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Di Cicco M, Sepich M, Ragazzo V, Peroni DG, Comberiati P. Potential effects of E-cigarettes and vaping on pediatric asthma. Minerva Pediatr 2020; 72:372-382. [PMID: 32686924 DOI: 10.23736/s0026-4946.20.05973-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Asthma is the most common chronic disease in childhood and exposure to tobacco smoke has been long recognized as a risk factor for its onset as well as for exacerbations and poor disease control. Since the early 2000s, electronic cigarettes have been marketed worldwide as a non-harmful electronic alternative to combustible cigarettes and as a device likely to help stop smoking, and their use is continuously rising, particularly among adolescents. However, several studies have shown that vape contains many different well-known toxicants, causing significant cytotoxic and pro-inflammatory effects on the airways in-vitro and in animal models. In humans, a variety of harmful lung effects related to vaping, ranging from bronchoconstriction to severe respiratory distress has been already reported. To investigate the potential effects of vaping in pediatric asthma, we searched relevant published studies in the MEDLINE/PubMed database by combining the adequate Medical Subject Headings terms and key words. At the end of our study selection process, five cross-sectional studies focusing on electronic cigarettes use in adolescents and self-reported asthma and/or other respiratory symptoms, one study focusing on the effects of electronic cigarettes second-hand exposure and one case report were retrieved. These preliminary data support a likely detrimental effect of vaping in asthmatic adolescents. Currently available evidence supports that electronic cigarettes are a potential threat to respiratory health, particularly in adolescents with asthma. High-quality studies on larger population assessing the long-term effects of vape exposure, are urgently needed.
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Affiliation(s)
- Maria Di Cicco
- Unit of Pediatrics, Pisa University Hospital, Pisa, Italy - .,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy -
| | - Margherita Sepich
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Vincenzo Ragazzo
- Division of Pediatrics and Neonatology, Department of Women's and Children's Health, Versilia Hospital, Camaiore, Lucca, Italy
| | - Diego G Peroni
- Unit of Pediatrics, Pisa University Hospital, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Pasquale Comberiati
- Unit of Pediatrics, Pisa University Hospital, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Patrounova V, Yoon JH, Schmitz JM, Nguyen K, Alaniz J, Yammine L. Combustible and electronic cigarette use among patients at a large academic dental school clinic: A preimplementation needs assessment survey. J Am Dent Assoc 2020; 151:510-518. [PMID: 32593353 DOI: 10.1016/j.adaj.2020.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 03/15/2020] [Accepted: 03/17/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Tobacco product use is a significant public health concern, particularly with the increasing use of electronic nicotine delivery systems (electronic cigarettes [e-cigarettes]). Dental care providers are well positioned to screen and provide guidance regarding tobacco use, but these services are generally underused. METHODS In preparation for a quality improvement project, patients at a large academic dental school clinic were anonymously surveyed regarding past and current use of combustible cigarettes and e-cigarettes, attitudes about quitting, and health beliefs regarding these products. RESULTS Among 166 surveyed patients, past month use of combustible cigarettes, e-cigarettes, and both combustible cigarettes and e-cigarettes (dual use) was reported by 14.5%, 2.4%, and 5.4% of patients, respectively. Daily combustible cigarette, e-cigarette, and dual use was reported by 12.7%, 1.2%, and 1.8% of patients, respectively. Most current tobacco users expressed thoughts or plans about changing their tobacco use and concerns regarding continued use of these products on their oral health. More than one-half of the current tobacco users expressed interest in receiving additional support to help them quit. CONCLUSIONS Dental care providers see a sizable number of patients who use combustible cigarettes and e-cigarettes, many of whom are concerned about the potential harms of these products on their health and express interest in tobacco-use cessation support. PRACTICAL IMPLICATIONS It is critical that dental care professionals engage in efforts to assess combustible cigarette and e-cigarette use and provide guidance regarding these products to their patients.
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Khouja JN, Munafò MR, Relton CL, Taylor AE, Gage SH, Richmond RC. Investigating the added value of biomarkers compared with self-reported smoking in predicting future e-cigarette use: Evidence from a longitudinal UK cohort study. PLoS One 2020; 15:e0235629. [PMID: 32663218 PMCID: PMC7360042 DOI: 10.1371/journal.pone.0235629] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/19/2020] [Indexed: 12/26/2022] Open
Abstract
Biomarkers can be used to assess smoking behaviour more accurately and objectively than self-report. This study assessed the association between cotinine (a biomarker of smoke exposure) and later e-cigarette use among a population who were unexposed to e-cigarettes in youth. Young people in the Avon Longitudinal Study of Parents and Children took part in the study. We observed associations between cotinine at 15 years (measured between 2006 and 2008 before the wide availability of e-cigarettes) and self-reported ever use of e-cigarettes at 22 (measured between 2014 and 2015 when e-cigarettes were widely available) using logistic regression. A range of potential confounders were adjusted for (age, sex, body mass index, alcohol use and passive smoke exposure). Additionally, we adjusted for the young people's self-reported smoking status/history to explore potential misreporting and measurement error. In a sample of N = 1,194 young people, cotinine levels consistent with active smoking at 15 years were associated with increased odds of e-cigarette ever use at 22 years (Odds Ratio [OR] = 7.24, 95% CI 3.29 to 15.93) even when self-reported active smoking status at age 16 (OR = 3.14, 95% CI 1.32 to 7.48) and latent classes of smoking behaviour from 14 to 16 (OR = 2.70, 95% CI 0.98 to 7.44) were included in the model. Cotinine levels consistent with smoking in adolescence were strongly associated with increased odds of later e-cigarette use, even after adjusting for reported smoking behaviour at age 16 and smoking transitions from 14 to 16.
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Affiliation(s)
- Jasmine N. Khouja
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, United Kingdom
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
| | - Marcus R. Munafò
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
- NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, United Kingdom
| | - Caroline L. Relton
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Amy E. Taylor
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, United Kingdom
- NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, United Kingdom
| | - Suzanne H. Gage
- Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Rebecca C. Richmond
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, United Kingdom
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Galo J, Celli D, Gross D, Holt G, Campos M. A presentation of E-Cigarette vaping associated lung injury (EVALI) caused by THC-Containing electronic smoking device. Respir Med Case Rep 2020; 31:101154. [PMID: 32690998 PMCID: PMC7348611 DOI: 10.1016/j.rmcr.2020.101154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/11/2020] [Accepted: 07/03/2020] [Indexed: 01/08/2023] Open
Abstract
Several cases have recently been reported concerning the development of a syndrome of acute lung injury associated with the use of electronic cigarettes, leading to respiratory failure and several deaths. We present a case of a young veteran who presented with e-cigarette vaping associated lung injury (EVALI) to a primary care clinic and who required subsequent inpatient admission and home oxygen therapy after discharge. The patient afterwards improved after a three-month course of steroids and cessation of THC-containing electronic cigarettes, consistent with previously reported cases. Furthermore, evidence on bronchoscopy and biopsy demonstrated intracellular lipid droplets in the patient's macrophages. This outpatient case of EVALI prompts primary care providers to raise suspicion of this condition, and enquire about the use of e-cigarettes, particularly THC-containing vaping products. Furthermore, in the setting of the COVID-19 pandemic, similar clinical and radiographic presentations between COVID-19 and EVALI can be seen.
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Affiliation(s)
- Jason Galo
- University of Miami/Jackson Memorial Hospital, Department of Internal Medicine, United States
| | - Diego Celli
- University of Miami/Jackson Memorial Hospital, Department of Internal Medicine, United States
| | - Dana Gross
- University of Miami, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Miami VA Medical Center, United States
| | - Gregory Holt
- University of Miami, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Miami VA Medical Center, United States
| | - Michael Campos
- University of Miami, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Miami VA Medical Center, United States
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255
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Herman M, Tarran R. E-cigarettes, nicotine, the lung and the brain: multi-level cascading pathophysiology. J Physiol 2020; 598:5063-5071. [PMID: 32515030 DOI: 10.1113/jp278388] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 03/13/2020] [Indexed: 12/13/2022] Open
Abstract
Tobacco smoking is highly addictive and causes respiratory disease, cardiovascular disease and multiple types of cancer. Electronic-cigarettes (e-cigarettes) are non-combustible tobacco alternatives that aerosolize nicotine and flavouring agents in a propylene glycol-vegetable glycerine vehicle. They were originally envisaged as a tobacco cessation aid, but whether or not they help people to quit tobacco use is controversial. In this review, we have compared and contrasted what is known regarding the effects of nicotine on the lungs vs. the effects of nicotine in the brain in the context of addiction. Critically, both combustible tobacco products and e-cigarettes contain nicotine, a highly addictive, plant-derived alkaloid that binds to nicotinic acetylcholine receptors (nAChRs). Nicotine's reinforcing properties are primarily mediated by activation of the brain's mesolimbic reward circuitry and release of the neurotransmitter dopamine that contribute to the development of addiction. Moreover, nicotine addiction drives repeated intake that results in chronic pulmonary exposure to either tobacco smoke or e-cigarettes despite negative respiratory symptoms. Beyond the brain, nAChRs are also highly expressed in peripheral neurons, epithelia and immune cells, where their activation may cause harmful effects. Thus, nicotine, a key ingredient of both conventional and electronic cigarettes, produces neurological effects that drive addiction and may damage the lungs in the process, producing a complex, multilevel pathological state. We conclude that vaping needs to be studied by multi-disciplinary teams that include pulmonary and neurophysiologists as well as behaviourists and addiction specialists to fully understand their impact on human physiology.
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Affiliation(s)
- Melissa Herman
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.,Department of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Robert Tarran
- Department of Cell Biology & Physiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
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256
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YOON S, DAVIS N, ODLUM M, CHO H, BROADWELL P, PATRAO M, BALES M, ALCANTARA C, MITTELMAN M. Applying Artificial Intelligence to Predict Self-Reported Poor Health Among Black and Hispanic Caregivers with Mild Cognitive Impairment. Stud Health Technol Inform 2020; 272:433-436. [PMID: 32604695 PMCID: PMC7337992 DOI: 10.3233/shti200588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
We applied artificial intelligence techniques to build correlate models that predict general poor health in a national sample of caregivers with mild cognitive impairment (MCI). Our application of deep learning identified age, duration of caregiving, amount of alcohol intake, weight, myocardial infarction (MI) and frequency of MCI symptoms for Blacks and Hispanics whereas frequency of MCI symptoms, income, weight, coronary heart disease (CHD), age, and use of e-cigarette for the others as the strongest correlates of poor health among 81 variables entered. The application of artificial intelligence efficiently provided intervention strategies for Black and Hispanic caregivers with MCI.
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Affiliation(s)
- Sunmoo YOON
- Columbia University Irving Medical Center,,Sunmoo Yoon, PhD, MS, RN, General Medicine, Department of Medicine, Columbia University Medical Center, 630W 168 street, PH105, New York, NY, 10032, USA;
| | | | | | | | | | | | | | | | - Mary MITTELMAN
- Department of Psychiatry, NYU Grossman School of Medicine, USA
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257
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Jackson A, Grobman B, Krishnan-Sarin S. Recent findings in the pharmacology of inhaled nicotine: Preclinical and clinical in vivo studies. Neuropharmacology 2020; 176:108218. [PMID: 32592708 DOI: 10.1016/j.neuropharm.2020.108218] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/13/2020] [Accepted: 06/17/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The rise of vaping in adolescents, the recent entrance of new inhaled nicotine products such as iQOS on the market and e-cigarette or vaping product use-associated lung injury cases has created concern for the use of inhaled non-combustible nicotine products. This narrative review discusses recent experimental in vivo studies that utilize human, rat and mouse models to understand the pharmacological impact of nicotine from non-combustible products. METHODS The search engine PubMed was utilized with the following search terms: inhaled nicotine, nicotine e-cigarette, heated tobacco products, iQOS, electronic cigarette, nicotine inhaler, nicotine vaping. This review highlights recent primary in vivo studies of inhaled nicotine administration experimental paradigms that occurred in laboratory settings using human and rodent (rats and mice) models that have been published from January 2017-December 2019. RESULTS The pharmacokinetics of nicotine via e-cigarettes is influenced by the PG/VG and flavor constituents in e-liquids, the presence of nicotine salts in e-liquids, puff topography of nicotine and tobacco product users and the power of the e-cigarette device. The pharmacodynamic impact of inhaled nicotine has cardiovascular, pulmonary and central nervous system implications. CONCLUSION The articles reviewed here highlight the importance of both animal and human models to fully understand the impact of inhaled nicotine pharmacology There is a need for more rodent pharmacokinetic inhaled nicotine studies to understand the influences of factors such as flavor and nicotine salts. Additionally, consensus on nicotine measurement in both human and rodent studies is greatly needed.
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Affiliation(s)
- Asti Jackson
- Department of Psychiatry, Yale School of Medicine, United States.
| | - Ben Grobman
- Department of Psychiatry, Yale School of Medicine, United States
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Abstract
Data sources The review included 42 pre-clinical in-vitro studies, published between 1995 and 2017. Study selection The study selected in-vitro studies which had assessed the effect of nicotine on human gingival and periodontal fibroblasts and epithelial cells. Typically, diluted pure nicotine was added to a cell culture medium in a variety of doses for a variety of time periods and the cells were then compared against a no-nicotine control. Outcomes assessed were: Cell viability, cell attachment or adhesion, cell proliferation or inflammatory mediator production. Studies were restricted to English language and full-text only.Data extraction and synthesis Two members of the review team screened abstracts and reviewed the full-texts independently. Disagreements regarding inclusion were resolved by discussion and consultation with the third author. Data were also extracted independently using a specifically designed data extraction form which included a quality assessment specifically designed for in-vitro studies. A narrative synthesis of the results was carried out.Results The included studies were heterogeneous in their designs, with a wide variety of cell types, concentrations of nicotine (1 nM to 100 mM), exposure times (30 minutes to four weeks), and assays used. All studies were assessed at being at high risk of bias due to lack of randomisation, allocation concealment, and blinding. No effect on cell viability was observed when the nicotine concentrations used were within the ranges observed in-vivo in smokers, nicotine replacement therapy users (NRT) and e-cigarette users. Cell viability was adversely affected only when concentrations of nicotine reached those observed in the saliva of smokeless tobacco users (>5 mM). However, periodontal ligament cells are not usually exposed to saliva in-vivo. Effects on cell attachment, cell proliferation and production of inflammatory mediators were reported at a wide range of concentrations, but the effects were contradictory. The authors make several recommendations for future research in this area, to improve the quality of the primary studies. Conclusions At the concentrations found in smokers and users of NRT including e-cigarettes, nicotine is unlikely to be toxic to human gingival and periodontal ligament cells in in-vitro. Higher concentrations of nicotine, of the levels observed in the saliva of smokeless tobacco users, have been shown to be cytotoxic in vitro.
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259
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Chung S, Bengtson CD, Kim MD, Salathe M. CrossTalk opposing view: E-cigarettes expose users to adverse effects of vapours and the potential for nicotine addiction. J Physiol 2020; 598:3053-3056. [PMID: 32495948 DOI: 10.1113/jp279271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Samuel Chung
- Department of Internal Medicine - Division of Pulmonary, Critical Care and Sleep Medicine, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | - Charles D Bengtson
- Department of Internal Medicine - Division of Pulmonary, Critical Care and Sleep Medicine, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | - Michael D Kim
- Department of Internal Medicine - Division of Pulmonary, Critical Care and Sleep Medicine, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | - Matthias Salathe
- Department of Internal Medicine - Division of Pulmonary, Critical Care and Sleep Medicine, University of Kansas Medical Center, Kansas City, KS, 66160, USA
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260
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Abstract
Can tobacco and e-cigarette use affect the outcomes of COVID-19? Graham Cope looks at the early evidence
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261
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262
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Bush A, Pabary R. Pulmonary alveolarproteinosis in children. Breathe (Sheff) 2020; 16:200001. [PMID: 32684993 PMCID: PMC7341618 DOI: 10.1183/20734735.0001-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 03/01/2020] [Indexed: 12/15/2022] Open
Abstract
Pulmonary alveolar proteinosis (PAP) is an umbrella term for a wide spectrum of conditions that have a very characteristic appearance on computed tomography. There is outlining of the secondary pulmonary lobules on the background of ground-glass shadowing and pathologically, filling of the alveolar spaces with normal or abnormal surfactant. PAP is rare and the common causes in children are very different from those seen in adults; autoimmune PAP is rare and macrophage blockade not described in children. There are many genetic causes of PAP, the best known of which are mutations in the genes encoding surfactant protein (SP)-B, SP-C, thyroid transcription factor 1, ATP-binding cassette protein 3, and the granulocyte-macrophage colony-stimulating factor (GM-CSF) receptor α- and β- chains. PAP may also be a manifestation of rheumatological and metabolic disease, congenital immunodeficiency, and haematological malignancy. Precise diagnosis of the underlying cause is essential in planning treatment, as well as for genetic counselling. The evidence base for treatment is poor. Some forms of PAP respond well to whole-lung lavage, and autoimmune PAP, which is much commoner in adults, responds to inhaled or subcutaneous GM-CSF. Emerging therapies based on studies in murine models of PAP include stem-cell transplantation for GM-CSF receptor mutations. EDUCATIONAL AIMS To understand when to suspect that a child has pulmonary alveolar proteinosis (PAP) and how to confirm that this is the cause of the presentation.To show that PAP is an umbrella term for conditions characterised by alveolar filling by normal or abnormal surfactant, and that this term is the start, not the end, of the diagnostic journey.To review the developmental differences in the spectrum of conditions that may cause PAP, and specifically to understand the differences between causes in adults and children.To discuss when to treat PAP with whole-lung lavage and/or granulocyte-macrophage colony-stimulating factor, and review potential promising new therapies.
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Affiliation(s)
- Andrew Bush
- Imperial College, London, UK
- Royal Brompton Harefield NHS Foundation Trust, London, UK
| | - Rishi Pabary
- Imperial College, London, UK
- Royal Brompton Harefield NHS Foundation Trust, London, UK
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263
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E-vapor aerosols do not compromise bone integrity relative to cigarette smoke after 6-month inhalation in an ApoE -/- mouse model. Arch Toxicol 2020; 94:2163-2177. [PMID: 32409933 PMCID: PMC7303066 DOI: 10.1007/s00204-020-02769-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/30/2020] [Indexed: 12/12/2022]
Abstract
Cigarette smoke (CS) exposure is one of the leading risk factors for human health. Nicotine-containing inhalable products, such as e-cigarettes, can effectively support tobacco harm reduction approaches. However, there are limited comparative data on the effects of the aerosols generated from electronic vapor products (e-vapor) and CS on bone. Here, we report the effects of e-vapor aerosols and CS on bone morphology, structure, and strength in a 6-month inhalation study. Eight-week-old ApoE-/- mice were exposed to aerosols from three different e-vapor formulations-CARRIER (propylene glycol and vegetable glycerol), BASE (CARRIER and nicotine), TEST (BASE and flavor)-to CS from 3R4F reference cigarettes at matched nicotine concentrations (35 µg/L) or to fresh air (Sham) (N = 10 per group). Tibiae were analyzed for bone morphology by µCT imaging, biomechanics by three-point bending, and by histological analysis. CS inhalation caused a significant decrease in cortical and total bone volume fraction and bone density relative to e-vapor aerosols. Additionally, CS exposure caused a decrease in ultimate load and stiffness. In contrast, bone structural and biomechanical parameters were not significantly affected by e-vapor aerosol or Sham exposure. At the dissection time point, there was no significant difference in body weight or tibia bone weight or length among the groups. Histological findings revealed microcracks in cortical bone areas among all exposed groups compared to Sham control. In conclusion, because of the bone-preserving effect of e-vapor aerosols relative to CS exposure, e-vapor products could potentially constitute less harmful alternatives to cigarettes in situations in which bone health is of importance.
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264
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Li D, Croft DP, Ossip DJ, Xie Z. Are Vapers More Susceptible to COVID-19 Infection? MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.05.05.20092379. [PMID: 32511560 PMCID: PMC7274241 DOI: 10.1101/2020.05.05.20092379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was declared a global pandemic in March 2020. Electronic cigarette use (vaping) rapidly gained popularity in the US in recent years. Whether electronic cigarette users (vapers) are more susceptible to COVID-19 infection is unknown. Methods Using integrated data in each US state from the 2018 Behavioral Risk Factor Surveillance System (BRFSS), United States Census Bureau and the 1Point3Acres.com website, generalized estimating equation (GEE) models with negative binomial distribution assumption and log link functions were used to examine the association of weighted proportions of vapers with number of COVID-19 infections and deaths in the US. Results The weighted proportion of vapers who used e-cigarettes every day or some days ranged from 2.86% to 6.42% for US states. Statistically significant associations were observed between the weighted proportion of vapers and number of COVID-19 infected cases as well as COVID-19 deaths in the US after adjusting for the weighted proportion of smokers and other significant covariates in the GEE models. With every one percent increase in weighted proportion of vapers in each state, the number of COVID-19 infected cases increase by 0.3139 (95% CI: 0.0554 - 0.5723) and the number of COVID-19 deaths increase by 0.3705 (95% CI: 0.0623 - 0.6786) in log scale in each US state. Conclusions The positive associations between the proportion of vapers and the number of COVID-19 infected cases and deaths in each US state suggest an increased susceptibility of vapers to COVID-19 infections and deaths.
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265
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Affiliation(s)
- Claudio Nardiello
- Department of Lung Development and Remodeling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
- Department of Internal Medicine (Pulmonology), University of Giessen and Marburg Lung Center (UGMLC), member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Rory E Morty
- Department of Lung Development and Remodeling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
- Department of Internal Medicine (Pulmonology), University of Giessen and Marburg Lung Center (UGMLC), member of the German Center for Lung Research (DZL), Giessen, Germany
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266
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Young SE, Henderson CA, Couperus KS. The Effects of Electronic Nicotine Delivery Systems on Athletes. Curr Sports Med Rep 2020; 19:146-150. [PMID: 32282460 DOI: 10.1249/jsr.0000000000000705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The rapid rise in popularity of Electronic Nicotine Delivery Systems (ENDS), or vaping, has not eluded the athletic population. Increasing use of youth sports participants, as well as collegiate and professionals, means sports medicine providers and coaches alike should be familiar with the effects of these devices. Current evidence demonstrates an impact on both the cardiovascular and pulmonary systems. These effects appear less significant than smoking tobacco cigarettes, but the extent and longevity of the consequences of ENDS use is unclear. Mechanisms for recovery, such as sleep and injury healing, also are affected. Lastly, the emergence of life-threatening pulmonary disease associated with ENDS use may have devastating effects on an athlete. This article will highlight the recent literature on the impact of ENDS on athletes and athletic performance, as well as the potentially life-threatening consequences of use.
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267
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Patanavanich R, Glantz SA. Smoking is Associated with COVID-19 Progression: A Meta-Analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.04.13.20063669. [PMID: 32511645 PMCID: PMC7277001 DOI: 10.1101/2020.04.13.20063669] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To determine the association between smoking and progression of COVID-19. DESIGN A meta-analysis of 12 published papers. DATA SOURCE PubMed database was searched on April 6, 2020. ELIGIBILITY CRITERIA AND DATA ANALYSIS We included studies reporting smoking behavior of COVID-19 patients and progression of disease. Search terms included smoking, smoker*, characteristics, risk factors, outcomes, and COVID-19, COVID, coronavirus, sar cov-2, sar cov 2. There were no language limitations. One author extracted information for each study, screened the abstract or the full text, with questions resolved through discussion among both authors. A random effects meta-analysis was applied. MAIN OUTCOME MEASURES The study outcome was progression of COVID-19 among people who already had the disease. RESULTS We identified 12 papers with a total of 9,025 COVID-19 patients, 878 (9.7%) with severe disease and 495 with a history of smoking (5.5%). The meta-analysis showed a significant association between smoking and progression of COVID-19 (OR 2.25, 95% CI 1.49-3.39, p=0.001). Limitations in the 12 papers suggest that the actual risk of smoking may be higher. CONCLUSIONS Smoking is a risk factor for progression of COVID-19, with smokers having higher odds of COVID-19 progression than never smokers. Physicians and public health professionals should collect data on smoking as part of clinical management and add smoking cessation to the list of practices to blunt the COVID-19 pandemic.
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268
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Abstract
E-cigarette or vaping product use-associated lung injury is a recently recognised, acute pulmonary syndrome which has been reported (particularly from June to October 2019) throughout the USA, but not in Europe (although one probable case, in the UK, has been reported; Medicines and Healthcare products Regulatory Agency, 2020). It presents acutely, most often in young men, as severe pulmonary consolidation, usually with respiratory failure. The mortality is around 2%. The cause(s) are unknown, but it is associated with vaping, particularly using unlicensed cannabis-containing products with tetrahydrocannabinol. Vitamin E acetate, often present in tetrahydrocannabinol-containing vape products as a solvent, has been implicated, as it has been identified in the bronchoalveolar lavage fluid of patients with e-cigarette or vaping product use-associated lung injury. This article reviews the recent literature, including clinical features, presentation and investigations, and possible mechanisms, in the context of vaping practices in the USA and the UK.
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Affiliation(s)
- Philip W Ind
- Department of Respiratory Medicine, Hammersmith Hospital, Imperial College Healthcare Trust, Imperial College London, London, UK
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269
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Tzortzi A, Kapetanstrataki M, Evangelopoulou V, Behrakis P. A Systematic Literature Review of E-Cigarette-Related Illness and Injury: Not Just for the Respirologist. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2248. [PMID: 32230711 PMCID: PMC7177608 DOI: 10.3390/ijerph17072248] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/20/2020] [Accepted: 03/25/2020] [Indexed: 12/13/2022]
Abstract
Following the recent electronic cigarette (e-cigarette) illness outbreak, the current review aimed to collect all related clinical cases for study and analysis and provide a critical synopsis of the proposed injury mechanism. Adhering to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines, e-cigarette-related clinical cases were identified via Google Scholar and PubMed databases. Additionally, references of published case reports and previous review papers were manually searched, revealing 159 publications presenting e-cigarette-related case reports and 19 reports by the Centers for Disease Control and Prevention. 238 individual cases were identified; 53% traumatic injuries due to e-cigarette explosion or self-combustion, 24% respiratory cases, and 12% poisonings. Additional cases pertained to oral, cardiovascular, immunologic, hematologic, allergic reactions, infant complications, and altered medication levels. Case reports were mainly published between 2016-2019 (78%). The oldest case, a lipoid pneumonia, was published in 2012. The current review showed that e-cigarette-related health effects extend beyond the acute lung injury syndrome, including traumatic, thermal injuries and acute intoxications. Physicians should be aware of the distinct clinical presentations and be trained to respond and treat effectively. Regulators and public health authorities should address the regulatory gap regarding electronic nicotine delivery systems (ENDS) and novel tobacco products.
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Affiliation(s)
- Anna Tzortzi
- George D. Behrakis Research Lab, Hellenic Cancer Society, 17B Ipitou Street, 10557 Athens, Greece; (V.E.); (P.B.)
- Institute of Public Health, The American College of Greece, 17B Ipitou Street, 10557 Athens, Greece
| | - Melpo Kapetanstrataki
- George D. Behrakis Research Lab, Hellenic Cancer Society, 17B Ipitou Street, 10557 Athens, Greece; (V.E.); (P.B.)
| | - Vaso Evangelopoulou
- George D. Behrakis Research Lab, Hellenic Cancer Society, 17B Ipitou Street, 10557 Athens, Greece; (V.E.); (P.B.)
| | - Panagiotis Behrakis
- George D. Behrakis Research Lab, Hellenic Cancer Society, 17B Ipitou Street, 10557 Athens, Greece; (V.E.); (P.B.)
- Institute of Public Health, The American College of Greece, 17B Ipitou Street, 10557 Athens, Greece
- Pulmonary Department, Athens Medical Center, Distomou 5-7, Marousi, 15125 Athens, Greece
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270
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Ahmed W, Marin-Gomez X, Vidal-Alaball J. Contextualising the 2019 E-Cigarette Health Scare: Insights from Twitter. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072236. [PMID: 32225020 PMCID: PMC7177596 DOI: 10.3390/ijerph17072236] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/24/2020] [Accepted: 03/26/2020] [Indexed: 11/16/2022]
Abstract
A health scare can be described as a campaign that attempts to alert the public of a particular substance or activity that can lead to a negative effect on health. A recent health scare to emerge relates to the health hazards associated with the use of e-cigarettes, which has caused widespread debate, which peaked towards the end of 2019. Health scares need to be studied in the context in which they occur, and one method of studying them is through social media. This paper identifies two key topics of discussion on Twitter, which consisted of pro-vaping and anti-vaping views. The paper then identifies influential users, frequently occurring words, hashtags, and websites related to this time period in order to gain insight into e-cigarette perceptions. The paper then reviews current scientific evidence and develops a flowchart for the general public, which can be used to for public reassurance and guidance.
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Affiliation(s)
- Wasim Ahmed
- Newcastle University Business School, Newcastle University, 5 Barrack Rd, Newcastle upon Tyne NE1 4SE, UK
- Correspondence:
| | - Xavier Marin-Gomez
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, 08272 Sant Fruitós de Bages, Spain; (X.M.-G.); (J.V.-A.)
- Servei d’Atenció Primària d’Osona, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, 08500 Vic, Spain
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, 08272 Sant Fruitós de Bages, Spain; (X.M.-G.); (J.V.-A.)
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08272 Sant Fruitós de Bages, Spain
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271
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Zhang Q, Fan X, Yue Y, Zheng R. Electronic cigarettes: Emerging trends and research hotspots. Tob Induc Dis 2020; 18:16. [PMID: 32256280 PMCID: PMC7107908 DOI: 10.18332/tid/118719] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/06/2020] [Accepted: 03/03/2020] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Research on electronic cigarettes is an emerging field, with the number of articles in this field noted to have grown exponentially over recent years. We used a bibliometric analysis method (co-word analysis) to analyze the emerging trends and research hotspots in this field. METHODS Publication data on electronic cigarettes from 2010 to 2018 were retrieved and downloaded from the PubMed database. Theme trends and knowledge structures were analyzed on the relevant research fields of electronic cigarettes by using a biclustering analysis, strategic diagram analysis, and social network analysis methods. Research hotspots were extracted and compared from three periods. RESULTS Core topics that have continuously develop between the years 2010 and 2018 include: tobacco use cessation devices; tobacco products; tobacco use cessation devices/adverse effects; smoking prevention and adverse effects; electronic nicotine delivery systems/economics; and public health. Some currently undeveloped topics that could be considered as new future research directions include: tobacco use disorder/therapy; tobacco use disorder/epidemiology; students/psychology; students/statistics and numerical data; adolescent behavior/psychology; nicotine/toxicity; nicotinic agonists/administration and dosage; and electronic nicotine delivery systems/legislation and jurisprudence. CONCLUSIONS Results suggest that some currently immature topics in strategic coordinates and emerging hotspots in social network graphs can be used as future research directions.
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Affiliation(s)
- Qiang Zhang
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xinyue Fan
- Student Affairs Department, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yuanyi Yue
- Department of Gastroenterology Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Rui Zheng
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China
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272
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Härkänen T, Kuulasmaa K, Sares-Jäske L, Jousilahti P, Peltonen M, Borodulin K, Knekt P, Koskinen S. Estimating expected life-years and risk factor associations with mortality in Finland: cohort study. BMJ Open 2020; 10:e033741. [PMID: 32152164 PMCID: PMC7064132 DOI: 10.1136/bmjopen-2019-033741] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 01/21/2020] [Accepted: 01/24/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To develop a tool to inform individuals and general practitioners about benefits of lifestyle changes by providing estimates of the expected age of death (EAD) for different risk factor values, and for those who plan and decide on preventive activities and health services at population level, to calculate potential need for these. DESIGN Prospective cohort study to estimate EAD using a model with 27 established risk factors, categorised into four groups: (1) sociodemographic background and medical history, (2) lifestyles, (3) life satisfaction, and (4) biological risk factors. We apply a Poisson regression model on the survival data split into 1-year intervals. PARTICIPANTS Total of 38 549 participants aged 25-74 years at baseline of the National FINRISK Study between 1987 and 2007. PRIMARY OUTCOME MEASURES Register-based comprehensive mortality data from 1987 to 2014 with an average follow-up time of 16 years and 4310 deaths. RESULTS Almost all risk factors included in the model were statistically significantly associated with death. The largest influence on the EAD appeared to be a current heavy smoker versus a never smoker as the EAD for a 30-year-old man decreased from 86.8 years, which corresponds to the reference values of the risk factors, to 80.2 years. Diabetes decreased EAD by >6.6 years. Whole or full milk consumers had 3.4 years lower EAD compared with those consuming skimmed milk. Physically inactive men had 2.4 years lower EAD than those with high activity. Men who found their life almost unbearable due to stress had 2.8 years lower EAD. CONCLUSIONS The biological risk factors and lifestyles, and the factors connected with life satisfaction were clearly associated with EAD. Our model for estimating a person's EAD can be used to motivate lifestyle changes.
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Affiliation(s)
- Tommi Härkänen
- Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Kari Kuulasmaa
- Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Laura Sares-Jäske
- Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Pekka Jousilahti
- Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Markku Peltonen
- Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Katja Borodulin
- Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
- Age Institute, Helsinki, Finland
| | - Paul Knekt
- Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Seppo Koskinen
- Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
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273
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Vallone DM, Cuccia AF, Briggs J, Xiao H, Schillo BA, Hair EC. Electronic Cigarette and JUUL Use Among Adolescents and Young Adults. JAMA Pediatr 2020; 174:277-286. [PMID: 31961395 PMCID: PMC6990671 DOI: 10.1001/jamapediatrics.2019.5436] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
IMPORTANCE The increasing use rates of electronic cigarettes (e-cigarettes) among young people in the United States have been largely associated with the emergence of high-nicotine-delivery device JUUL. Relevant data are needed to monitor e-cigarette, specifically JUUL, use to help inform intervention efforts. OBJECTIVE To estimate the prevalence, patterns, and factors associated over time with e-cigarette use among adolescents and younger adults in the United States. DESIGN, SETTING, AND PARTICIPANTS Two nationally representative longitudinal samples of adolescents and younger adults aged 15 to 34 years were drawn from the Truth Longitudinal Cohort, a national, probability-based cohort. Participants in this cohort were recruited through address-based sampling, and subsamples were recruited from a probability-based online panel. The present cohort study used data from follow-up online surveys, specifically, wave 7 (N = 14 379; collected from February 15, 2018, to May 25, 2018) and wave 8 (N = 12 114; collected from February 10, 2019, to May 17, 2019). Respondents reported their use of e-cigarettes, JUUL, and combustible tobacco products as well as their harm perceptions, household smoking status, sensation-seeking, friends' e-cigarette use, and demographic information. MAIN OUTCOMES AND MEASURES The main outcomes were ever and current (past 30 days) JUUL use. χ2 Analyses assessed differences in JUUL use by psychosocial and demographic characteristics. Logistic regression models identified the significant factors associated with wave 8 ever and current JUUL use among wave 7 e-cigarette-naive participants. RESULTS A total of 14 379 participants (mean [SD] age, 24.3 [0.09] years; 8142 female [51.0%]) were included in wave 7 and 12 114 (mean [SD] age, 24.5 [0.10] years; 6835 female [50.1%]) in wave 8. JUUL use statistically significantly increased from wave 7 to wave 8 among ever users (6.0% [n = 1105] to 13.5% [2111]; P < .001) and current users (3.3% [680] to 6.1% [993]; P < .001). JUUL use increased among every age group and was highest among those aged 18 to 20 years (23.9% [491] ever users and 12.8% [340] current users) and 21 to 24 years (18.1% [360] ever users and 8.2% [207] current users). Users reported a higher prevalence of frequent use in wave 8 compared with wave 7 (37.6% vs 26.1%; P < .01). Significant factors associated with future JUUL use among e-cigarette-naive participants included younger age, combustible tobacco use, lower harm perceptions, sensation seeking, and friends' e-cigarette use. CONCLUSIONS AND RELEVANCE This study found that the e-cigarette device JUUL appears to be associated with the youth e-cigarette epidemic, attracting new users and facilitating frequent use with their highly addictive nicotine content and appealing flavors. Findings of this study underscore the critical need for increased e-cigarette product regulation at the federal, state, and local levels.
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Affiliation(s)
- Donna M. Vallone
- Schroeder Institute, Truth Initiative, Washington, District of Columbia,Bloomberg School of Public Health, Department of Health, Behavior, and Society, Johns Hopkins University, Baltimore, Maryland,College of Global Public Health, New York University, New York
| | - Alison F. Cuccia
- Schroeder Institute, Truth Initiative, Washington, District of Columbia
| | - Jodie Briggs
- Schroeder Institute, Truth Initiative, Washington, District of Columbia
| | - Haijun Xiao
- Schroeder Institute, Truth Initiative, Washington, District of Columbia
| | | | - Elizabeth C. Hair
- Schroeder Institute, Truth Initiative, Washington, District of Columbia,Bloomberg School of Public Health, Department of Health, Behavior, and Society, Johns Hopkins University, Baltimore, Maryland
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274
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Erku D, Gartner CE, Morphett K, Snoswell CL, Steadman KJ. Nicotine vaping products as a harm reduction tool among smokers: Review of evidence and implications for pharmacy practice. Res Social Adm Pharm 2020; 16:1272-1278. [PMID: 32061550 DOI: 10.1016/j.sapharm.2020.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 02/06/2020] [Indexed: 12/26/2022]
Abstract
With the growing popularity and use of nicotine vaping products (NVPs, also known as e-cigarettes) as a way to quit smoking, pharmacy staff are frequently asked by smokers for advice about NVPs. In Australia, there are currently no clear guidelines or policy statements provided by any of the professional organisations for pharmacists on how they should handle customer enquiries about NVPs, or on extemporaneous compounding of prescriptions for nicotine solution for use in NVPs as a smoking cessation aid. This commentary summarises the current evidence surrounding the safety and efficacy of NVPs, the Australian regulatory landscape, and provides a guide for pharmacy staff to use in discussions with customers regarding NVPs. Evidence strongly points to NVPs being considerably less harmful than smoking tobacco cigarettes and that they can be effective for smoking cessation. The maximum benefit from using NVPs as a harm reduction tool, however, will only be realised if smokers completely stop smoking rather than using NVPs as a partial substitute, because even low level smoking still confers substantial health risk. Vaping products containing nicotine are illegal to sell in Australia but users can still legally access nicotine e-liquid through some limited pathways if they hold a valid prescription from a registered medical practitioner. It is important that pharmacy staff keep abreast of the current evidence surrounding these products and provide evidence-based advice to customers.
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Affiliation(s)
- Daniel Erku
- 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.
| | - Kylie Morphett
- School of Public Health, The University of Queensland, Herston Road, Herston, 4006, Queensland, Australia.
| | - Centaine L Snoswell
- School of Pharmacy, The University of Queensland, 20 Cornwall Street, Woolloongabba, 4102, Queensland, Australia; Centre for Health Services Research, The University of Queensland, Princess Alexandra Hospital, Brisbane, Qld, 4102, Australia.
| | - Kathryn J Steadman
- School of Pharmacy, The University of Queensland, 20 Cornwall Street, Woolloongabba, 4102, Queensland, Australia.
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275
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Schupp JC, Prasse A, Erythropel HC. [E-Cigarettes - Operating Principle, Ingredients, and Associated Acute Lung Injury]. Pneumologie 2020; 74:77-87. [PMID: 32016924 DOI: 10.1055/a-1078-8126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Beginning in April of 2019, the US saw > 2,000 cases of hospitalized, often young, patients with severe acute lung injury, of which over 40 died, and the only existing connection between patients was their use of electronic cigarettes (e-cigarettes). The acronym EVALI ("e-cigarette, or vaping, product use associated lung injury") has since been established for the condition. This review article is intended to provide an overview of recent, mainly US literature on EVALI, including the case definition, epidemiology, clinical presentation, typical disease progression, as well as potential triggers. Ancillary to this, the review further provides a general overview of the basic function of e-cigarettes, the ingredients of the liquids used in these (e-liquids), as well as a brief description of the associated potential inhalation risks.
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Affiliation(s)
- J C Schupp
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT, USA
| | - A Prasse
- Klinik für Pneumologie, Medizinische Hochschule Hannover, und Fraunhofer ITEM, DZL BREATH, Hannover, Deutschland
| | - H C Erythropel
- Dept. of Chemical & Environmental Engineering, Yale University, New Haven, CT, USA.,Yale Tobacco Center of Regulatory Science, Dept. Of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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276
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Davis DR, Fucito LM, Kong G, Jackson A, Bold KW, Baldassarri SR, Krishnan-Sarin S, O'Malley SS. Adapting Research Protocols in Response to E-Cigarette, or Vaping, Product Use Associated Lung Injury: A Response to CDC Recommendations for E-Cigarette Trials. Nicotine Tob Res 2020; 23:619-620. [PMID: 31903483 DOI: 10.1093/ntr/ntaa002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/02/2020] [Indexed: 11/13/2022]
Affiliation(s)
- Danielle R Davis
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Lisa M Fucito
- Department of Psychiatry, Yale School of Medicine, New Haven, CT.,Yale Cancer Center, Smilow Cancer Hospital at Yale, New Haven, CT
| | - Grace Kong
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Asti Jackson
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Krysten W Bold
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Stephen R Baldassarri
- Department of Internal Medicine, Section of Pulmonary, Critical Care, & Sleep Medicine, Yale School of Medicine, New Haven, CT
| | | | - Stephanie S O'Malley
- Department of Psychiatry, Yale School of Medicine, New Haven, CT.,Yale Cancer Center, Smilow Cancer Hospital at Yale, New Haven, CT
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277
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Gaiha SM, Halpern-Felsher B. Escalating Safety Concerns Are Not Changing Adolescent E-Cigarette Use Patterns: The Possible Role of Adolescent Mental Health. J Adolesc Health 2020; 66:3-5. [PMID: 31866056 PMCID: PMC7012649 DOI: 10.1016/j.jadohealth.2019.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 10/21/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Shivani Mathur Gaiha
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, California
| | - Bonnie Halpern-Felsher
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, California
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278
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The vaping phenomenon – knowing the risks of consuming electronic cigarettes in teenagers. PEDIATRU.RO 2020. [DOI: 10.26416/pedi.59.3.2020.3898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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279
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Cho HJ. Comparison of the risks of combustible cigarettes, e-cigarettes, and heated tobacco products. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2020. [DOI: 10.5124/jkma.2020.63.2.96] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Hong-Jun Cho
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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280
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Underner M, Perriot J, Peiffer G, Jaafari N. [Electronic cigarette use and asthma in adolescents]. Rev Mal Respir 2019; 37:91-92. [PMID: 31864880 DOI: 10.1016/j.rmr.2019.11.644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 11/07/2019] [Indexed: 02/05/2023]
Affiliation(s)
- M Underner
- Unité de recherche clinique, centre hospitalier Henri-Laborit, université de Poitiers, 370, avenue Jacques-Cœur, CS 10587, 86021 Poitiers, France.
| | - J Perriot
- Centre de tabacologie, Dispensaire Émile-Roux, 63100 Clermont-Ferrand, France
| | - G Peiffer
- Service de pneumologie, CHR de Metz-Thionville, 57038 Metz, France
| | - N Jaafari
- Unité de recherche clinique, centre hospitalier Henri-Laborit, université de Poitiers, 370, avenue Jacques-Cœur, CS 10587, 86021 Poitiers, France
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281
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Boudi FB, Patel S, Boudi A, Chan C. Vitamin E Acetate as a Plausible Cause of Acute Vaping-related Illness. Cureus 2019; 11:e6350. [PMID: 31938636 PMCID: PMC6952050 DOI: 10.7759/cureus.6350] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The United States Federal Centers for Disease Control and Prevention (CDC) has been working with state investigators on reported cases of lung illnesses linked to e-cigarette or vaping products. Symptoms of difficulty breathing, shortness of breath, chest pains, gastrointestinal sickness leading to serious lung damage and death has been linked to the risk behavior of using vaping products bought on the streets in healthy young people. CDC has detected vitamin E acetate as a chemical of concern among people with the lung injury. Vitamin E acetate is a condensing agent in vaping products, and all injured lung fluid samples appear to harbor this agent. The mysterious outbreak is identified in individuals vaping within the 90 days, ranging over a few days to developing over several weeks. There is growing evidence that vaping is hazardous to your health including immediate health dangers such as death from respiratory causes, long term health effects, cardiovascular events, depression which increases the risk of suicidal thoughts and suicide. This review article summarizes the growing knowledge of acute respiratory complications associated with vaping.
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Affiliation(s)
- F Brian Boudi
- Cardiology, University of Arizona College of Medicine, Phoenix, USA
| | - Sonia Patel
- Psychology, Arizona State University, Phoenix, USA
| | - Ava Boudi
- Miscellaneous, Arizona State University, Phoenix, USA
| | - Connie Chan
- Internal Medicine, University of Arizona College of Medicine, Phoenix, USA
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282
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Theron AJ, Feldman C, Richards GA, Tintinger GR, Anderson R. Electronic cigarettes: where to from here? J Thorac Dis 2019; 11:5572-5585. [PMID: 32030277 DOI: 10.21037/jtd.2019.11.82] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Although the usage of electronic (e)-cigarettes (EC) and similar devices has gained in popularity as an apparent smoking cessation strategy, serious concerns are emerging in relation to both the efficacy of this strategy, as well as the inappropriate use of these devices. While the comparative safety of e-cigarettes is based on the reasonable contention that the levels of inhaled toxicants present in the aerosols generated by these devices are considerably lower than those present in tobacco smoke, the perception that they are indeed relatively risk-free is being challenged on several fronts. Notwithstanding lack of convincing evidence of efficacy as a superior smoking cessation strategy, foremost among emerging concerns is the increasing use of electronic nicotine-delivery devices by young never-smokers. Other concerns include increasing levels of sophistication in the design and capacity of these devices in relation to nicotine content and delivery, the potential threat of manipulation of the contents of e-liquids, as well as other additives such as illicit drugs and other potentially toxic agents that can be vaporised. These issues, together with the potential risks to respiratory health, specifically "e-cigarette or vaping product use-associated lung injury" represent the major thrusts of this review.
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Affiliation(s)
- Annette J Theron
- Department Immunology and Institute for Cellular and Molecular Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Charles Feldman
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Guy A Richards
- Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gregory R Tintinger
- Department of Internal Medicine, Steve Biko Academic Hospital and Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Ronald Anderson
- Department Immunology and Institute for Cellular and Molecular Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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