Trends and sociodemographic factors of e‐cigarette use among adult daily smokers in South Korea

Oral health status, self-perceptions, and risk awareness among young adult users of electronic cigarettes in Pakistan

INTRODUCTION

The use of electronic cigarettes (ECs) has surged globally, particularly among young individuals. This study aimed to assess the perceptions of vaping-related oral health risks, clinical oral health status, and self-perceived dental and periodontal conditions among young adult users of ECs in Pakistan.

METHODS

A cross-sectional study was conducted from June 2023 to March 2024, recruiting 142 young users of ECs. Intraoral examinations assessed Decayed, Missing, and Filled Teeth (DMFT) index, Oral Hygiene Index Simplified (OHI-S), Gingival Bleeding Index (GBI), Plaque Index (PI), and dental stain. Data on sociodemographic characteristics, oral health behaviors, vaping habits, and perceptions of impact of vaping on oral health were gathered through a self-administered questionnaire. Associations between EC use and various oral health variables were analyzed using the chi-squared and Fisher's exact tests.

RESULTS

Mean DMFT was 5.66 (SD=2.20). Poor oral hygiene (29.6%) and severe dental staining were prevalent. Most participants (76.1%) brushed once daily, while only 34.5% attended regular dental check-ups. Gingival bleeding and plaque accumulation were observed in 47.2% and 35.3% of participants. Around 66% reported daily EC use, with 80.3% initiating vaping before the age of 18 years. Most common reason for vaping was perception that ECs are safer than traditional smoking (31.7%). Participants' perceptions of vaping-related oral health risks were relatively low, with 45% associating vaping with tooth decay, 48% with gum disease, and 58.5% with tooth staining. Tooth brushing frequency, vaping frequency (per day), and time since vaping started, were significantly associated with oral clinical indicators (p<0.05). The education level was the only variable significantly associated with vaping-related risk perception (p<0.05).

CONCLUSIONS

The study reveals that oral health awareness among young vapers is low, with many starting EC use at a young age and exhibiting poor oral health behaviors. Misconceptions about the safety of ECs compared to conventional cigarettes may contribute to increased vaping.

Impact of electronic cigarette use on the increased risk of diabetes: the Korean Community Health Survey

OBJECTIVES

Only a few studies have solely investigated the health impacts of electronic cigarettes on diabetes while considering the impact of conventional cigarettes. Therefore, this study aimed to examine the effect of electronic cigarette smoking on diabetes in Korean dual smokers, electronic cigarette smokers, conventional cigarette smokers, and non-smokers.

METHODS

Data were obtained from the 2021 and 2022 Korean Community Health Surveys of 460,603 Korean adults. The main independent variable was smoking behavior. Participants were categorized according to their smoking behavior, as dual smokers, electronic cigarette smokers, conventional cigarette smokers, and non-smokers. The dependent variable, the presence of diabetes, was defined by a doctor's diagnosis. Multiple logistic regression analysis was performed to examine the association between smoking behavior and diabetes. Subgroup analyses were also performed to investigate the associations among different socioeconomic groups.

RESULTS

Conventional cigarette smokers had a higher risk of diabetes than did non-smokers (adjusted odds ratio [aOR], 1.22; 95% confidence interval [CI], 1.19 to 1.26). More importantly, those who only vaped electronic cigarettes were at high risk of diabetes (aOR, 1.15; 95% CI, 1.01 to 1.31). Lastly, dual smokers had the highest aOR for diabetes among other smoking behavior groups (aOR, 1.39; 95% CI, 1.22 to 1.58). Dual smoking was associated with the highest risk of diabetes in most subgroups.

CONCLUSIONS

This study suggests that conventional cigarette use and smoking electronic cigarettes negatively impact diabetes, and using both types leads to worse health outcomes. Therefore, cessation of all types of smoking is necessary for a healthy life.

Comparative study of lung toxicity of E-cigarette ingredients to investigate E-cigarette or vaping product associated lung injury

No comparative study has yet been performed on the respiratory effects of individual E-cigarette ingredients. Here, lung toxicity of individual ingredients of E-cigarette products containing nicotine or tetrahydrocannabinol was investigated. Mice were intratracheally administered propylene glycol (PG), vegetable glycerin (VG), vitamin E acetate (VEA), or nicotine individually for two weeks. Cytological and histological changes were noticed in PG- and VEA-treated mice that exhibited pathophysiological changes which were associated with symptoms seen in patients with symptoms of E-cigarette or Vaping Use-Associated Lung Injuries (EVALI) or E-cigarette users. Compared to potential human exposure situations, while the VEA exposure condition was similar to the dose equivalent of VEA content in E-cigarettes, the PG condition was about 47-137 times higher than the dose equivalent of the daily PG intake of E-cigarette users. These results reveal that VEA exposure is much more likely to cause problems related to EVALI in humans than PG. Transcriptomic analysis revealed that PG exposure was associated with fibrotic lung injury via the AKT signaling pathway and M2 macrophage polarization, and VEA exposure was associated with asthmatic airway inflammation via the mitogen-activated protein kinase signaling pathway. This study provides novel insights into the pathophysiological effects of individual ingredients of E-cigarettes.

The prevalence of electronic cigarettes vaping globally: a systematic review and meta-analysis

BACKGROUND

The purpose of this systematic review study was to determine the national, regional, and global prevalence of electronic cigarettes (e-cigarettes) vaping.

METHOD

The articles were searched in July 2020 without a time limit in Web of Science (ISI), Scopus, PubMed, and Ovid-MEDLINE. At first, the titles and abstracts of the articles were reviewed, and if they were appropriate, they entered the second stage of screening. In the second stage, the whole articles were reviewed and articles that met the inclusion criteria were selected. In this study, search, selection of studies, qualitative evaluation, and data extraction were performed by two authors independently, and any disagreement between the two authors was reviewed and corrected by a third author.

RESULTS

In this study, the lifetime and current prevalence of e-cigarettes vaping globally were 23% and 11%, respectively. Lifetime and current prevalence of e-cigarettes vaping in women were 16% and 8%, respectively. Also, lifetime and current prevalence of e-cigarettes vaping in men were 22% and 12%, respectively. In this study, the current prevalence of e-cigarettes vaping in who had lifetime smoked conventional cigarette was 39%, and in current smokers was 43%. The lifetime prevalence of e-cigarettes vaping in the Continents of America, Europe, Asia, and Oceania were 24%, 26%, 16%, and 25%, respectively. The current prevalence of e-cigarettes vaping in the Continents of America, Europe, Asia, and Oceania were 10%, 14%, 11%, and 6%, respectively.

CONCLUSIONS

Based on the results of this study, it can be concluded that the popularity of e-cigarettes is increasing globally. Therefore, it is necessary for countries to have more control over the consumption and distribution of e-cigarettes, as well as to formulate the laws prohibiting about the e-cigarettes vaping in public places. There is also a need to design and conduct information campaigns to increase community awareness about e-cigarettes vaping.

Awareness About and E-Cigarette Use Among Adults in 15 Low- and Middle-Income Countries, 2014-2018 Estimates From Global Adult Tobacco Surveys

INTRODUCTION

E-cigarette (EC) use is seldom reported from low- and middle-income countries (LMICs). We report the prevalence of "awareness" about EC, its use, and distribution of EC use by sociodemographic factors and cigarette smoking (CS) status.

AIMS AND METHODS

We analyzed Global Adult Tobacco Survey data in Bangladesh, China, Costa Rica, Ethiopia, India, Kazakhstan, Mexico, Philippines, Romania, Russia, Senegal, Ukraine, Turkey, Uruguay, and Viet Nam during 2014-2018. The weighted prevalence of "awareness" (heard about), "ever" (even once), and "current" (daily/nondaily) EC use among never, current, and former cigarette smokers and quit ratios (past smokers/ever smokers) was estimated. Association of EC use with sociodemographic, and CS, was explored by multilevel regression.

RESULTS

Overall, prevalence of "awareness," "ever," and "current" ECs use was 19.3% (95% confidence interval [CI] 27.4, 31.1), 2.6% (95% CI 2.4, 2.8), and 0.7% (95% CI 0.6, 0.8), respectively. In most countries, "ever use" <10%, and "current use" was about 1% except Romania (4.4%) and Russia (3.5%). "Current use" was 0.1%, 2.9%, and 3.1% among never, current, and former smokers, respectively. "Current" and "ever" EC use was higher among current and former than never smokers (2.8% and 3.1% vs. 0.1%; 9.9% and 10.9% vs. 0.7%), respectively. Current EC use was associated with male sex, urban residence and younger age, higher education, and wealth. "Quit attempts" (aOR 1.3, 95% CI 1.2, 1.5) and cigarettes smoked per day (aOR 1.6, 95% CI 1.4, 1.9) were associated with "ever use."

CONCLUSIONS

EC use was low in most countries. "Dual use" was common among current smokers and the quit ratio was higher among ECs users.

IMPLICATIONS

EC use is increasing in high-income countries (HICs) where regulations on ECs are usually permissive. Evidence on the individual- or population-level impact of ECs on CS cessation is inconclusive. Little is known about the prevalence of EC use in LMICs where regulations are nonexistent or less restrictive. Studying the distribution of EC use rates by population subgroups, CS status, and quit ratios for CS among EC users will assist the formulation of EC regulatory policies. We provide comparable nationally representative prevalence estimates of "awareness" about and, use of ECs to serve as a benchmark for future monitoring. EC use was associated with the attempt to quit CS and smoking >10 cigarettes per day. However, "dual use" was common, and the quit ratio for CS was higher among EC users. EC use was very low relative to HICs. Nevertheless, comprehensive EC regulatory policies should be implemented to prevent the escalation of EC use by targeting population subgroups such as young adults, educated and wealthier individuals.

Reasons why Chinese smokers prefer not to use electronic cigarettes

INTRODUCTION

China is the world’s largest e-cigarette manufacturer. It also has the world’s largest smoking population. Although smoking is strongly associated with e-cigarette use, the prevalence of e-cigarette use is low among Chinese smokers compared with smokers in countries such as the US and UK. This study aims to explore the reasons why Chinese smokers prefer not to use e-cigarettes.

METHODS

Cross-sectional data from the Tobacco Questions for Surveys (TQS) conducted in four large Chinese cities (Chengdu, Wuhan, Xiamen, and Xi’an) in 2017–2018 were analyzed. A multi-stage cluster sampling approach was applied to select a representative sample of adults for each city. Weighted percentages and 95% confidence intervals (CIs) were estimated for self-reported reasons why smokers in China had never tried e-cigarettes, in total and by demographic characteristics. Multivariate logistic regression models were used to examine the adjusted associations between the top reasons why smokers never tried e-cigarettes and demographic and socioeconomic characteristics.

RESULTS

The top three reasons that Chinese adult smokers reported for never having tried e-cigarettes were: ‘I do not want to quit smoking’ (35.35%), ‘I do not think they would help me quit or cut down’ (24.31%), and ‘I am not addicted to smoking and don't need help to quit’ (14.93%). Other prominent reasons included: ‘I am concerned they are not safe enough’, and ‘I do not want to substitute one addiction for another’. Generally, there were no statistically significant associations between reasons why smokers never tried e-cigarettes and demographic and socioeconomic characteristics.

CONCLUSIONS

Our results suggest that many Chinese smokers associate e-cigarette use with smoking cessation. Continued monitoring of smokers’ views, beliefs, and risk perceptions regarding e-cigarettes is warranted. Health education campaigns communicating the risks of e-cigarettes are also needed.

Public Health Threat of Tobacco and Substance Use in Asia: An Introduction to the Theme Issue

Tobacco and substance use is a great public health concern in Asia. The prevalence of tobacco smoking, while steadily declined in Western countries over past few decades, has increased in many regions of Asia, especially in low- and middle-income countries. And high-income countries in the region have reported rapid growth rates in e-cigarette use in recent years. Furthermore, illicit drugs, specially cannabis, amphetamines, and opioids, have begun to threaten the health of the people in the region like never before. To better understand the landscape of the two primary public health concerns in Asia, tobacco and substance use, this special issue examines cigarette/e-cigarette use and tobacco control policies for five selected countries (Singapore, China, South Korea, Japan, and Laos People's Democratic Republic); and explores substance use related issues focused on prevention, influencing factors, and policies of three countries (Hon Kong, Malaysia, and India). The research, policy, and clinical implications from this issue will contribute to mitigating the global burden of tobacco and substance use-related public health issues in Asia.