showed that current e-cigarette use was similarly significantly associated with increased past-12-month quit attempts and smoking cessation. Significant interactions were found for smoking frequency (everyday and some-day smoking) and current e-cigarette use for both outcomes (p < .0001) with the strongest positive effects seen in everyday smokers. CONCLUSIONS Compared with 2006, past-12-month quit attempts and smoking cessation increased among adults aged 25-44 in recent years. Current e-cigarette use was associated with increased past-12-month quit attempts and successful smoking cessation among established smokers. These findings are relevant to future tobacco policy decisions. IMPLICATIONS E-cigarettes were introduced into the US market over the past decade. During this period, past-12-month quit attempts and smoking cessation have increased among US adults aged 25-44. These trends are inconsistent with the hypothesis that e-cigarette use is delaying quit attempts and leading to decreased smoking cessation. In contrast, current e-cigarette use was associated with significantly higher past-12-month quit attempts and past-12-month cessation. These findings suggest that e-cigarette use contributes to a reduction in combustible cigarette use among established smokers.
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Affiliation(s)
- Linda Johnson
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Yinjiao Ma
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Sherri L Fisher
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Alex T Ramsey
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Li-Shiun Chen
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Sarah M Hartz
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Robert C Culverhouse
- Department of Medicine and Division of Biostatistics, Washington University School of Medicine, St. Louis, MO
| | - Richard A Grucza
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Nancy L Saccone
- Department of Genetics and Division of Biostatistics, Washington University School of Medicine, St. Louis, MO
| | - Timothy B Baker
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Laura J Bierut
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
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Ranabhat CL, Kim CB, Park MB, Jakovljevic M(M. Situation, Impacts, and Future Challenges of Tobacco Control Policies for Youth: An Explorative Systematic Policy Review. Front Pharmacol 2019; 10:981. [PMID: 31551784 PMCID: PMC6745506 DOI: 10.3389/fphar.2019.00981] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 07/31/2019] [Indexed: 12/15/2022] Open
Abstract
Background: Tobacco use in youths is a major public health challenge globally, and approaches to the challenge have not been sufficiently addressed. The existing policies for tobacco control are not well specified by age. Objective: Our study aims to systematically investigate existing tobacco control policies, potential impacts, and national and international challenges to control tobacco use targeting the youth. Data sources: We used the statistics of the Global Youth Tobacco Survey (GYTS), studies, and approaches of tobacco control policies targeting youth. Considering country, continent, age, and significance, PubMed, Health Inter-Network Access to Research Initiative (HINARI), Scopus, the Cochrane Library, Google, and Google Scholar were searched. The related keywords were tobacco control, youth, smoking, smoking reduction policies, prevalence of tobacco use in youth, classification of tobacco control policies, incentives to prevent young people from using tobacco, WHO Framework Convention on Tobacco Control (FTCT), etc. The search strategy was by timeline, specific and popular policies, reliability, significance, and applicability. Results: We found 122 studies related to this topic. There were 25 studies focusing on situation, significance, and theoretical aspects of tobacco control policies associated with youth; 41 studies on national population polices and challenges; and 7 studies for global challenges to overcome the youth tobacco epidemic. All national policies have been guided by WHO-MPOWER strategies. Increases in tobacco tax, warning signs on packaging, restriction of tobacco product advertisements, national law to discourage young people, and peer-based approaches to quit tobacco are popular policies. Smuggling of tobacco products by youth and ignorance of smokeless tobacco control approach are major challenges. Limitation: Our study was flexible for the standard age of youth and we were not able to include all countries in the world and most of the studies focused on smoking control rather than all smokeless tobaccos. Conclusion: The policies of tobacco control adopted by many countries are based on the WHO Framework Convention on Tobacco Control but not necessarily focused on youth. Due to the physical and economic burden of tobacco consumption by youth, this is a high priority that needs to be addressed. Youth-focused creative policies are necessary, and more priority must be given to tobacco prevention in youth. Tobacco control should be a social, public health, and quality-of-life concern rather than a business and trade issue. Implication of key findings: There is limited research on how and in what ways tobacco control policies reach young people and their engagement with these policies from physical, physiological, and psychological aspects. Analysis of these aspects, popular polices practiced in different countries, and creative strategies support the need to review current practices and future ways to discourage youth from tobacco use.
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Affiliation(s)
- Chhabi Lal Ranabhat
- Policy Research Institute, Kathmandu, Nepal
- Institute for Poverty Alleviation and International Development, Yonsei University, Wonju, South Korea
- Manmohan Memorial Institute of Health Science, Kathmandu, Nepal
- Department of Gerontology, Pai Chai University, Daejeon, South Korea
| | - Chun-Bae Kim
- Institute for Poverty Alleviation and International Development, Yonsei University, Wonju, South Korea
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Myung Bae Park
- Department of Gerontology, Pai Chai University, Daejeon, South Korea
| | - Mihajlo (Michael) Jakovljevic
- Department of Global Health Economics and Policy, University of Kragujevac, Kragujevac, Serbia
- Division of Health Economics, Lund University, Lund, Sweden
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231
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Where Do People Vape? Insights from Twitter Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173056. [PMID: 31443591 PMCID: PMC6747114 DOI: 10.3390/ijerph16173056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 08/17/2019] [Accepted: 08/21/2019] [Indexed: 11/19/2022]
Abstract
Background: Emerging evidence suggests that exposure to secondhand and thirdhand aerosol from electronic cigarettes may have serious health risks including respiratory and cardiovascular diseases. Social media data can help identify common locations referenced in vaping-related discussions and offer clues about where individuals vape. These insights can strengthen current tobacco regulations and prioritize new policies to improve public health. This study identified commonly referenced locations in vaping-related discussions on Twitter in 2018. Methods: Vaping-related posts to Twitter were obtained from 1 January 2018 to 31 December 2018. Rule-based classifiers categorized each Twitter post into 11 location-related categories (social venues, living spaces, stores, modes of transportation, schools, workplaces, healthcare offices, eateries, correctional facilities, religious institutions, and miscellaneous) using a data dictionary of location-related keywords (n = 290,816). Results: The most prevalent category was social venues (17.9%), followed by living spaces (16.7%), stores (15.9%), modes of transportation (15.5%), schools (14.9%), and workplaces (11.9%). Other categories pertained to: healthcare offices (2.0%), eateries (1.2%), correctional facilities (0.7%), and religious institutions (0.4%). Conclusion: This study suggests that locations related to socialization venues may be priority areas for future surveillance and enforcement of smoke-free air policies. Similarly, development and enforcement of similar policies at workplaces, schools and multi-unit housing may curb exposure to secondhand and thirdhand aerosol among the public.
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Harrell PT, Brandon TH, England KJ, Barnett TE, Brockenberry LO, Simmons VN, Quinn GP. Vaping Expectancies: A Qualitative Study among Young Adult Nonusers, Smokers, Vapers, and Dual Users. Subst Abuse 2019; 13:1178221819866210. [PMID: 31456638 PMCID: PMC6702779 DOI: 10.1177/1178221819866210] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 07/05/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND "Expectancies," or beliefs about outcomes, robustly correlate with and predict several behaviors including electronic nicotine delivery system ("e-cigarette") use. However, there is limited qualitative research available regarding relevant e-cigarette vaping expectancies. OBJECTIVES The present study used a qualitative approach to derive and refine e-cigarette expectancy themes among young adults. METHODS We conducted 12 focus groups and two individual interviews with young adult nonusers, e-cigarette vapers, cigarette smokers, and dual users to assess beliefs about the effects of e-cigarettes. After a series of open-ended questions, follow-up questions assessed reactions to domains previously examined in expectancy measures for cigarette smoking and e-cigarette vaping. The constant comparative method was used to derive themes from transcripts. RESULTS Four main themes (Positive Reinforcement, Social Benefits, Negative Affect Reduction, Negative Consequences) emerged from the results. Each theme contained three associated subthemes (Positive Reinforcement: Sensorimotor Experiences, Taste, Stimulation; Social Benefits: Social Facilitation, Influence on Others, Convenience; Negative Affect Reduction: Stress Reduction, Appetite Reduction, Boredom Reduction; and Negative Consequences: Health Risks, Addiction, Secondhand Effects). CONCLUSIONS/IMPORTANCE Previously identified smoking expectancies appear relevant for young adult vaping, with some notable refinements. Positive reinforcement aspects encompassed aerosol clouds, vaping tricks, and unique flavors. Social benefits included influencing others via social media and competitive activity, as well as the convenience of use in a variety of places. Negative affect reduction was controversial among user groups, but vaping was seen as more interesting than smoking and thus more effective at boredom reduction. Young adults were uncertain regarding negative consequences, but appreciated a potential for secondhand effects. Measure refinement via qualitative research and future field testing can enhance our understanding of this relatively new behavior, supporting tobacco control surveillance, marketing/labeling regulations, and counter-advertising development/evaluation.
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Affiliation(s)
- Paul T Harrell
- Division of Community Health & Research, Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA, USA
- Department of Psychiatry & Behavioral Sciences, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Thomas H Brandon
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Kelli J England
- Division of Community Health & Research, Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA, USA
- Department of Psychiatry & Behavioral Sciences, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Tracey E Barnett
- School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Laurel O Brockenberry
- Division of Community Health & Research, Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA, USA
- Department of Psychiatry & Behavioral Sciences, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Vani N Simmons
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Gwendolyn P Quinn
- Department of Population Health, New York University, New York, NY, USA
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Araújo AJD. Reasons for smoking or reasons for quitting, that is the question: can administering the Modified Reasons for Smoking Scale make a difference in clinical practice? J Bras Pneumol 2019; 45:e20190253. [PMID: 31411281 PMCID: PMC6733720 DOI: 10.1590/1806-3713/e20190253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Alberto José de Araújo
- . Núcleo de Estudos e Tratamento do Tabagismo, Instituto de Doenças do Tórax, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
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234
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Fadus MC, Smith TT, Squeglia LM. The rise of e-cigarettes, pod mod devices, and JUUL among youth: Factors influencing use, health implications, and downstream effects. Drug Alcohol Depend 2019; 201:85-93. [PMID: 31200279 PMCID: PMC7183384 DOI: 10.1016/j.drugalcdep.2019.04.011] [Citation(s) in RCA: 210] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 03/15/2019] [Accepted: 04/05/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Electronic cigarettes (e-cigarettes) were first introduced in the U.S. market in 2006, with the more recent evolution of "pod-mod" e-cigarettes such as JUUL introduced in 2015. Although marketed as a smoking cessation tool, e-cigarettes are rarely used for this purpose in youth. This review aims to synthesize the literature regarding e-cigarette use among youth, and provides a resource for clinicians, educators, and families that helps answer commonly asked questions about e-cigarettes. METHODS PubMed, Scopus, and PsycINFO search was performed using search terms "Electronic Nicotine Delivery Systems," "e cigarettes," "e-cigarettes," "electronic cigarettes," "vaping," "JUUL," "e-cigs," and "vape pens." Search results were filtered to only include those related to adolescents and young adults. RESULTS E-cigarette use among youth is common, with rates of use increasing from 1.5% in 2011 to 20.8% in 2018. Pod mod devices such as JUUL have gained favor among youth for their sleek design, user-friendly function, desirable flavors, and ability to be used discreetly in places where smoking is forbidden. Adolescents are often uninformed about the constituents of e-cigarettes, and little is known about the long-term effects of e-cigarettes. Studies have suggested a "gateway" effect for combustible cigarettes and cannabis use. CONCLUSIONS E-cigarette use is becoming increasingly common among youth, leading to a myriad of questions and concerns from providers, educators, and family members. More research is needed to determine the ultimate public health impact of e-cigarette use. The authors provide a summary table of frequently asked questions in order to help clarify these common concerns.
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Affiliation(s)
- Matthew C Fadus
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC, 29425, USA.
| | - Tracy T Smith
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC, 29425, USA
| | - Lindsay M Squeglia
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC, 29425, USA
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235
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Tucker JS, Shadel WG, Golinelli D, Seelam R, Siconolfi D. Correlates of cigarette and alternative tobacco product use among young tobacco users experiencing homelessness. Addict Behav 2019; 95:145-151. [PMID: 30921625 PMCID: PMC6545131 DOI: 10.1016/j.addbeh.2019.03.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 03/12/2019] [Accepted: 03/19/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Most young people experiencing homelessness smoke cigarettes, but little is known about use of alternative tobacco products (ATPs) such as e-cigarettes or other electronic nicotine delivery systems (ENDS) and little cigars/cigarillos (LCCs). This study examines past month use and correlates of cigarettes and ATP among young tobacco users experiencing homelessness. METHODS We surveyed a probability sample of N = 469 unaccompanied homeless 13-25 year olds (mean age = 22; 71% male), who reported past month use of any type of tobacco product, from 25 service and street sites in Los Angeles County. RESULTS Nearly all (90%) participants reported smoking regular cigarettes, and 78% reported using at least one tobacco product other than regular cigarettes. The most commonly used of these other products was natural cigarettes (55%), followed by LCCs (43%), ENDS (34%), cigars (31%), hookah (14%), chewing tobacco (7%), and snus (5%). Multivariable models indicated that correlates of past month use differed by product, but included sociodemographic characteristics, homelessness severity, depression, exposure to other people who used the product, and product perceptions (e.g., relative access, cost, and harm compared to cigarettes). CONCLUSION Use of cigarettes and ATPs are both widespread among young homeless tobacco users, suggesting that efforts to reduce tobacco use in this population should have a broad focus that includes a variety of products. The effectiveness of these efforts may be enhanced by addressing their considerable exposure to other tobacco users, as well as their perceptions of certain products as being less harmful or more cost-effective options than regular cigarettes.
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Affiliation(s)
- Joan S Tucker
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138, United States of America.
| | - William G Shadel
- RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213-2665, United States of America
| | - Daniela Golinelli
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138, United States of America
| | - Rachana Seelam
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138, United States of America
| | - Daniel Siconolfi
- RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213-2665, United States of America
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Künzli N, Puhan MA, Suggs LS. Will the Swiss pavilion at Expo 2020 Dubai damage your health? Int J Public Health 2019; 64:1125-1126. [PMID: 31363790 DOI: 10.1007/s00038-019-01286-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 07/26/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
- Nino Künzli
- Swiss School of Public Health (SSPH+), Hirschengraben 82, 8001, Zurich, Switzerland.
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland.
- University of Basel, Basel, Switzerland.
| | - Milo A Puhan
- Swiss School of Public Health (SSPH+), Hirschengraben 82, 8001, Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - L Suzanne Suggs
- Swiss School of Public Health (SSPH+), Hirschengraben 82, 8001, Zurich, Switzerland
- Università della Svizzera Italiana, Lugano, Switzerland
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Scott JG, Jhetam S, Chen R, Daglish M. Should psychiatrists support the availability of nicotine e-cigarettes in Australia? Australas Psychiatry 2019; 27:392-395. [PMID: 31246116 DOI: 10.1177/1039856219859271] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To examine the position statement of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) regarding the availability of electronic cigarettes in Australia. CONCLUSION There is limited evidence supporting the efficacy of nicotine e-cigarettes as an effective tobacco harm-reduction or cessation strategy for people with mental illness. The recommendations to increase their availability under regulation must be balanced with the physical and mental health risks of vapour inhalation and nicotine use, particularly for youth. Future recommendations by the RANZCP in relation to e-cigarettes must consider both the available evidence for harm reduction and the potential risks associated with youth e-cigarette use.
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Affiliation(s)
- James G Scott
- Faculty of Medicine, The University of Queensland, Herston, QLD, and; Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, and; Queensland Centre for Mental Health Research, Wacol, Brisbane, QLD, Australia
| | - Sarah Jhetam
- Faculty of Science, The University of Queensland, St Lucia, QLD, Australia
| | - Renee Chen
- Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, Australia
| | - Mark Daglish
- Faculty of Medicine, The University of Queensland, Herston, QLD, and; Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, Australia
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238
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Jongenelis MI, Brennan E, Slevin T, Kameron C, Jardine E, Rudaizky D, Pettigrew S. Factors associated with intentions to use e-cigarettes among Australian young adult non-smokers. Drug Alcohol Rev 2019; 38:579-587. [PMID: 31317596 DOI: 10.1111/dar.12963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/21/2019] [Accepted: 06/04/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND AIMS A growing body of evidence suggests e-cigarette use increases the risk of conventional cigarette use. Assessing the factors associated with intentions to use e-cigarettes can inform programs designed to minimise uptake, potentially assisting in preventing a new population of smokers. This study developed and tested a model assessing the importance of various factors that may be associated with intentions to use e-cigarettes among young adults who have never used e-cigarettes or tobacco cigarettes. DESIGN AND METHODS A web-panel provider recruited 429 Australian 18- to 25-year-olds who had never used e-cigarettes or smoked tobacco cigarettes (56% female, mean age = 21.17 years). Various individual and social factors were assessed as potential direct and indirect predictors of e-cigarette use intentions. RESULTS The developed model provided an excellent fit to the data and accounted for 49% of the variance in use intentions. Males had greater intentions to use e-cigarettes compared to females (β = -0.13). Having a greater number of friends who smoke tobacco cigarettes (β = 0.11) and curiosity about e-cigarette use (β = 0.58) were also directly associated with greater use intentions. Positive expectancies about e-cigarettes (β = 0.14), having family members who use e-cigarettes (β = 0.11), and having friends who smoke tobacco cigarettes (β = 0.07) were indirectly associated with intentions via curiosity. DISCUSSION AND CONCLUSIONS Curiosity about e-cigarette use was strongly associated with use intentions. Aspects of the social environment were also important. Further research is needed to identify effective means of challenging positive e-cigarette expectancies given these were found to be strongly associated with intentions via curiosity.
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Affiliation(s)
| | - Emily Brennan
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia
| | - Terry Slevin
- School of Psychology, Curtin University, Perth, Australia.,Public Health Association of Australia, Canberra, Australia
| | - Caitlin Kameron
- School of Psychology, Curtin University, Perth, Australia.,Cancer Council WA, Perth, Australia
| | | | - Daniel Rudaizky
- School of Psychological Sciences, The University of Western Australia, Perth, Western Australia, Australia
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239
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Zhao L, Mbulo L, Palipudi K, Wang J, King B. Awareness and use of e-cigarettes among urban residents in China. Tob Induc Dis 2019; 17:53. [PMID: 31582942 PMCID: PMC6770619 DOI: 10.18332/tid/109904] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The long-term health effects of e-cigarettes are uncertain, and data on e-cigarette use among Chinese adults are limited. This study examined the prevalence and correlates of e-cigarette awareness and use among urban residents in China. Data came from the China City Adult Tobacco Survey (CCATS), a city-representative household survey conducted using electronic tablets during 2013–2014 in 14 major Chinese cities. METHODS CCATS used multistage geographically clustered samples with standardized survey protocols and questionnaire to ensure data comparability. Overall, 31151 adults completed the survey, with sample size varying from 1977 to 3838 across cities, and survey response rates ranging from 79.8% to 97.5%. Respondents were considered current e-cigarette users if they self-reported using e-cigarettes ‘daily’ or ‘less than daily’ at the time of the survey. Descriptive statistics and multivariate logistic regression were conducted. Assessed correlates included: age, education, quit attempts in past 12 months, cigarettes smoked per day, and monthly expenditures on cigarettes. RESULTS Overall, 46.7% of respondents were aware of e-cigarettes, 2.9% ever used, and 0.8% currently used. Most current e-cigarette users (93.0%) also currently smoked tobacco. Among male current tobacco smokers, adjusted odds ratio (AOR) of current e-cigarette use was higher among those aged 15–29 (AOR=2.5; 95% CI: 1.5–4.3) or 30–49 (AOR=1.9; 95% CI: 1.0–3.4) than those ≥50 years; those who attempted to quit in the past 12 months than those who did not (AOR=4.7; 95% CI: 2.2–10.1); those with a college degree (AOR=3.4; 95% CI: 1.9–6.2) or just finished high school (AOR=2.2; 95% CI: 1.2–4.2) than those who did not finish high school; and those who smoked ≥15 cigarettes per day (AOR=2.8; 95% CI: 1.4–5.6) than those who smoked fewer. CONCLUSIONS These findings reveal that during 2013–2014, many urban Chinese adults were aware of e-cigarettes, while use was relatively low and most current users also smoked tobacco. Continued monitoring of e-cigarettes could help inform public health policy, planning, and practice.
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Affiliation(s)
- Luhua Zhao
- Centers for Disease Control and Prevention, Atlanta, United States
| | - Lazarous Mbulo
- Centers for Disease Control and Prevention, Atlanta, United States
| | - Krishna Palipudi
- Centers for Disease Control and Prevention, Atlanta, United States
| | - Jijiang Wang
- University of California San Diego, La Jolla, United States
| | - Brian King
- Centers for Disease Control and Prevention, Atlanta, United States
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240
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Cho YG. Electronic and Conventional Cigarette Use and Drinking Behaviors in Korean Adolescents. Korean J Fam Med 2019; 40:201-203. [PMID: 31344993 PMCID: PMC6669395 DOI: 10.4082/kjfm.40.4e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Young Gyu Cho
- Department of Family Medicine, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
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241
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Bhatta DN, Glantz SA. Electronic Cigarette Use and Myocardial Infarction Among Adults in the US Population Assessment of Tobacco and Health. J Am Heart Assoc 2019; 8:e012317. [PMID: 31165662 PMCID: PMC6645634 DOI: 10.1161/jaha.119.012317] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 04/30/2019] [Indexed: 12/21/2022]
Abstract
Background E-cigarettes are popular for smoking cessation and as an alternative to combustible cigarettes. We assess the association between e-cigarette use and having had a myocardial infarction ( MI ) and whether reverse causality can explain the observed cross-sectional association between e-cigarette use and MI . Methods and Results Cross-sectional analysis of the Population Assessment of Tobacco and Health Wave 1 for association between e-cigarette use and having had and MI . Longitudinal analysis of Population Assessment of Tobacco and Health Waves 1 and 2 for reverse causality analysis. Logistic regression was performed to determine the associations between e-cigarette initiation and MI , adjusting for cigarette smoking, demographic and clinical variables. Every-day (adjusted odds ratio, 2.25, 95% CI : 1.23-4.11) and some-day (1.99, 95% CI : 1.11-3.58) e-cigarette use were independently associated with increased odds of having had an MI with a significant dose-response ( P<0.0005). Odds ratio for daily dual use of both products was 6.64 compared with a never cigarette smoker who never used e-cigarettes. Having had a myocardial infarction at Wave 1 did not predict e-cigarette use at Wave 2 ( P>0.62), suggesting that reverse causality cannot explain the cross-sectional association between e-cigarette use and MI observed at Wave 1. Conclusions Some-day and every-day e-cigarette use are associated with increased risk of having had a myocardial infarction, adjusted for combustible cigarette smoking. Effect of e-cigarettes are similar as conventional cigarette and dual use of e-cigarettes and conventional cigarettes at the same time is risker than using either product alone.
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Affiliation(s)
- Dharma N. Bhatta
- Center for Tobacco Control Research and EducationUniversity of California, San FranciscoSan FranciscoCA
- Helen Diller Family Comprehensive Cancer CenterUniversity of California, San FranciscoSan FranciscoCA
| | - Stanton A. Glantz
- Center for Tobacco Control Research and EducationUniversity of California, San FranciscoSan FranciscoCA
- Helen Diller Family Comprehensive Cancer CenterUniversity of California, San FranciscoSan FranciscoCA
- Department of Medicine (Cardiology)Cardiovascular Research Institute, and Philip R Lee Institute for Health Policy StudiesUniversity of California, San FranciscoSan FranciscoCA
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242
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Strongin RM. E-Cigarette Chemistry and Analytical Detection. ANNUAL REVIEW OF ANALYTICAL CHEMISTRY (PALO ALTO, CALIF.) 2019; 12:23-39. [PMID: 30848928 PMCID: PMC6565477 DOI: 10.1146/annurev-anchem-061318-115329] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The study of e-cigarette aerosol properties can inform public health while longer-term epidemiological investigations are ongoing. The determination of aerosol levels of known toxins, as well as of molecules with unknown inhalation toxicity profiles, affords specific information for estimating the risks of e-cigarettes and for uncovering areas that should be prioritized for further investigation.
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Affiliation(s)
- Robert M Strongin
- Department of Chemistry, Portland State University, Portland, Oregon 97201, USA;
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243
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Pamplona P, Ravara S, Boléo-Tomé JP, Rosa P, Morais A. Breathe, breathe in the air, don't be afraid to care. Pulmonology 2019; 25:131-133. [PMID: 31176476 DOI: 10.1016/j.pulmoe.2019.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- P Pamplona
- Hospital Pulido Valente, Lisboa, Portugal
| | - S Ravara
- University of Beira Interior. Faculty of Health Sciences,Preventive Medecine, Lisboa, Portugal
| | - J P Boléo-Tomé
- Hospital Prof. Dr. Fernando Fonseca EPE, Amadora, Portugal
| | - P Rosa
- Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal
| | - A Morais
- Centro Hospitalar Universitário São João, Faculdade de Medicina do Porto, Portugal.
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244
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Espinoza-Derout J, Hasan KM, Shao XM, Jordan MC, Sims C, Lee DL, Sinha S, Simmons Z, Mtume N, Liu Y, Roos KP, Sinha-Hikim AP, Friedman TC. Chronic intermittent electronic cigarette exposure induces cardiac dysfunction and atherosclerosis in apolipoprotein-E knockout mice. Am J Physiol Heart Circ Physiol 2019; 317:H445-H459. [PMID: 31172811 DOI: 10.1152/ajpheart.00738.2018] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Electronic cigarettes (e-cigarettes), also known as electronic nicotine delivery systems, are a popular alternative to conventional nicotine cigarettes, both among smokers and those who have never smoked. In spite of the widespread use of e-cigarettes and the proposed detrimental cardiac and atherosclerotic effects of nicotine, the effects of e-cigarettes on these systems are not known. In this study, we investigated the cardiovascular and cardiac effects of e-cigarettes with and without nicotine in apolipoprotein-E knockout (ApoE-/-) mice. We developed an e-cigarette exposure model that delivers nicotine in a manner similar to that of human e-cigarettes users. Using commercially available e-cigarettes, bluCig PLUS, ApoE-/- mice were exposed to saline, e-cigarette without nicotine [e-cigarette (0%)], and e-cigarette with 2.4% nicotine [e-cigarette (2.4%)] aerosol for 12 wk. Echocardiographic data show that mice treated with e-cigarette (2.4%) had decreased left ventricular fractional shortening and ejection fraction compared with e-cigarette (0%) and saline. Ventricular transcriptomic analysis revealed changes in genes associated with metabolism, circadian rhythm, and inflammation in e-cigarette (2.4%)-treated ApoE-/- mice. Transmission electron microscopy revealed that cardiomyocytes of mice treated with e-cigarette (2.4%) exhibited ultrastructural abnormalities indicative of cardiomyopathy. Additionally, we observed increased oxidative stress and mitochondrial DNA mutations in mice treated with e-cigarette (2.4%). ApoE-/- mice on e-cigarette (2.4%) had also increased atherosclerotic lesions compared with saline aerosol-treated mice. These results demonstrate adverse effects of e-cigarettes on cardiac function in mice.NEW & NOTEWORTHY The present study is the first to show that mice exposed to nicotine electronic cigarettes (e-cigarettes) have decreased cardiac fractional shortening and ejection fraction in comparison with controls. RNA-seq analysis reveals a proinflammatory phenotype induced by e-cigarettes with nicotine. We also found increased atherosclerosis in the aortic root of mice treated with e-cigarettes with nicotine. Our results show that e-cigarettes with nicotine lead to detrimental effects on the heart that should serve as a warning to e-cigarette users and agencies that regulate them.
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Affiliation(s)
- Jorge Espinoza-Derout
- Division of Endocrinology, Metabolism and Molecular Medicine, Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California
| | - Kamrul M Hasan
- Division of Endocrinology, Metabolism and Molecular Medicine, Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California
| | - Xuesi M Shao
- Division of Endocrinology, Metabolism and Molecular Medicine, Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California.,David Geffen School of Medicine at University of California, Los Angeles, California
| | - Maria C Jordan
- David Geffen School of Medicine at University of California, Los Angeles, California
| | - Carl Sims
- Division of Endocrinology, Metabolism and Molecular Medicine, Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California
| | - Desean L Lee
- Division of Endocrinology, Metabolism and Molecular Medicine, Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California
| | - Satyesh Sinha
- Division of Endocrinology, Metabolism and Molecular Medicine, Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California.,David Geffen School of Medicine at University of California, Los Angeles, California
| | - Zena Simmons
- Division of Endocrinology, Metabolism and Molecular Medicine, Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California
| | - Norma Mtume
- Division of Endocrinology, Metabolism and Molecular Medicine, Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California
| | - Yanjun Liu
- Division of Endocrinology, Metabolism and Molecular Medicine, Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California.,David Geffen School of Medicine at University of California, Los Angeles, California
| | - Kenneth P Roos
- David Geffen School of Medicine at University of California, Los Angeles, California
| | - Amiya P Sinha-Hikim
- Division of Endocrinology, Metabolism and Molecular Medicine, Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California.,David Geffen School of Medicine at University of California, Los Angeles, California
| | - Theodore C Friedman
- Division of Endocrinology, Metabolism and Molecular Medicine, Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California.,David Geffen School of Medicine at University of California, Los Angeles, California
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245
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Walley SC, Wilson KM, Winickoff JP, Groner J. A Public Health Crisis: Electronic Cigarettes, Vape, and JUUL. Pediatrics 2019; 143:peds.2018-2741. [PMID: 31122947 DOI: 10.1542/peds.2018-2741] [Citation(s) in RCA: 155] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2019] [Indexed: 12/15/2022] Open
Abstract
Electronic cigarettes (e-cigarettes) and vape devices have rapidly become the most common tobacco products used by youth, driven in large part by marketing and advertising by e-cigarette companies. There is substantial evidence that adolescent e-cigarette use leads to use of combustible tobacco products. E-cigarette companies commonly advertise that e-cigarettes contain nicotine, flavoring chemicals, and humectants (propylene glycol and/or vegetable glycerin), but toxicants, ultrafine particles, and carcinogens have also been found in e-cigarette solutions and emissions, many of which are known to cause adverse health effects. Most major e-cigarette brands are owned by big tobacco companies that use similar marketing and advertising strategies to attract youth users as they did with traditional tobacco products. In this review, we provide an overview of e-cigarettes and vape devices with an emphasis on the impact for the pediatric population. We describe the vast array of e-cigarette devices and solutions, concern for nicotine addiction, and the scientific background on the known health harms. There are accompanying visual depictions to assist in identifying these products, including newer e-cigarette products and JUUL. Because current federal regulations are insufficient to protect youth from e-cigarette use, exposure, and nicotine addiction, there are recommendations for pediatricians and pediatric health care providers to counsel and advocate for a tobacco-free lifestyle for patients and families.
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Affiliation(s)
- Susan C Walley
- Division of Pediatric Hospital Medicine, The University of Alabama at Birmingham and Children's of Alabama, Birmingham, Alabama;
| | - Karen M Wilson
- Division of General Pediatrics, Icahn School of Medicine at Mount Sinai and Mount Sinai Kravis Children's Hospital, New York, New York
| | - Jonathan P Winickoff
- Division of General Academic Pediatrics, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts; and
| | - Judith Groner
- Division of Primary Care, College of Medicine, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio
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246
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Adolescent Smoking in Hong Kong: Prevalence, Psychosocial Correlates, and Prevention. J Adolesc Health 2019; 64:S19-S27. [PMID: 31122545 DOI: 10.1016/j.jadohealth.2019.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 01/04/2019] [Accepted: 01/04/2019] [Indexed: 11/24/2022]
Abstract
Preventing adolescent smoking is important as smoking is typically initiated by young people. This article reviews the prevalence, psychosocial correlates, and prevention of smoking in Hong Kong adolescents. The past 30-day smoking prevalence in adolescents decreased from 9.6% in 2003 to 2.5% in 2017. Tobacco advertisements, parental and best friends smoking, nonintact families, poor family relationships, lower socioeconomic status, being a new immigrant, poor knowledge of smoking-related harm, positive attitudes toward smoking, overestimation of peer smoking, and depressive symptoms were positively associated with smoking outcomes, whereas positive youth development, authoritative mother and permissive father, family functioning, school competence, and stronger tobacco industry denormalization beliefs were protective against smoking. Along with tobacco tax increase, ban on tobacco advertisements, smoke-free law and pictorial warnings, educational efforts through theater performances, social norms campaigns, and positive adolescent training programs have been conducted to prevent adolescent smoking. To achieve the ultimate goal of tobacco endgame, further tax increase, plain packaging, banning point-of-sale display of tobacco products, smoke-free area extension, and raising minimum age of purchase should be implemented. The government proposed law to ban e-cigarettes, and heated tobacco products should be passed soon to protect children and adolescents from using these products.
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247
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Cuadra GA, Smith MT, Nelson JM, Loh EK, Palazzolo DL. A Comparison of Flavorless Electronic Cigarette-Generated Aerosol and Conventional Cigarette Smoke on the Survival and Growth of Common Oral Commensal Streptococci. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1669. [PMID: 31091650 PMCID: PMC6572406 DOI: 10.3390/ijerph16101669] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/26/2019] [Accepted: 05/08/2019] [Indexed: 12/15/2022]
Abstract
Background: The use of electronic cigarettes (ECIG) has become very common. Consequently, critical analysis of the biological effects of ECIG aerosol deserves attention. Flavorless ECIG aerosol is known to comprise fewer harmful constituents than cigarette smoke. Therefore, we hypothesize that aerosol has less immediate effect on the viability of oral commensal streptococci than smoke. Methods: Survival and growth of four strains of commensal streptococci were measured after exposure to flavorless ECIG aerosol ± nicotine and smoke. Peristaltic pumps were used to transport aerosol or smoke into chambers containing recently seeded colony-forming units (CFUs) of the oral commensal streptococci on agar plates. Bacterial survival and growth, based on colony counts and sizes, were determined 24 h post-exposure. Additionally, aerosol or smoke were delivered into chambers containing pre-adhered streptococci to plastic coverslips and biofilm formation was determined 24 h post-exposure via scanning electron microscopy. Results: The results suggest that flavorless aerosol ± nicotine has a modest effect on bacterial growth both as colonies on agar and as biofilms. In contrast, smoke dramatically decreased bacterial survival and growth in all parameters measured. Conclusion: Unlike cigarette smoke, flavorless ECIG aerosol has only a small effect on the survival and growth of oral commensal streptococci.
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Affiliation(s)
| | - Maxwell T Smith
- Department of Medical Laboratory Science, School of Allied Health Sciences, Lincoln Memorial University, Harrogate, TN 37752, USA.
| | - John M Nelson
- Department of Biology, School of Mathematics and Sciences, Lincoln Memorial University, Harrogate, TN 37752, USA.
| | - Emma K Loh
- Department of Biology, Muhlenberg College, Allentown, PA 18104, USA.
| | - Dominic L Palazzolo
- Department of Physiology, DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Harrogate, TN 37752, USA.
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248
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Brandon KO, Simmons VN, Meltzer LR, Drobes DJ, Martínez Ú, Sutton SK, Palmer AM, Bullen CR, Harrell PT, Brandon TH. Vaping characteristics and expectancies are associated with smoking cessation propensity among dual users of combustible and electronic cigarettes. Addiction 2019; 114:896-906. [PMID: 30644627 PMCID: PMC6629519 DOI: 10.1111/add.14551] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/21/2018] [Accepted: 01/04/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND AIMS Most e-cigarette users who also smoke combustible cigarettes (dual users) begin vaping to quit smoking, yet only a subset succeeds. We hypothesized that reinforcing characteristics of e-cigarettes (vaping reinforcement) would positively predict smoking cessation propensity (SCP) among dual users. DESIGN Secondary analysis of cross-sectional baseline data from dual users in an ongoing smoking cessation trial. Exploratory and confirmatory factor analysis (EFA and CFA) created latent variables for vaping reinforcement and SCP. A structural equation modeling (SEM) approach was used to test the hypothesis. SETTING United States. PARTICIPANTS A national sample of dual users of combustible and electronic cigarettes who smoke and vape at least once per week (n = 2896) were enrolled (63% male; mean age = 29.9 years) into a randomized controlled trial in which they would receive either smoking cessation materials or no smoking cessation materials. MEASUREMENTS Vaping reinforcement was indexed by vaping frequency (days/week vaping, times/day vaping, puffs/e-cigarette use), e-cigarette characteristics [numbers of modifications and tobacco or non-tobacco flavors, nicotine content (mg) and positive e-cigarette expectancies]. SCP was measured by items of confidence, commitment to being smoke-free, cessation motivation (contemplation ladder), change in cigarettes per day since beginning e-cigarette use and negative smoking expectancies. FINDINGS Four factors emerged from the EFA: vaping propensity (vaping frequency, positive expectancies), vaping enthusiasm (e-cigarette modifications, using non-tobacco flavors, puffs per use), nicotine/tobacco flavor (nicotine strength, tobacco flavors) and SCP (negative expectancies about smoking, motivation to quit smoking, reduction in smoking). A CFA upheld the exploratory factor structure [root mean square error of approximation (RMSEA) = 0.046, CFI = 0.91]. An SEM with the three vaping latent variables directly predicting SCP had good model fit (RMSEA = 0.030, CFI = 0.97) with a positive relationship of vaping propensity (0.509, P < 0.001), and small negative relationships of vaping enthusiasm (-0.158, P = 0.014) and nicotine/tobacco flavor (-0.230, P < 0.001). CONCLUSIONS Among e-cigarette users who also smoke combustible cigarettes, frequent vaping combined with positive e-cigarette expectancies appears to predict greater smoking cessation propensity. However, vaping enthusiasm (measured by e-cigarette modifications, using non-tobacco flavors and puffs per use), higher nicotine content and use of tobacco flavored solution may reduce cessation propensity.
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Affiliation(s)
- Karen O. Brandon
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Vani N. Simmons
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA,Department of Psychology, University of South Florida,Tampa, FL, USA,Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
| | - Lauren R. Meltzer
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - David J. Drobes
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA,Department of Psychology, University of South Florida,Tampa, FL, USA,Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
| | - Úrsula Martínez
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Steven K. Sutton
- Department of Psychology, University of South Florida,Tampa, FL, USA,Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA,Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Amanda M. Palmer
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA,Department of Psychology, University of South Florida,Tampa, FL, USA
| | - Christopher R. Bullen
- School of Population Health, Faculty of Medical and Health Science, University of Auckland, New Zealand
| | - Paul T. Harrell
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Thomas H. Brandon
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA,Department of Psychology, University of South Florida,Tampa, FL, USA,Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
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249
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Olfson M, Wall MM, Liu SM, Sultan RS, Blanco C. E-cigarette Use Among Young Adults in the U.S. Am J Prev Med 2019; 56:655-663. [PMID: 30885517 PMCID: PMC6475482 DOI: 10.1016/j.amepre.2018.12.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/30/2018] [Accepted: 12/01/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Use of e-cigarettes is increasing among young adults in the U.S. Whether e-cigarette use serves as an aid to smoking reduction or cessation among young adults remains a matter of contention. This analysis examines patterns of e-cigarette use in relation to cigarette smoking in a nationally representative sample of U.S. young adults. METHODS Data were analyzed from nationally representative U.S. adults, aged 18 to 35years (N=12,415), in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III. Logistic regression assessed associations between e-cigarette use and smoking intensity, continuity, and reduction while controlling for several potential confounding factors. Data were analyzed in 2018. RESULTS Among cigarette smokers, e-cigarette use was associated with higher odds of tobacco use disorder (AOR=2.58, 95% CI=1.73, 3.83) and daily cigarette smoking (AOR=1.67, 95% CI=1.73, 3.83). Among adults aged 26-35years, e-cigarette use was also associated with heavy cigarette smoking (AOR=2.01, 95% CI=1.09, 3.74). Among lifetime smokers, e-cigarette use was associated with lower odds of stopping smoking (AOR=0.14, 95% CI=0.08, 0.23) and lower odds of a 50% reduction in cigarettes smoked per day (AOR=0.63, 95% CI=0.43, 0.93). Only 13.1% of young adults who ever used e-cigarettes reported using them to help stop or quit smoking. CONCLUSIONS Use of e-cigarettes by U.S. young adults, most of which is not intended to help reduce smoking, is related to more rather than less frequent and intensive cigarette smoking.
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Affiliation(s)
- Mark Olfson
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York; New York State Psychiatric Institute, New York, New York.
| | - Melanie M Wall
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York; New York State Psychiatric Institute, New York, New York
| | - Shang-Min Liu
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York; New York State Psychiatric Institute, New York, New York
| | - Ryan S Sultan
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York; New York State Psychiatric Institute, New York, New York
| | - Carlos Blanco
- National Institute on Drug Abuse, Division of Epidemiology, Services, and Prevention Research, Rockville, Maryland
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Tobacco Evidence-Based Practice Implementation and Employee Tobacco-Related Outcomes at Small Low-Wage Worksites. J Occup Environ Med 2019; 61:e312-e316. [PMID: 31022102 DOI: 10.1097/jom.0000000000001618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to assess whether tobacco policy, program, and communication evidence-based practice implementation is associated with employee tobacco outcomes [current smoking; quit attempt; smokeless tobacco (SLT) use; and perceived worksite support for cessation] at small low-wage worksites. METHODS We analyzed data from a randomized controlled trial testing an intervention to increase implementation of evidence-based health promotion practices. We used generalized estimating equations to examine relationships between practice implementation and tobacco outcomes. RESULTS Communication practice implementation was associated with better perceived worksite support for cessation (P = 0.027). Policy and program implementation were associated with increased odds of being a current SLT user; these findings should be interpreted with caution given small sample sizes. CONCLUSION Tobacco communication evidence-based practice implementation was associated with favorable perceptions of worksite support for cessation; more may be needed to change tobacco use behavior.
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