E-cigarettes in Europe: does regulation swing from overcautious to careless?

The use of electronic cigarettes and other tobacco products among university students and their potential relationship with oral health: A cross-sectional study

BACKGROUND

The aim of this study was to evaluate oral alterations among university students and explore possible associations with tobacco consumption in its various forms.

METHODS

A cross-sectional study was conducted in 2 phases: the first phase involved administering an electronic questionnaire to participants determine the prevalence of tobacco use and the second phase involved a physical examination of the participants. The participants were grouped on the basis of their reported habits and compared using statistical analysis (P < .05).

RESULTS

Of the 620 participants, 57.1% reported using tobacco in some form, with 47.4% reporting electronic cigarette (e-cigarette) use. In the clinical phase, comparing the presence of oral changes in tobacco users vs nonusers, e-cigarette users had a higher proportion of white-spot caries lesions (P = .041) and gingivitis (P = .012). When e-cigarette use was combined with other forms of tobacco use, additional oral changes were more prevalent, including coated tongue and nicotinic stomatitis (P < .05).

CONCLUSIONS

The use of alternative forms of tobacco consumption is common among university students, with e-cigarette use being the most prevalent form, and may lead to detrimental effects on the oral cavity, such as caries and gingivitis, particularly when used in conjunction with other tobacco products.

PRACTICAL IMPLICATIONS

The use of tobacco in alternative forms, such as e-cigarettes, can affect oral health directly or indirectly. Dentists should be familiar with the characteristics of this population and the potential oral repercussions associated with tobacco use to address the impact on health and raise awareness of the associated risks.

Comparing the regulation and incentivization of e-cigarettes across 97 countries

E-cigarette use continues to increase globally despite uncertainty regarding their long-term health impacts and around their effectiveness for tobacco smoking cessation. This uncertainty creates unique challenges for governments as they attempt to optimally regulate and positively or negatively incentivize these products in a way that maximizes the public's health. Current approaches to e-cigarette regulation and incentivization fall within a spectrum of options ranging from a singular focus on health protection, whereby policies intend to prevent the dangers of e-cigarettes, to a singular focus on using e-cigarettes for harm reduction, whereby policies intend to reduce the more harmful effects of smoking tobacco. Regulation options include prohibition, component ban, and regulation as medicinal products, poisons, tobacco products, consumer products, and/or unique products. Incentivization options include taxation, subsidization, and providing a financial reward. Through comparative public policy analysis, this study describes, compares and assesses the variety of approaches that 97 countries have taken to regulate and incentivize e-cigarettes. The goal is to inform future decisions by governments on how they approach the public health challenge posed by e-cigarettes, building on a nuanced understanding of the complexities of this challenge and what other jurisdictions have already implemented and learned.

Electronic cigarettes and narghile users in Brazil: Do they differ from cigarettes smokers?

BACKGROUND

Cigarette smoking prevalence is declining, however, other tobacco products have emerged recently, such as electronic cigarettes (e-cigarettes) and narghile (hookah/shisha/waterpipe). Narghile sales are not prohibited in Brazil, but e-cigarettes are. Accurate estimates of such products are key for proper monitoring and control.

OBJECTIVE

To describe the prevalence of e-cigarettes and narghile use and to investigate whether sociodemographic characteristics of individuals who are using these products differ from those who are using manufactured cigarettes.

METHODS

Using a nationally representative sample survey of Brazilians aged 12-65 years in 2015, we estimated the prevalence rates of each tobacco products within the last 12-months, stratified by macro-region, municipality size, sex-at-birth, sexual orientation, color/race, age-group, and monthly income. Multivariable logistic models were fitted to understand determinants of each tobacco product use, considering the complex sample design.

RESULTS

E-cigarette, narghile, and cigarette prevalence rates were estimated at 0.43%, 1.65% and 15.35%, respectively, corresponding to around 0.6million e-cigarette users, 2.5 million narghile users and 23.5 million cigarette users. Non-heterosexual individuals were a most-at-risk group for both e-cigarette/narghile and cigarette use. Despite similarities, e-cigarette/narghile users were younger and had higher socioeconomic status than cigarette users. Additional analyses showed that recent cigarette use seems to be more associated with e-cigarette/narghile use among youth than among adults.

CONCLUSIONS

Our findings may provide valuable information about e-cigarette/narghile use in Brazil. Prevention strategies targeted to youth to both narghile and e-cigarettes use should be implemented together, which might be one strategy to prevent the emergency of a new generation of smokers in Brazil.

Support for e-cigarette regulations among Australian young adults

BACKGROUND

Surveying support for various regulatory options relating to e-cigarettes can assist policymakers to identify those that have broad support and are therefore likely to be easier to implement. However, data on support for potential e-cigarette regulations in Australia are limited. To inform regulatory efforts, the present study assessed attitudes to the regulation of e-cigarettes among Australian young adults, the most prevalent users of e-cigarettes and therefore the most likely population segment to be affected by e-cigarette regulations.

METHODS

A total of 1116 Australians aged 18 to 25 years (59% female) completed an online survey where they were presented with various statements relating to the regulation of e-cigarettes and asked to report on the extent to which they agreed or disagreed with each. Statements presented either a restrictive or non-restrictive approach to e-cigarette regulation.

RESULTS

Across all statements, 10-22% of respondents responded "don't know" while 23-35% neither agreed nor disagreed, indicating general ambivalence. There was a moderate level of support (33-37%) for regulating e-cigarette sales/use and treating e-cigarettes like tobacco products. Only 20% of respondents were in favour of allowing the use of e-cigarettes in smoke-free areas. Smokers, e-cigarette users, and those who did not believe in the harms associated with e-cigarettes were typically less likely than other respondents to support restrictive approaches.

CONCLUSIONS

The young Australian adults surveyed were somewhat supportive of restrictions around the sale and use of e-cigarettes, but generally opposed outright bans and any need for a prescription from a medical practitioner. Increasing awareness of the harms associated with the use of e-cigarettes represents a potential strategy to gaining regulatory support.

Differences in use of electronic nicotine delivery systems by smoking status and demographic characteristics among Australian young adults

ISSUE ADDRESSED

Electronic nicotine delivery systems (ENDS) continue to grow in popularity, particularly among young adults. Understanding by whom various ENDS are being used and why within this population segment can assist the development of appropriate interventions targeting those most vulnerable to use and inform policy decisions in this area. Accordingly, this study assessed the demographic characteristics associated with ENDS use among Australian young adults, and reasons for current e-cigarette use.

METHODS

An online survey was administered to 1116 Australians aged 18-25 years (59% female).

RESULTS

Smokers were more likely than non-smokers to report (a) ever use of ENDS (67% vs 28%), (b) ever use of an e-cigarette (64% vs 24%), e-cigar (17% vs 8%) or e-hookah (15% vs 8%) and (c) current use of e-cigarettes (19% vs 6%). Male smokers were more likely than female smokers to be current e-cigarette users. The most common reason for current e-cigarette use was enjoyment.

CONCLUSIONS

Young male adults appear to be particularly vulnerable to becoming regular e-cigarette users. This demographic group may need to be a primary focus of prevention and intervention efforts. Contrary to popular belief, smoking cessation was not a primary reason for e-cigarette use. SO WHAT?: Greater efforts are needed to educate young adults on the harms associated with ENDS use, especially if use is being driven by the perception that they are a harmless means of amusement. Maintaining existing regulations limiting the accessibility of these products is crucial to ensuring widespread use is minimised.