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Polosa R, Casale TB, Tashkin DP. A Close Look at Vaping in Adolescents and Young Adults in the United States. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2831-2842. [PMID: 35718259 DOI: 10.1016/j.jaip.2022.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/27/2022] [Accepted: 06/09/2022] [Indexed: 06/15/2023]
Abstract
Vaping by adolescents and young adults is a legitimate concern as there is a risk that some may start smoking and that electronic cigarette (EC) use may have adverse effects in the developing lungs of adolescents. This commentary provides updated information on vaping patterns among adolescents and young adults in the United States, as well as the impact of EC usage on respiratory health. EC use has surged greatly among high school students and young adults over the last decade but fortunately has declined significantly since its peak in 2019. During the same time period, smoking rates have constantly fallen to new low record levels. These trends argue against EC use as a gateway to smoking. Most EC usage is infrequent and unlikely to increase a person's risk of negative health consequences. Furthermore, the majority of EC usage has happened among those who have previously smoked. There is a dearth of data on the long-term health implications of EC usage in adolescents and young adults. We do not know whether short-term or intermittent use of EC in youth can lead to negative health outcomes in adulthood, and long-term high-quality studies in well-defined groups are needed. Although vaping has been linked to respiratory symptoms, they tend to be transient and of uncertain significance. This commentary provides up-to-date information so health care providers can give objective and responsible medical advice on EC usage.
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Affiliation(s)
- Riccardo Polosa
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy; Center of Excellence for the Acceleration of Harm Reduction (CoEHAR), Università di Catania, Catania, Italy; Center for the Prevention and Treatment of Tobacco Addiction (CPCT), Teaching Hospital "Policlinico V. Emanuele," University of Catania, Catania, Italy; ECLAT Srl, Spin-off of the University of Catania, Catania, Italy; Institute of Internal Medicine, AOU "Policlinico V. Emanuele-S. Marco," Catania, Italy.
| | - Thomas B Casale
- Department of Medicine, Division of Allergy/Immunology, Morsani College of Medicine, University of South Florida, Tampa, Fla
| | - Donald P Tashkin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, UCLA Health Sciences, Los Angeles, Calif
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Solinas A, Paoletti G, Firinu D, Di Pino M, Tusconi M, Mura JF, Del Giacco S, Marongiu F. Vaping effects on asthma: results from a web survey and clinical investigation. Intern Emerg Med 2020; 15:663-671. [PMID: 31960343 DOI: 10.1007/s11739-019-02247-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 11/22/2019] [Indexed: 12/28/2022]
Abstract
It is well known that tobacco smoking worsens asthma. Conversely, few data are currently available in the literature on the effects of vaping in asthmatic patients. This work aims to investigate the effects of vaping on asthmatic patients and in asthmatic patients that switched from tobacco smoking to electronic cigarette (e-cig), in particular focusing on quality of life, asthma control, and pulmonary function. We designed a two-group study. One group encompassed vapers with asthma selected through a web survey with questions on quality of life and symptoms worsening; the other group encompassed vapers that switched from tobacco smoking to e-cig, and that volunteered to undergo clinical visits at our outpatient clinic. 2787 people responded to the web survey, including 631 asthmatics. In the second group, 55 volunteers, including 15 asthmatics, were enrolled after a visit. The visit included physical examination and pulmonary function tests (PFT). Internationally validated questionnaires were administered to all subjects: Asthma Control Test (ACT), Asthma Control Questionnaire (ACQ), 36-Item Short Form Survey (SF-36) and Asthma Quality of Life Questionnaire (AQLQ). The 382 asthmatic vapers-only in the web survey were mainly males (86.9%), 31-65 years old. 90% of them declared that vaping did not worsen asthma symptoms and would recommend asthmatic smokers to switch to vaping (98.4%). There was worsening of asthma symptoms due to the actual asthma therapy used by the participants, while no relationship was found with other aspects analysed. In the second group, the analysis of variance in the questionnaires administered to the 10 asthmatics showed a significant improvement in ACQ, ACT and SF-36 for asthmatics that switched from tobacco to vaping, while PFT remained stable throughout the three visits. Almost all of the asthmatics who previously smoked would recommend switching to e-cig, and vaping did not worsen their asthma symptoms. Furthermore, switching from tobacco smoking to e-cigs showed a significant improvement in asthma control and quality of life, not showing, in the period studied, to affect pulmonary function tests.
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Affiliation(s)
- Alessandro Solinas
- Department of Medical Sciences and Public Health, University of Cagliari, Cittadella Universitaria, Asse Didattico "E1", 09042, Monserrato, Cagliari, Italy
| | - Giovanni Paoletti
- Department of Medical Sciences and Public Health, University of Cagliari, Cittadella Universitaria, Asse Didattico "E1", 09042, Monserrato, Cagliari, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Personalized Medicine, Asthma and Allergy - Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Davide Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, Cittadella Universitaria, Asse Didattico "E1", 09042, Monserrato, Cagliari, Italy
| | - Marina Di Pino
- Department of Medical Sciences and Public Health, University of Cagliari, Cittadella Universitaria, Asse Didattico "E1", 09042, Monserrato, Cagliari, Italy
| | - Massimo Tusconi
- Section of Psychiatry, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Cittadella Universitaria, Asse Didattico "E1", 09042, Monserrato, Cagliari, Italy
| | - Francesco Marongiu
- Department of Medical Sciences and Public Health, University of Cagliari, Cittadella Universitaria, Asse Didattico "E1", 09042, Monserrato, Cagliari, Italy.
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Polosa R, Farsalinos K, Prisco D. Health impact of electronic cigarettes and heated tobacco systems. Intern Emerg Med 2019; 14:817-820. [PMID: 31414334 DOI: 10.1007/s11739-019-02167-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 07/29/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Riccardo Polosa
- Centro per la Prevenzione e Cura del Tabagismo (CPCT), Azienda Ospedaliero-Universitaria "Policlinico-V. Emanuele", Università of Catania, Catania, Italy.
- Dipartimento di Medicina Clinica e Sperimentale (MEDCLIN), University of Catania, Catania, Italy.
- Center of Excellence for the Acceleration of HArm Reduction (CoEHAR), University of Catania, Catania, Italy.
| | - Konstantinos Farsalinos
- Department of Cardiology, Onassis Cardiac Surgery Center, Kallithea, Greece
- Department of Pharmacy, University of Patras, Patras, Greece
- National School of Public Health, Athens, Greece
| | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Interdisciplinary Internal Medicine, Careggi University Hospital, Florence, Italy
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Polosa R, O'Leary R, Tashkin D, Emma R, Caruso M. The effect of e-cigarette aerosol emissions on respiratory health: a narrative review. Expert Rev Respir Med 2019; 13:899-915. [PMID: 31375047 DOI: 10.1080/17476348.2019.1649146] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Introduction: Due to the uptake in the use of e-cigarettes (ECs), evidence on their health effects is needed to inform health care and policy. Some regulators and health professionals have raised concerns that the respirable aerosols generated by ECs contain several constituents of potential toxicological and biological relevance to respiratory health. Areas covered: We critically assess published research on the respiratory system investigating the effects of ECs in preclinical models, clinical studies of people who switched to ECs from tobacco cigarettes, and population surveys. We assess the studies for the quality of their methodology and accuracy of their interpretation. To adequately assess the impact of EC use on human health, addressing common mistakes and developing robust and realistic methodological recommendations is an urgent priority. The findings of this review indicate that ECs under normal conditions of use demonstrate far fewer respiratory risks than combustible tobacco cigarettes. EC users and smokers considering ECs have the right to be informed about the relative risks of EC use, and to be made aware that findings of studies published by the media are not always reliable. Expert opinion: Growing evidence supports the relative safety of EC emission aerosols for the respiratory tract compared to tobacco smoke.
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Affiliation(s)
- Riccardo Polosa
- Centro per la Prevenzione e Cura del Tabagismo (CPCT), Azienda Ospedaliero-Universitaria "Policlinico-V. Emanuele", Università of Catania , Catania , Italy.,Center of Excellence for the acceleration of HArm Reduction (CoEHAR), University of Catania , Catania , Italy
| | - Renée O'Leary
- Canadian Institute for Substance Use Research , Victoria , Canada
| | - Donald Tashkin
- David Geffen School of Medicine at the University of California, Los Angeles (UCLA) , Los Angeles , CA , USA
| | - Rosalia Emma
- Dipartimento di Medicina Clinica e Sperimentale (MEDCLIN), University of Catania , Catania , Italy.,Dipartimento di Scienze biomediche e biotecnologiche (BIOMETEC), University of Catania , Catania , Italy
| | - Massimo Caruso
- Dipartimento di Medicina Clinica e Sperimentale (MEDCLIN), University of Catania , Catania , Italy.,Dipartimento di Scienze biomediche e biotecnologiche (BIOMETEC), University of Catania , Catania , Italy
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Affiliation(s)
- K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, USA
| | - Riccardo Polosa
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy. .,Institute of Internal and Emergency Medicine, Teaching Hospital "Policlinico - V. Emanuele," University of Catania, Catania, Italy.
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Valentine GW, Hefner K, Jatlow PI, Rosenheck RA, Gueorguieva R, Sofuoglu M. Impact of E-cigarettes on Smoking and Related Outcomes in Veteran Smokers With Psychiatric Comorbidity. J Dual Diagn 2018; 14:2-13. [PMID: 29083287 PMCID: PMC7131866 DOI: 10.1080/15504263.2017.1384877] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Compared to the general U.S. population, smokers with comorbid psychiatric and/or substance use disorders have lower quit rates after evidence-based treatments and disproportionately high smoking-related deaths. Improved modalities for reducing tobacco-related harm in this subpopulation are needed. Because electronic cigarettes (e-cigarettes) can now deliver physiologically relevant levels of nicotine to consumers, they represent an additional nicotine delivery system that could be used in cessation interventions. While current data suggest that the use of e-cigarettes by smokers promotes a reduction in combustible cigarette use, smoking quit rates through use of e-cigarettes appears to be low. The goal of this study was to examine impact of e-cigarette use on combustible tobacco use as well as on the readiness to quit smoking and changes in nicotine dependence in a multimorbid population. METHODS We conducted a 4-week, open-label study in 43 military veteran smokers who had no immediate intention to stop smoking and were currently receiving psychiatric services from the Department of Veterans Affairs health care system. Participants were provided with a study e-cigarette they could use ad libitum along with other tobacco products and were encouraged to attend weekly laboratory visits and a one-month follow-up visit. Main outcome measures were number of cigarettes smoked per day (CPD), the frequency of e-cigarette use, the amount of money spent on combustible cigarettes (U.S. dollars/week), alveolar carbon monoxide (CO) levels, and urine cotinine levels. RESULTS Mean e-cigarette use was 5.7 days per week and only 9% of participants used the e-cigarette for fewer than 4 days per week. Significant reductions in breath CO (9.3 ppm to 7.3 ppm, p < .02) and CPD (from 16.6 to 5.7, p < .001) were observed across study weeks, and no serious adverse events were reported. Three participants (10% of completers) reported smoking cessation that was corroborated biochemically. At one-month follow-up, motivation to quit smoking remained significantly higher and the level of nicotine dependence was significantly lower than at baseline. CONCLUSIONS E-cigarettes are acceptable to smokers with psychiatric comorbidities, as indicated by sustained and frequent e-cigarette use by 90% of participants, and may promote reduction and/or cessation of combustible cigarette use. E-cigarettes appear to be a viable harm reduction modality in smokers with psychiatric comorbidities.
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Affiliation(s)
- Gerald W Valentine
- a Department of Psychiatry , Yale School of Medicine , New Haven , Connecticut , USA.,b Veterans Health Administration Mental Illness Research, Education and Clinical Center (MIRECC) , West Haven , Connecticut , USA
| | - Kathryn Hefner
- a Department of Psychiatry , Yale School of Medicine , New Haven , Connecticut , USA.,b Veterans Health Administration Mental Illness Research, Education and Clinical Center (MIRECC) , West Haven , Connecticut , USA
| | - Peter I Jatlow
- a Department of Psychiatry , Yale School of Medicine , New Haven , Connecticut , USA.,c Department of Laboratory Medicine , Yale School of Medicine , New Haven , Connecticut , USA
| | - Robert A Rosenheck
- a Department of Psychiatry , Yale School of Medicine , New Haven , Connecticut , USA.,b Veterans Health Administration Mental Illness Research, Education and Clinical Center (MIRECC) , West Haven , Connecticut , USA
| | - Ralitza Gueorguieva
- d Department of Biostatistics , Yale School of Public Health , New Haven , Connecticut , USA
| | - Mehmet Sofuoglu
- a Department of Psychiatry , Yale School of Medicine , New Haven , Connecticut , USA.,b Veterans Health Administration Mental Illness Research, Education and Clinical Center (MIRECC) , West Haven , Connecticut , USA
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Polosa R, Russell C, Nitzkin J, Farsalinos KE. A critique of the US Surgeon General's conclusions regarding e-cigarette use among youth and young adults in the United States of America. Harm Reduct J 2017; 14:61. [PMID: 28874159 PMCID: PMC5586058 DOI: 10.1186/s12954-017-0187-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 08/29/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In December 2016, the Surgeon General published a report that concluded e-cigarette use among youth and young adults is becoming a major public health concern in the United States of America. METHODS Re-analysis of key data sources on nicotine toxicity and prevalence of youth use of e-cigarettes cited in the Surgeon General report as the basis for its conclusions. RESULTS Multiple years of nationally representative surveys indicate the majority of e-cigarette use among US youth is either infrequent or experimental, and negligible among never-smoking youth. The majority of the very small proportion of US youth who use e-cigarettes on a regular basis, consume nicotine-free products. The sharpest declines in US youth smoking rates have occurred as e-cigarettes have become increasingly available. Most of the evidence presented in the Surgeon General's discussion of nicotine harm is not applicable to e-cigarette use, because it relies almost exclusively on exposure to nicotine in the cigarette smoke and not to nicotine present in e-cigarette aerosol emissions. Moreover, the referenced literature describes effects in adults, not youth, and in animal models that have little relevance to real-world e-cigarette use by youth. The Surgeon General's report is an excellent reference document for the adverse outcomes due to nicotine in combination with several other toxicants present in tobacco smoke, but fails to address the risks of nicotine decoupled from tobacco smoke constituents. The report exaggerates the toxicity of propylene glycol (PG) and vegetable glycerin (VG) by focusing on experimental conditions that do not reflect use in the real-world and provides little discussion of emerging evidence that e-cigarettes may significantly reduce harm to smokers who have completely switched. CONCLUSIONS The U.S. Surgeon General's claim that e-cigarette use among U.S. youth and young adults is an emerging public health concern does not appear to be supported by the best available evidence on the health risks of nicotine use and population survey data on prevalence of frequent e-cigarette use. Nonetheless, patterns of e-cigarettes use in youth must be constantly monitored for early detection of significant changes. The next US Surgeon General should consider the possibility that future generations of young Americans will be less likely to start smoking tobacco because of, not in spite of, the availability of e-cigarettes.
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Affiliation(s)
- Riccardo Polosa
- Centro Prevenzione e Cura del Tabagismo, Azienda Ospedaliero Universitaria "Policlinico-V. Emanuele", Catania, Italy.
- Dipartimento di Medicina Clinica e Sperimentale, Università di Catania, Catania, Italy.
- UOC di Medicina Interna e d'Urgenza, Azienda Ospedaliero Universitaria "Policlinico-V. Emanuele", Catania, Italy.
| | | | | | - Konstantinos E Farsalinos
- Department of Cardiology, Onassis Cardiac Surgery Center, Sygrou 356, 17674, Kallithea, Greece
- Department of Pharmacy, University of Patras, 17674, Rio, Greece
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