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McLeish AC, Hart JL, Wood LA, Walker KL. Differences in young adults' perceptions of e-cigarettes by history of use. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:2099-2103. [PMID: 35882085 PMCID: PMC9877241 DOI: 10.1080/07448481.2022.2103375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 05/04/2022] [Accepted: 07/12/2022] [Indexed: 06/15/2023]
Abstract
Objective: The current study examined group differences in college students' views on e-cigarettes in terms of safety, popularity, health risks, social acceptability, efficacy as a cessation aid, and promoting combustible cigarette use. Participants: 337 undergraduates (Mage = 20.84, SD = 3.79; 72.1% female; 68.5% White) divided into three groups: Never Users (n = 178), Ever Users (n = 108), and Current Users (n = 51). Methods: Participants completed questionnaires for course credit. Results: Compared to Ever and Never Users, Current Users believed e-cigarettes were safer, healthier, a useful tool to quit smoking, did not lead to combustible cigarette smoking, and that nicotine was less dangerous. Current Users also were less likely to endorse boosting social image as a motive for use. Conclusions: Public health campaigns could benefit from targeting current users' positive beliefs about e-cigarettes to reduce the prevalence of e-cigarette use among college students.
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Affiliation(s)
- Alison C. McLeish
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY
- American Heart Association Tobacco Center for Regulatory Science, Dallas, TX
| | - Joy L. Hart
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY
- American Heart Association Tobacco Center for Regulatory Science, Dallas, TX
- Department of Communication, University of Louisville
| | - Lindsey A. Wood
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY
- Department of Epidemiology, University of Louisville
| | - Kandi L. Walker
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY
- American Heart Association Tobacco Center for Regulatory Science, Dallas, TX
- Department of Communication, University of Louisville
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McLeish AC, Smith CL, Tomlinson MM, Kerstiens S, Walker KL, Hart JL. E-Cigarette Use Behavior and Expectancies Among Sexual Minority and Heterosexual College Student E-Cigarette Users. Subst Use Misuse 2024:1-8. [PMID: 39155511 DOI: 10.1080/10826084.2024.2392532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Abstract
Background: College students who identify as a sexual minority (i.e., lesbian, gay, bisexual, or other sexual orientation) are at higher risk for e-cigarette use than their heterosexual or "straight" peers. However, little is known about factors, such as e-cigarette outcome expectancies, that might influence these differences in prevalence rates. Therefore, the current study examined differences between heterosexual and sexual minority college student e-cigarette users in terms of days of past-month e-cigarette use, e-cigarette dependence, and e-cigarette outcome expectancies. A secondary aim of the study was to examine whether outcome expectancies served as an explanatory mechanism in the association between sexual minority status and e-cigarette use frequency and dependence. Methods: Participants were heterosexual (n = 90; Mage = 19.65, SD = 2.70; 76.7% female; 77.8% White) and sexual minority (n = 44; Mage = 20.02, SD = 2.18; 68.2% female; 90.9% White) college student e-cigarette users who completed self-report measures. Results: Students who identified as a sexual minority reported greater e-cigarette dependence, more frequent past 30-day use, and greater negative consequences and positive reinforcement e-cigarette outcome expectancies. Follow-up mediation analyses indicated a significant indirect effect of sexual minority status on both days of past-month e-cigarette use and e-cigarette dependence through expectancies for negative consequences and positive reinforcement. Conclusions: These findings suggest that positive reinforcement and negative consequences outcome expectancies may be contributing to the disparities in e-cigarette use among college students who identify as a sexual minority and could be useful targets for cessation interventions for this population.
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Affiliation(s)
- Alison C McLeish
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, USA
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Courteney L Smith
- Brian Lamb School of Communication, Purdue University, West Lafayette, Indiana, USA
| | - Madeline M Tomlinson
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky, USA
- Department of Epidemiology and Population Health, School of Public Health and Information Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Savanna Kerstiens
- School of Communication, Northwestern University, Evanston, Illinois, USA
| | - Kandi L Walker
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky, USA
- Department of Communication, University of Louisville, Louisville, Kentucky, USA
| | - Joy L Hart
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky, USA
- Department of Communication, University of Louisville, Louisville, Kentucky, USA
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Egbe CO, Khan A, Scheibe A, Ayo-Yusuf OA. E-cigarettes and harm reduction: a view from sub-Saharan Africa. Tob Control 2024; 33:419-421. [PMID: 38901968 DOI: 10.1136/tc-2024-058840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Affiliation(s)
- Catherine O Egbe
- Mental health, Alcohol, Substance use & Tobacco Research Unit, South African Medical Research Council, Pretoria, South Africa
- Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Arshima Khan
- Mental health, Alcohol, Substance use & Tobacco Research Unit, South African Medical Research Council, Pretoria, South Africa
- Department of Psychology, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrew Scheibe
- Community Oriented Primary Care Research Unit, Department of Family Medicine, University of Pretoria, Pretoria, South Africa
| | - Olalekan A Ayo-Yusuf
- Africa Centre for Tobacco Industry Monitoring and Policy Research, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
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Xie W, Berlowitz JB, Raquib R, Harlow AF, Benjamin EJ, Bhatnagar A, Stokes AC. Association of cigarette and electronic cigarette use patterns with all-cause mortality: A national cohort study of 145,390 US adults. Prev Med 2024; 182:107943. [PMID: 38552720 PMCID: PMC11039355 DOI: 10.1016/j.ypmed.2024.107943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVE While e-cigarette use is associated with adverse cardiopulmonary health effects, the mortality risks associated with e-cigarette use alone and combined with smoking remain unexamined. METHODS Data between 2014 and 2018 were obtained from the National Health Interview Survey (NHIS), an annual cross-sectional survey of US adults. All-cause mortality and date of death were obtained via linkage of the NHIS to the National Death Index through December 31, 2019. A 6-category composite cigarette (never, former, current) and e-cigarette (current, non-current) exposure variable was created. We examined the association of cigarette and e-cigarette use patterns with all-cause mortality using adjusted Cox models. RESULTS Among 145,390 participants (79,294 women [51.5%]; 60,560 aged 18-44 [47.4%]), 5220 deaths were observed over a median follow-up of 3.5 years (508,545 total person-years). Dual use of cigarettes and e-cigarettes was associated with higher mortality risk compared with non-current e-cigarette use in combination with never smoking (hazard ratio [HR] 2.44; 95% CI, 1.90-3.13) and had a risk that did not differ from current exclusive smoking (HR, 1.06; 95% CI, 0.83-1.37). Current e-cigarette use in combination with former smoking was associated with a lower mortality risk than current exclusive cigarette smoking (HR 0.64; 95% CI, 0.41-0.99). CONCLUSIONS The addition of e-cigarette use to smoking does not reduce mortality risk compared with exclusive smoking. However, transitioning completely from cigarettes to e-cigarettes may be associated with mortality risk reduction. Further research is needed to verify these findings in larger cohorts and over longer periods of follow-up.
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Affiliation(s)
- Wubin Xie
- Population and Global Health, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Jonathan B Berlowitz
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA; Department of Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Rafeya Raquib
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Alyssa F Harlow
- University of Southern California Keck School of Medicine, Department of Population and Public Health Sciences, Los Angeles, CA, USA
| | - Emelia J Benjamin
- Department of Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Aruni Bhatnagar
- Department of Medicine, University of Louisville, Louisville, KY, USA
| | - Andrew C Stokes
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA.
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Patanavanich R, Worawattanakul M, Glantz S. Longitudinal bidirectional association between youth electronic cigarette use and tobacco cigarette smoking initiation in Thailand. Tob Control 2024; 33:310-316. [PMID: 36104174 DOI: 10.1136/tc-2022-057491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 09/01/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION This study quantifies the longitudinal association between e-cigarette use and subsequent conventional cigarette initiation and vice versa among Thai youths. METHODS Data from a longitudinal survey of 6045 Thai seventh grade students with baseline in 2019 and the 12-month follow-up in 2020 were analysed using complex survey multivariate logistic regressions to assess whether e-cigarette use was associated with subsequent cigarette smoking (ever, current and dual product users at follow-up) among baseline never smokers. RESULTS Consistent with prior findings from other countries, among those who had never smoked cigarettes at baseline, ever e-cigarette users were more likely to try cigarette smoking (adjusted OR 4.44; 95% CI 2.23 to 8.86; p<0.001), or become dual users (adjusted OR 5.31; 95% CI 2.63 to 10.74; p<0.001) 1 year later. Baseline current e-cigarette users were more likely to become ever smokers (adjusted OR 5.37; 95% CI 1.82 to 15.90; p=0.005), current smokers (OR 3.92; 95% CI 1.69 to 9.14; p=0.003) and dual product users (adjusted OR 6.96; 95% CI 1.54 to 31.38; p=0.015) at the 12-month follow-up than non-e-cigarette users. Similarly, among never e-cigarette users at baseline, ever cigarette smoking were more likely to try e-cigarettes (adjusted OR 3.38; 95% CI 1.66 to 6.88; p=0.002), currently use e-cigarettes (adjusted OR 2.75; 95% CI 1.47 to 5.13; p=0.003) and currently use both e-cigarettes and cigarettes (adjusted OR 4.87; 95% CI 2.92 to 8.13; p<0.001) at the follow-up than never smokers. Among never e-cigarette users at baseline, current-cigarette smoking were more likely to try e-cigarettes (adjusted OR 6.21; 95% CI 2.58 to 14.95; p<0.001), currently use e-cigarettes (adjusted OR 2.80; 95% CI 1.27 to 6.14; p=0.014) and currently use both e-cigarettes and cigarettes (adjusted OR 7.70; 95% CI 3.45 to 17.19; p<0.001) at the follow-up than never smokers. CONCLUSIONS This longitudinal study in Asian low-income and middle-income countries supports the prospective association of youth e-cigarette use with subsequent smoking initiation and youth cigarette use with subsequent e-cigarette initiation that is similar to that observed in high-income Western countries.
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Affiliation(s)
- Roengrudee Patanavanich
- Department of Community Medicine, Mahidol University Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand
| | - Methavee Worawattanakul
- Department of Community Medicine, Mahidol University Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand
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Glantz S, Lempert LK. Vuse Solo e-cigarettes do not provide net benefits to public health: a scientific analysis of FDA's marketing authorisation. Tob Control 2024; 33:e108-e115. [PMID: 36764683 PMCID: PMC10409877 DOI: 10.1136/tc-2022-057296] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 11/04/2022] [Indexed: 02/12/2023]
Abstract
In October 2021, the US Food and Drug Administration (FDA) authorised marketing of RJ Reynolds Vapor Company's (RJR) Vuse Solo e-cigarette through FDA's Premarket Tobacco Product Application (PMTA) pathway. FDA concluded that RJR demonstrated Vuse products met the statutory standard of providing a net benefit to public health. A review of FDA's scientific justification reveals deficiencies: (1) not adequately considering Vuse's popularity with youth and evidence that e-cigarettes expanded the nicotine market and stimulate cigarette smoking; (2) trading youth addiction for unproven adult benefit without quantifying these risks and benefits; (3) not considering design factors that appeal to youth; (4) not addressing evidence that e-cigarettes used as consumer products do not help smokers quit and promote relapse in former smokers; (5) not discussing evidence that dual use is more dangerous than smoking; (6) narrowly focusing on the fact that e-cigarettes deliver lower levels of some toxicants without addressing direct evidence on adverse health effects; (7) downplaying significant evidence of other substantial harms; (8) not acting on FDA's own study showing no all-cause mortality benefit of reducing (but not stopping) cigarette use; and (9) improperly considering e-cigarettes' high abuse liability and potential for high youth addiction and undermining tobacco cessation. Because marketing these products is not appropriate for the protection of the public health, FDA should reconsider its Vuse marketing order as statutorily required and not use it as a template for other e-cigarette PMTAs. Policymakers outside the USA should anticipate that tobacco companies will use FDA's decision to try to weaken tobacco control regulation of e-cigarettes and promote their products.
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Affiliation(s)
| | - Lauren Kass Lempert
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California, USA
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Glantz SA, Nguyen N, Oliveira da Silva AL. Population-Based Disease Odds for E-Cigarettes and Dual Use versus Cigarettes. NEJM EVIDENCE 2024; 3:EVIDoa2300229. [PMID: 38411454 DOI: 10.1056/evidoa2300229] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
BACKGROUND: E-cigarettes are promoted as less harmful than cigarettes. There has not been a direct comparison of health effects of e-cigarettes or dual use (concurrently using e-cigarettes and cigarettes) with those of cigarettes in the general population. METHODS: Studies in PubMed, EMBASE, Web of Science, and PsychINFO published through October 1, 2023, were pooled in a random-effects meta-analysis if five or more studies were identified with a disease outcome. We assessed risk of bias with Risk Of Bias In Non-randomized Studies of Exposure and certainty with Grading of Recommendations, Assessment, Development, and Evaluations. Outcomes with fewer studies were summarized but not pooled. RESULTS: We identified 124 odds ratios (94 cross-sectional and 30 longitudinal) from 107 studies. Pooled odds ratios for current e-cigarette versus cigarette use were not different for cardiovascular disease (odds ratio, 0.81; 95% confidence interval, 0.58 to 1.14), stroke (0.73; 0.47 to 1.13), or metabolic dysfunction (0.99; 0.91 to 1.09) but were lower for asthma (0.84; 0.74 to 0.95), chronic obstructive pulmonary disease (0.53; 0.38 to 0.74), and oral disease (0.87; 0.76 to 1.00). Pooled odds ratios for dual use versus cigarettes were increased for all outcomes (range, 1.20 to 1.41). Pooled odds ratios for e-cigarettes and dual use compared with nonuse of either product were increased (e-cigarette range, 1.24 to 1.47; dual use, 1.49 to 3.29). All included studies were assessed as having a low risk of bias. Results were generally not sensitive to study characteristics. Limited studies of other outcomes suggest that e-cigarette use is associated with additional diseases. CONCLUSIONS: There is a need to reassess the assumption that e-cigarette use provides substantial harm reduction across all cigarette-caused diseases, particularly accounting for dual use.
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Affiliation(s)
| | - Nhung Nguyen
- Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco
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McLeish AC, Walker KL, Hart JL. Emotion Dysregulation and E-Cigarette Expectancies among College Student E-Cigarette Users. Subst Use Misuse 2024; 59:920-927. [PMID: 38317024 PMCID: PMC11078561 DOI: 10.1080/10826084.2024.2310491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Background: E-cigarette outcome expectancies (i.e., beliefs about the expected consequences of e-cigarette use) are a key factor in motivating use. Emotion regulation difficulties have demonstrated significant associations with outcome expectancies; however, there has yet to be an examination of associations between specific emotion regulation difficulties and specific e-cigarette outcome expectancies, which could serve as targets for intervention efforts. Therefore, the current study sought to examine the unique predictive ability of specific emotion regulation difficulties in terms of e-cigarette outcome expectancies. Methods: Participants were 116 college student e-cigarette users (Mage = 19.72, SD = 1.88; 71.6% female) who completed self-report questionnaires for course credit. Results: Greater difficulties engaging in goal-directed behavior when experiencing negative emotions and fewer difficulties accessing effective emotion regulation strategies were associated with positive reinforcement outcome expectancies. Greater emotion regulation difficulties in general were also associated with negative reinforcement outcome expectancies, though there were no significant individual predictors. Conclusion: These results suggest that greater emotion regulation difficulties are associated with mood-related e-cigarette outcome expectancies, and targeting emotion regulation difficulties, particularly difficulty engaging in goal-directed behavior when upset, may be useful to incorporate into intervention efforts.
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Affiliation(s)
- Alison C. McLeish
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY
| | - Kandi L. Walker
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY
- Department of Communication, University of Louisville, Louisville, KY
| | - Joy L. Hart
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY
- Department of Communication, University of Louisville, Louisville, KY
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Strongin RM, Sharma E, Erythropel HC, El-Hellani A, Kassem NOF, Mikheev VB, Noël A, Peyton DH, Springer ML. Emerging ENDS products and challenges in tobacco control toxicity research. Tob Control 2023; 33:110-115. [PMID: 35715171 PMCID: PMC9758272 DOI: 10.1136/tobaccocontrol-2022-057268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 06/03/2022] [Indexed: 11/04/2022]
Abstract
Electronic nicotine delivery systems (ENDS) continue to rapidly evolve. Current products pose unique challenges and opportunities for researchers and regulators. This commentary aims to highlight research gaps, particularly in toxicity research, and provide guidance on priority research questions for the tobacco regulatory community. Disposable flavoured ENDS have become the most popular device class among youth and may contain higher nicotine levels than JUUL devices. They also exhibit enhanced harmful and potentially harmful constituents production, contain elevated levels of synthetic coolants and pose environmental concerns. Synthetic nicotine and flavour capsules are innovations that have recently enabled the circumvention of Food and Drug Administration oversight. Coil-less ENDS offer the promise of delivering fewer toxicants due to the absence of heating coils, but initial studies show that these products exhibit similar toxicological profiles compared with JUULs. Each of these topic areas requires further research to understand and mitigate their impact on human health, especially their risks to young users.
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Affiliation(s)
| | - Eva Sharma
- Behavioral Health and Health Policy, Westat, Rockville, Maryland, USA
| | - Hanno C Erythropel
- Chemical and Environmental Engineering, Yale University, New Haven, Connecticut, USA
| | - Ahmad El-Hellani
- Center for Tobacco Research and the Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, Ohio, USA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Nada O F Kassem
- Division of Health Promotion and Behavioral Science, San Diego State University Research Foundation, San Diego, California, USA
| | - Vladimir B Mikheev
- Battelle Public Health Center for Tobacco Research, Battelle Memorial Institute, Columbus, Ohio, USA
| | - Alexandra Noël
- Department of Comparative Biomedical Sciences, Louisiana State University, Baton Rouge, Louisiana, USA
| | - David H Peyton
- Chemistry, Portland State University, Portland, Oregon, USA
| | - Matthew L Springer
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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Wang Y, Sung HY, Lightwood J, Yao T, Max WB. Healthcare utilisation and expenditures attributable to current e-cigarette use among US adults. Tob Control 2023; 32:723-728. [PMID: 35606163 DOI: 10.1136/tobaccocontrol-2021-057058] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 04/13/2022] [Indexed: 11/03/2022]
Abstract
AIMS This study estimated annual healthcare expenditures attributable to current e-cigarette use among US adults, including current exclusive and dual/poly e-cigarette use. METHODS Analysing the 2015-2018 National Health Interview Survey data, we estimated the impacts of e-cigarette use on healthcare utilisation among adults aged 18+ years. Healthcare utilisation outcomes were hospital nights, emergency room (ER) visits, doctor visits and home visits. Current e-cigarette use was categorised as exclusive and dual/poly e-cigarette use. The econometric model included two equations: health status as a function of e-cigarette use and other independent variables, and healthcare utilisation as a function of health status, e-cigarette use, and other independent variables. Using an 'excess utilisation' approach, we multiplied the e-cigarette-attributable fraction derived from the model by annual health expenditures to calculate healthcare expenditures attributable to current exclusive and dual/poly e-cigarette use, the sum of which were expenditures attributable to all current e-cigarette use. RESULTS Current exclusive and dual/poly e-cigarette use, with 0.2% and 3.5% prevalence in 2015-2018, were associated with higher odds of reporting poor health status than never tobacco users. Poor health status was associated with higher odds of using the four healthcare services and a greater number of ER and doctor visits. Annual healthcare expenditures attributable to all current e-cigarette use was $15.1 billion ($2024 per user) in 2018, including $1.3 billion attributable to exclusive e-cigarette use ($1796 per user) and $13.8 billion attributable to dual/poly e-cigarette use ($2050 per user). CONCLUSION Adult current e-cigarette use was associated with substantial excess healthcare utilisation and expenditures.
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Affiliation(s)
- Yingning Wang
- Institute for Health & Aging, University of California San Francisco, San Francisco, California, USA
| | - Hai-Yen Sung
- Institute for Health & Aging, University of California San Francisco, San Francisco, California, USA
| | - James Lightwood
- Department of Clinical Pharmacy, School of Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Tingting Yao
- Institute for Health & Aging, University of California San Francisco, San Francisco, California, USA
| | - Wendy B Max
- Institute for Health & Aging, University of California San Francisco, San Francisco, California, USA
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Kolaczyk K, Jiang H. Photometric Monitoring of Electronic Cigarette Puff Topography. SENSORS (BASEL, SWITZERLAND) 2023; 23:8220. [PMID: 37837050 PMCID: PMC10575377 DOI: 10.3390/s23198220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 09/29/2023] [Accepted: 10/01/2023] [Indexed: 10/15/2023]
Abstract
To study and monitor the adverse health consequences of using electronic cigarettes, a user's puff topography, which are quantification parameters of the user's vaping habits, plays a central role. In this work, we introduce a topography sensor to measure the mass of total particulate matter generated in every puff and to estimate the nicotine yield. The sensor is compact and low-cost, and is integrated into the electronic cigarette device to promptly and conveniently monitor the user's daily puff topography. The topography sensor is comprised of a photometric sensor and a pressure sensor. The photometric sensor measures the mass concentration of the aerosol, based on scattering of near-infrared light from airborne particles, while the pressure sensor measures the flow rate. The topography sensor was tested under various conditions including a wide range of atomizer power, puff duration, and inhalation pressure. The sensor's accuracy was validated by comparing the sensor's readings with reference measurements, and the results matched closely with the trends reported by existing studies on electronic cigarettes. An example application for tracking a user's puff topography was also demonstrated. Our topography sensor holds great promise in mitigating the health risks of vaping, and in promoting quality control of electronic cigarette products.
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Nguyen AX, Gaiha SM, Chung S, Halpern-Felsher B, Wu AY. Ocular Symptoms in Adolescents and Young Adults With Electronic Cigarette, Cigarette, and Dual Use. JAMA Ophthalmol 2023; 141:937-946. [PMID: 37651129 PMCID: PMC10472265 DOI: 10.1001/jamaophthalmol.2023.3852] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/05/2023] [Indexed: 09/01/2023]
Abstract
Importance Despite increasing use of cigarettes and electronic cigarettes (e-cigarettes) and related health effects among youth, few studies have reported their effects on eyes. Objective To examine the frequency and severity of ocular symptoms (ocular discomfort, pain, burning, itching, redness, dryness, glare, blurriness, strain, and headaches) in young e-cigarette and cigarette users. Design, Setting, and Participants In an observational cross-sectional study, a survey conducted in May 6 to 14, 2020, asked participants about use (ever, past 30 days, and past 7 days) of e-cigarettes and cigarettes. The participants included US individuals aged 13 to 24 years. Main Outcomes and Measures Associations between vision-related outcomes (general vision, severity/frequency of ocular symptoms) and tobacco use were analyzed using weighted multivariable logistic regressions, adjusting for sociodemographic factors, contact lens use, and other combustible use. Results There were 2168 never users, 2183 ever users, 1092 past 30-day users, and 919 past 7-day users of e-cigarettes; 55.9% of e-cigarette ever users also used cigarettes (dual users). Of the 4351 respondents, 63.8% identified as female, and mean (SD) age was 19.1 (2.9) years. Between 1.1% and 3.9% of ever dual users reported severe to very severe ocular symptoms; between 0.9% and 4.3% reported daily symptoms, which was higher than the proportion of symptoms in e-cigarette- or cigarette-only users. Past 7-day dual users had more severe itching (adjusted odds ratio [AOR], 2.37; 95% CI, 1.36-4.13; P = .002), redness (AOR, 2.58; 95% CI, 1.50-4.46; P = .001), dryness (AOR, 2.89; 95% CI, 1.64-5.08; P < .001), glare (AOR, 2.56; 95% CI, 1.50-4.35; P = .001), blurriness (AOR, 2.47; 95% CI, 1.36-4.50; P = .003), headaches (AOR, 2.31; 95% CI, 1.34-4.00; P = .003); and more frequent pain (AOR, 3.45; 95% CI, 2.09-5.68; P < .001), burning (AOR, 3.08; 95% CI, 1.86-5.09; P < .001), and redness (AOR, 2.72; 95% CI, 1.69-4.36; P < .001) than all other participants. Past 30-day dual users had more severe dryness (AOR, 2.65; 95% CI, 1.61-4.36; P < .001) and more frequent pain (AOR, 3.33; 95% CI, 2.12-5.21; P < .001) than all other participants. Ever dual users experienced more severe dryness (AOR, 1.60; 95% CI, 1.05-2.43; P = .03) and blurriness (AOR, 1.79; 95% CI, 1.21-2.64; P = .003) and more frequent pain (AOR, 1.69; 95% CI, 1.13-2.53; P = .01) and blurriness (AOR, 1.63; 95% CI, 1.13-2.36; P = .009) than never users. Conclusions and Relevance In this cross-sectional US study, adolescents and young adult users of both e-cigarettes and cigarettes had a higher likelihood of experiencing severe and frequent ocular symptoms, with past 7-day users reporting more symptoms than past 30-day users or ever users. These findings provide additional reasons for users of e-cigarettes and cigarettes to reduce their tobacco use to possibly prevent or minimize ocular symptoms.
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Affiliation(s)
- Anne X. Nguyen
- Faculty of Medicine, McGill University, Montréal, Quebec, Canada
| | - Shivani M. Gaiha
- REACH Lab, Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Stanford, California
| | - Sukyung Chung
- Center for Population Health Sciences, School of Medicine, Stanford University, Stanford, California
| | - Bonnie Halpern-Felsher
- REACH Lab, Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Stanford, California
| | - Albert Y. Wu
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California
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Hamann SL, Kungskulniti N, Charoenca N, Kasemsup V, Ruangkanchanasetr S, Jongkhajornpong P. Electronic Cigarette Harms: Aggregate Evidence Shows Damage to Biological Systems. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6808. [PMID: 37835078 PMCID: PMC10572885 DOI: 10.3390/ijerph20196808] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/25/2023] [Accepted: 09/15/2023] [Indexed: 10/15/2023]
Abstract
Evidence of the harms of e-cigarettes has been unfolding slowly and has been documented in many reviews and reports worldwide. A narrative review of new evidence is presented since, as research has continued, newly aggregated evidence of the dangers of electronic cigarettes on the brain, heart, and lungs is vital to inform decisions on restricting the use of e-cigarettes. Several biomedical research databases were searched for electronic cigarette health effects, emphasizing reviews, systematic reviews, and meta-analyses. Over 50 review studies, primarily in 2022 and 2023, illustrate some of the latest information on e-cigarette harms. Results show studies of respiratory, neurological, and cardiovascular effects. Researchers call for expanding studies through new methods to elaborate on initial findings of multiple harms emerging in clinical investigations. Since the use of electronic cigarettes for adult cessation is not sanctioned in most countries, it is clear that health authorities see significant costs to the health of the general population if the promotion and use of electronic cigarettes occur worldwide. Regulatory action to control electronic cigarettes should consider the substantial evidence of electronic cigarette harm.
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Affiliation(s)
- Stephen L. Hamann
- Tobacco Control Research and Knowledge Management Center, Bangkok 10400, Thailand; (S.L.H.); (V.K.); (S.R.); (P.J.)
| | - Nipapun Kungskulniti
- Faculty of Public Health, Mahidol University, Bangkok 10400, Thailand;
- Thailand Health Promotion Institute, Bangkok 10330, Thailand
| | - Naowarut Charoenca
- Faculty of Public Health, Mahidol University, Bangkok 10400, Thailand;
- Thailand Health Promotion Institute, Bangkok 10330, Thailand
| | - Vijj Kasemsup
- Tobacco Control Research and Knowledge Management Center, Bangkok 10400, Thailand; (S.L.H.); (V.K.); (S.R.); (P.J.)
| | - Suwanna Ruangkanchanasetr
- Tobacco Control Research and Knowledge Management Center, Bangkok 10400, Thailand; (S.L.H.); (V.K.); (S.R.); (P.J.)
| | - Passara Jongkhajornpong
- Tobacco Control Research and Knowledge Management Center, Bangkok 10400, Thailand; (S.L.H.); (V.K.); (S.R.); (P.J.)
- Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
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14
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Lazard AJ, Ebrahimi Kalan M, Nicolla S, Hall MG, Ribisl KM, Sheldon JM, Whitesell C, Queen TL, Brewer NT. Optimising messages and images for e-cigarette warnings. Tob Control 2023:tc-2022-057859. [PMID: 37344191 PMCID: PMC10733543 DOI: 10.1136/tc-2022-057859] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 06/08/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND The US Food and Drug Administration (FDA) requires electronic cigarettes (e-cigarettes) to have a single addiction warning, but many other health harms are associated with vaping and warnings grow stale over time. We aimed to develop new warning messages and images to discourage e-cigarette use. METHODS Participants were 1629 US adults who vaped or smoked. We randomised each participant to evaluate 7 of 28 messages on newly developed warning themes (metals exposure, DNA mutation, cardiovascular problems, chemical exposure, lung damage, impaired immunity, addiction), and the current FDA-required warning (total of 8 messages). Then, participants evaluated images of hazards (eg, metal), internal harms (eg, organ damage) or people experiencing harms. RESULTS Regarding intended effects, new warning themes all discouraged vaping more than the current FDA-required warning (all p<0.001), led to greater negative affect (all p<0.001) and led to more anticipated social interactions (all p<0.001). The most discouraging warnings were about toxic metals exposure. Regarding unintended effects, the new themes led to more stigma against people who vape (6 of 7 themes, p<0.001) and led to a greater likelihood of thinking vaping is more harmful than smoking (all 7 themes, p<0.001), although unintended effects were smaller than intended effects. Images of harms (internal or people experiencing) discouraged vaping more than images of hazards (all p<0.001). DISCUSSION Vaping warning policies should communicate a broader range of hazards and harms, beyond addiction, to potentially increase awareness of health harms. Images of internal harm or people experiencing harms may be particularly effective at discouraging vaping.
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Affiliation(s)
- Allison J Lazard
- Hussman School of Journalism and Media, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Mohammad Ebrahimi Kalan
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- School of Health Professions, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Sydney Nicolla
- Hussman School of Journalism and Media, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Marissa G Hall
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kurt M Ribisl
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jennifer Mendel Sheldon
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Callie Whitesell
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tara L Queen
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Noel T Brewer
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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15
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Han SG, Sillé FC, Mihalic JN, Rule AM. The relationship between the use of electronic nicotine delivery systems (ENDS) and effects on pulmonary immune responses-a literature review. ENVIRONMENTAL RESEARCH 2023; 221:115234. [PMID: 36634896 DOI: 10.1016/j.envres.2023.115234] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 12/16/2022] [Accepted: 01/04/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION The use of electronic nicotine delivery systems (ENDS), or vaping, is a relatively recent phenomenon, and there are various gaps in our current knowledge regarding the specific effects of e-cigarettes, such as their immunological effects. The importance of this question became even more relevant in light of the COVID-19 pandemic. OBJECTIVE This literature review examines the relationship between the use of electronic nicotine delivery systems (ENDS) and immunological effects to examine available information and identify gaps in the current knowledge. Our search strategy included studies focusing on the effects of ENDS on the immune response during infectious respiratory diseases such as COVID-19 and pneumonia. METHODS Peer-reviewed studies presenting quantitative data published from 2007, the year that e-cigarettes were introduced to the US market until 2022 have been included. All studies were indexed in PubMed. We excluded papers on THC and EVALI (E-cigarette, or Vaping Product, Use Associated Lung Injury) as we wanted to focus on the effects of nicotine devices. RESULTS Among the 21 articles that assessed the relationship between ENDS and immunological health effects, we found eight studies based on cell models, two articles based on both cell and mouse models, five articles based on mouse models, and six studies of human populations. Most of the articles identified in our review demonstrated a potential association between vaping and adverse immunological health effects. DISCUSSION Overall, the evidence from the cell and animal studies indicates that there is a positive, statistically significant association between vaping and adverse immune response during infectious respiratory diseases. The evidence from human studies is not conclusive.
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Affiliation(s)
- Seok Gyu Han
- Johns Hopkins Bloomberg School of Public Health; 615 N. Wolfe St, Baltimore, MD, 21205, United States
| | - Fenna Cm Sillé
- Johns Hopkins Bloomberg School of Public Health; 615 N. Wolfe St, Baltimore, MD, 21205, United States
| | - Jana N Mihalic
- Johns Hopkins Bloomberg School of Public Health; 615 N. Wolfe St, Baltimore, MD, 21205, United States
| | - Ana M Rule
- Johns Hopkins Bloomberg School of Public Health; 615 N. Wolfe St, Baltimore, MD, 21205, United States.
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16
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Luca AC, Curpăn AȘ, Iordache AC, Mîndru DE, Țarcă E, Luca FA, Pădureț IA. Cardiotoxicity of Electronic Cigarettes and Heat-Not-Burn Tobacco Products-A Problem for the Modern Pediatric Cardiologist. Healthcare (Basel) 2023; 11:healthcare11040491. [PMID: 36833024 PMCID: PMC9957306 DOI: 10.3390/healthcare11040491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/27/2023] [Accepted: 02/01/2023] [Indexed: 02/11/2023] Open
Abstract
Electronic nicotine delivery systems (ENDS) have become increasingly popular among adolescents, either as an alternative to conventional cigarettes (CCs) or as a newly acquired recreational habit. Although considered by most users as a safer option for nicotine intake, these devices pose significant health risks, resulting in multisystem damage. Heat-not-burn products, which, unlike ENDS, contain tobacco, are also alternatives to CCs that consumers use based on the idea that their safety profile is superior to that of cigarettes. Recent studies in the USA and EU show that adolescents are particularly prone to using these devices. Pediatric cardiologists, as well as other healthcare professionals, should be aware of the complications that may arise from acute and chronic consumption of these substances, considering the cardiovascular damage they elicit. This article summarized the known data about the impact of ENDS on the cardiovascular system, with emphasis on the pathophysiological and molecular changes that herald the onset of systemic lesions alongside the clinical cardiovascular manifestations in this scenario.
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Affiliation(s)
- Alina-Costina Luca
- Sfânta Maria’ Emergency Children’s Hospital, 700309 Iași, Romania
- Department of Pediatric Cardiology, Faculty of Medicine, Gr. T. Popa’ University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Alexandrina-Ștefania Curpăn
- Department of Biology, Faculty of Biology, “Alexandru Ioan Cuza” University of Iași, Bd. Carol I, 20A, 700505 Iași, Romania
- Correspondence: (A.-Ș.C.); (E.Ț.)
| | - Alin-Constantin Iordache
- Department of Mother and Child Medicine–Pediatric Cardiology, “Grigore T. Popa”, University of Medicine and Pharmacy of Iasi, 16 Universitatii Str., 700115 Iași, Romania
| | - Dana Elena Mîndru
- Department of Pediatric Cardiology, Faculty of Medicine, Gr. T. Popa’ University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Elena Țarcă
- Sfânta Maria’ Emergency Children’s Hospital, 700309 Iași, Romania
- Department of Surgery II—Pediatric Surgery, Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iași, Romania
- Correspondence: (A.-Ș.C.); (E.Ț.)
| | - Florin-Alexandru Luca
- Department BMTM, “Gheorghe Asachi” Technical University of Iasi, 700050 Iaşi, Romania
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17
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Michon M, Mercier C, Petit C, Leclerc L, Bertoletti L, Pourchez J, Forest V. In Vitro Biological Effects of E-Cigarette on the Cardiovascular System-Pro-Inflammatory Response Enhanced by the Presence of the Cinnamon Flavor. TOXICS 2022; 10:784. [PMID: 36548617 PMCID: PMC9782467 DOI: 10.3390/toxics10120784] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/06/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
The potential cardiovascular effects of e-cigarettes remain largely unidentified and poorly understood. E-liquids contain numerous chemical compounds and can induce exposure to potentially toxic ingredients (e.g., nicotine, flavorings, etc.). Moreover, the heating process can also lead to the formation of new thermal decomposition compounds that may be also hazardous. Clinical as well as in vitro and in vivo studies on e-cigarette toxicity have reported potential cardiovascular damages; however, results remain conflicting. The aim of this study was to assess, in vitro, the toxicity of e-liquids and e-cigarette aerosols on human aortic smooth muscle cells. To that purpose, cells were exposed either to e-liquids or to aerosol condensates obtained using an e-cigarette device at different power levels (8 W or 25 W) to assess the impact of the presence of: (i) nicotine, (ii) cinnamon flavor, and (iii) thermal degradation products. We observed that while no cytotoxicity and no ROS production was induced, a pro-inflammatory response was reported. In particular, the production of IL-8 was significantly enhanced at a high power level of the e-cigarette device and in the presence of the cinnamon flavor (confirming the suspected toxic effect of this additive). Further investigations are required, but this study contributes to shedding light on the biological effects of vaping on the cardiovascular system.
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Affiliation(s)
- Marine Michon
- Mines Saint-Etienne, Univ Jean Monnet, INSERM, U1059 Sainbiose, Centre CIS, 42023 Saint-Etienne, France
| | - Clément Mercier
- Mines Saint-Etienne, Univ Jean Monnet, INSERM, U1059 Sainbiose, Centre CIS, 42023 Saint-Etienne, France
| | - Claudie Petit
- Mines Saint-Etienne, Univ Jean Monnet, INSERM, U1059 Sainbiose, Centre CIS, 42023 Saint-Etienne, France
| | - Lara Leclerc
- Mines Saint-Etienne, Univ Jean Monnet, INSERM, U1059 Sainbiose, Centre CIS, 42023 Saint-Etienne, France
| | - Laurent Bertoletti
- Service de Médecine Vasculaire et Thérapeutique, CHU de Saint-Etienne, 42055 Saint-Etienne, France
- INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, 42055 Saint-Etienne, France
- INSERM, CIC-1408, CHU Saint-Etienne, 42055 Saint-Etienne, France
| | - Jérémie Pourchez
- Mines Saint-Etienne, Univ Jean Monnet, INSERM, U1059 Sainbiose, Centre CIS, 42023 Saint-Etienne, France
| | - Valérie Forest
- Mines Saint-Etienne, Univ Jean Monnet, INSERM, U1059 Sainbiose, Centre CIS, 42023 Saint-Etienne, France
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18
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Bhatta DN, Adhikari R. Incident respiratory disease among youths using combustible tobacco, electronic nicotine products, or both: a longitudinal analysis. World J Pediatr 2022; 18:786-790. [PMID: 35994170 DOI: 10.1007/s12519-022-00608-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/08/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Dharma N Bhatta
- Department of Community Medicine, Department of Medicine and Epidemiology, Peoples Dental College, Tribhuvan University, Kathmandu, Nepal.
| | - Ruchi Adhikari
- General Dentistry, School of Dentistry, University of California San Francisco, San Francisco, CA, USA
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19
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da Silva PF, de Matos NA, Ramos CDO, Castro TDF, Araújo NPDS, de Souza ABF, Costa GDP, Cangussú SD, Talvani A, Nagato AC, Bezerra FS. Acute Outcomes of Cigarette Smoke and Electronic Cigarette Aerosol Inhalation in a Murine Model. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9938179. [PMID: 36193298 PMCID: PMC9526610 DOI: 10.1155/2022/9938179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/14/2022] [Accepted: 09/08/2022] [Indexed: 11/17/2022]
Abstract
Cigarette smoking throughout life causes serious health issues in the lungs. The electronic cigarette (E-Cig) use increased, since it was first introduced in the world. This research work compared the short-term exposure consequences to e-cigarette vapor and cigarette smoke in male mice. Forty-five C57BL/6 mice were randomized into control (C) in an ambient air exposition cigarette smoke (CS) and aerosol electronic cigarette (EC), both were exposed to 120 puffs, 3 times/day during five days. Then, in the experimental protocol, the euthanized mice had their tissues removed for analysis. Our study showed that CS and EC resulted in higher cell influx into the airways, and an increase in macrophage counts in CS (209.25 ± 7.41) and EC (220.32 ± 8.15) when compared to C (108.40 ± 4.49) (p < 0.0001). The CS (1.92 ± 0.23) displayed a higher pulmonary lipid peroxidation as opposed to C (0.93 ± 0.06) and EC (1.23 ± 0.17) (p < 0.05). The EC (282.30 ± 25.68) and CS (368.50 ± 38.05) promoted increased levels of interleukin 17 when compared to C (177.20 ± 10.49) (p < 0.05). The EC developed shifts in lung histoarchitecture, characterized by a higher volume density in the alveolar air space (60.21; 55.00-65.83) related to C (51.25; 18.75-68.75) and CS (50.26; 43.75-62.08) (p =0.002). The EC (185.6 ± 9.01) presented a higher respiratory rate related to CS (133.6 ± 10.2) (p < 0.002). Therefore, our findings demonstrated that the short-term exposure to e-cig promoted more acute inflammation comparing to cigarette smoke in the ventilatory parameters of the animals.
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Affiliation(s)
- Pamela Félix da Silva
- Experimental Pathophysiology Laboratory (LAFEx), Biological Sciences Department (DECBI), Research Center in Biological Sciences (NUPEB), Federal University of Ouro Preto (UFOP), Brazil
| | - Natália Alves de Matos
- Experimental Pathophysiology Laboratory (LAFEx), Biological Sciences Department (DECBI), Research Center in Biological Sciences (NUPEB), Federal University of Ouro Preto (UFOP), Brazil
| | - Camila de Oliveira Ramos
- Experimental Pathophysiology Laboratory (LAFEx), Biological Sciences Department (DECBI), Research Center in Biological Sciences (NUPEB), Federal University of Ouro Preto (UFOP), Brazil
| | - Thalles de Freitas Castro
- Experimental Pathophysiology Laboratory (LAFEx), Biological Sciences Department (DECBI), Research Center in Biological Sciences (NUPEB), Federal University of Ouro Preto (UFOP), Brazil
| | - Natália Pereira da Silva Araújo
- Experimental Pathophysiology Laboratory (LAFEx), Biological Sciences Department (DECBI), Research Center in Biological Sciences (NUPEB), Federal University of Ouro Preto (UFOP), Brazil
| | - Ana Beatriz Farias de Souza
- Experimental Pathophysiology Laboratory (LAFEx), Biological Sciences Department (DECBI), Research Center in Biological Sciences (NUPEB), Federal University of Ouro Preto (UFOP), Brazil
| | - Guilherme de Paula Costa
- Immunobiology of Inflammation Laboratory (LABIIN), Biological Sciences Department (DECBI), Research Center in Biological Sciences (NUPEB), Federal University of Ouro Preto (UFOP), Brazil
| | - Sílvia Dantas Cangussú
- Experimental Pathophysiology Laboratory (LAFEx), Biological Sciences Department (DECBI), Research Center in Biological Sciences (NUPEB), Federal University of Ouro Preto (UFOP), Brazil
| | - André Talvani
- Immunobiology of Inflammation Laboratory (LABIIN), Biological Sciences Department (DECBI), Research Center in Biological Sciences (NUPEB), Federal University of Ouro Preto (UFOP), Brazil
| | - Akinori Cardozo Nagato
- Immunopathology Laboratory and Experimental Pathology, Reproductive Biology Center (CRB), Federal University of Juiz de Fora, Minas Gerais, Brazil
- Department of Physiology, Federal University of Juiz de Fora, Minas Gerais, Brazil
| | - Frank Silva Bezerra
- Experimental Pathophysiology Laboratory (LAFEx), Biological Sciences Department (DECBI), Research Center in Biological Sciences (NUPEB), Federal University of Ouro Preto (UFOP), Brazil
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20
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Benowitz NL, Goniewicz ML, Halpern-Felsher B, Krishnan-Sarin S, Ling PM, O'Connor RJ, Pentz MA, Robertson RM, Bhatnagar A. Tobacco product use and the risks of SARS-CoV-2 infection and COVID-19: current understanding and recommendations for future research. THE LANCET. RESPIRATORY MEDICINE 2022; 10:900-915. [PMID: 35985357 PMCID: PMC9381032 DOI: 10.1016/s2213-2600(22)00182-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 01/27/2022] [Accepted: 05/03/2022] [Indexed: 01/11/2023]
Abstract
Heterogeneity in the clinical presentation of SARS-CoV-2 infection and COVID-19 progression underscores the urgent need to identify individual-level susceptibility factors that affect infection vulnerability and disease severity. Tobacco product use is a potential susceptibility factor. In this Personal View, we provide an overview of the findings of peer-reviewed, published studies relating tobacco product use to SARS-CoV-2 infection and COVID-19 outcomes, with most studies focusing on cigarette smoking in adults. Findings pertaining to the effects of tobacco product use on the incidence of SARS-CoV-2 infection are inconsistent. However, evidence supports a role for cigarette smoking in increasing the risk of poor COVID-19 outcomes, including hospital admission, progression in disease severity, and COVID-19-related mortality. We discuss the potential effects of tobacco use behaviour on SARS-CoV-2 transmission and infection, and highlight the pathophysiological changes associated with cigarette smoking that could promote SARS-CoV-2 infection and increased disease severity. We consider the biological mechanisms by which nicotine and other tobacco product constituents might affect immune and inflammatory responses to SARS-CoV-2 infection. Finally, we identify current knowledge gaps and suggest priorities for research to address acute and post-acute health outcomes of COVID-19 during and after the pandemic.
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Affiliation(s)
- Neal L Benowitz
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | | | | | - Pamela M Ling
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Mary Ann Pentz
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Rose Marie Robertson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Aruni Bhatnagar
- Department of Medicine, University of Louisville, Louisville, KY, USA.
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21
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Rauschert C, Möckl J, Seitz NN, Wilms N, Olderbak S, Kraus L. The Use of Psychoactive Substances in Germany. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:527-534. [PMID: 35791270 PMCID: PMC9677535 DOI: 10.3238/arztebl.m2022.0244] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/01/2022] [Accepted: 06/01/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Monitoring the use of psychoactive substances and substance-related problems in the population allows for the assessment of prevalence and associated health and social consequences. METHODS The data are derived from the Epidemiological Survey of Substance Abuse (ESA) 2021 (n = 9046, 18-64 years). We estimated prevalence rates of the use of tobacco, alcohol, illegal drugs, and psychoactive medications, as well as the prevalence rates of their problematic use (indicating dependence) using screening instruments, and extrapolated the results to the resident population (N = 51 139 451). RESULTS Alcohol was the most frequently used substance, with a 30-day prevalence of 70.5% (36.1 million people), followed by non-opioid analgesic drugs (47.4%; 24.2 million) and conventional tobacco products (22.7%; 11.6 million). E-cigarettes were used by 4.3% (2.2 million) and heat-not-burn products by 1.3% (665 000). Among illegal drugs (12-month prevalence), cannabis was the most frequently used (8.8%; 4.5 million), followed by cocaine/crack (1.6%; 818 000) and amphetamine (1.4%; 716 000). Rates of problematic use among the study participants were 17.6% for alcohol (9.0 million), 7.8% for tobacco (4.0 million), 5.7% for psychoactive medications (2.9 million), and 2.5% for cannabis (1.3 million). CONCLUSION The consumption of psychoactive substances continues to be widespread in Germany. In view of the imminent legal changes, the high prevalence of cannabis use and its problematic use need to be taken into consideration.
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Affiliation(s)
- Christian Rauschert
- IFT Institut für Therapieforschung, Munich,*IFT Institut für Therapieforschung Leopoldstraße 175 80804 München, Germany
| | | | | | | | - Sally Olderbak
- IFT Institut für Therapieforschung, Munich,Psychology Department, University of Arizona, Tucson, USA
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, Munich,Department of Public Health Sciences, Stockholm University, Stockholm, Sweden,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
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22
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Wood LA, Agbonlahor O, Tomlinson MM, Kerstiens S, Vincent K, McLeish AC, Walker KL, Hart JL. Readability of online e-cigarette cessation information. Tob Induc Dis 2022; 20:53. [PMID: 35795399 PMCID: PMC9175538 DOI: 10.18332/tid/149906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/08/2022] [Accepted: 05/09/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Given the growing awareness of the health risks associated with e-cigarettes, many users will access information about how to effectively quit using e-cigarettes, and the internet likely will be a popular source of information. However, little is known about the readability of online e-cigarette cessation information. Therefore, the goal of the current study was to assess the readability of webpage information about e-cigarette cessation. METHODS A search of webpages was conducted using the following search terms: vaping addiction, quit vaping, quit Juul, stop vaping, stop Juul, and vaping cessation. The 464 webpages identified were coded for target audience, message valence, and source, and then assessed for reading level with the Flesch-Kincaid Grade Level assessment. RESULTS On average, webpage content was written at a 7th grade reading level (Flesch-Kincaid Grade Level Mean=7.34, SD=2.22) and less than 25% of webpages met readability guidelines (i.e. ≤6th grade reading level). There were no differences in readability by target audience, message valence, or webpage source. CONCLUSIONS The results suggest that most online content related to e-cigarette cessation is not written at a level that is easily understood by general audiences. Thus, tobacco control advocates should assess the reading level of their messaging to ensure wide accessibility of information.
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Affiliation(s)
- Lindsey A Wood
- Department of Communication, University of Louisville, Louisville, United States.,Christina Lee Brown Envirome Institute, University of Louisville, Louisville, United States
| | - Osayande Agbonlahor
- Department of Communication, University of Louisville, Louisville, United States.,Christina Lee Brown Envirome Institute, University of Louisville, Louisville, United States
| | - Madeline M Tomlinson
- Department of Communication, University of Louisville, Louisville, United States.,Christina Lee Brown Envirome Institute, University of Louisville, Louisville, United States
| | - Savanna Kerstiens
- Department of Communication, University of Louisville, Louisville, United States.,Christina Lee Brown Envirome Institute, University of Louisville, Louisville, United States
| | - Kolbie Vincent
- Department of Communication, University of Louisville, Louisville, United States.,Christina Lee Brown Envirome Institute, University of Louisville, Louisville, United States
| | - Alison C McLeish
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, United States.,Department of Psychological and Brain Sciences, University of Louisville, Louisville, United States.,American Heart Association Tobacco Center for Regulatory Science, Dallas, United States
| | - Kandi L Walker
- Department of Communication, University of Louisville, Louisville, United States.,Christina Lee Brown Envirome Institute, University of Louisville, Louisville, United States.,American Heart Association Tobacco Center for Regulatory Science, Dallas, United States
| | - Joy L Hart
- Department of Communication, University of Louisville, Louisville, United States.,Christina Lee Brown Envirome Institute, University of Louisville, Louisville, United States.,American Heart Association Tobacco Center for Regulatory Science, Dallas, United States
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23
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Ying KL, Brasky TM, Freudenheim JL, McElroy JP, Nickerson QA, Song MA, Weng DY, Wewers MD, Whiteman NB, Mathé EA, Shields PG. Saliva and Lung Microbiome Associations with Electronic Cigarette Use and Smoking. Cancer Prev Res (Phila) 2022; 15:435-446. [PMID: 35667088 PMCID: PMC9256774 DOI: 10.1158/1940-6207.capr-21-0601] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/17/2022] [Accepted: 04/06/2022] [Indexed: 01/07/2023]
Abstract
The microbiome has increasingly been linked to cancer. Little is known about the lung and oral cavity microbiomes in smokers, and even less for electronic cigarette (EC) users, compared with never-smokers. In a cross-sectional study (n = 28) of smokers, EC users, and never-smokers, bronchoalveolar lavage and saliva samples underwent metatranscriptome profiling to examine associations with lung and oral microbiomes. Pairwise comparisons assessed differentially abundant bacteria species. Total bacterial load was similar between groups, with no differences in bacterial diversity across lung microbiomes. In lungs, 44 bacteria species differed significantly (FDR < 0.1) between smokers/never-smokers, with most decreased in smokers. Twelve species differed between smokers/EC users, all decreased in smokers of which Neisseria sp. KEM232 and Curvibacter sp. AEP1-3 were observed. Among the top five decreased species in both comparisons, Neisseria elongata, Neisseria sicca, and Haemophilus parainfluenzae were observed. In the oral microbiome, 152 species were differentially abundant for smokers/never-smokers, and 17 between smokers/electronic cigarette users, but only 21 species were differentially abundant in both the lung and oral cavity. EC use is not associated with changes in the lung microbiome compared with never-smokers, indicating EC toxicity does not affect microbiota. Statistically different bacteria in smokers compared with EC users and never-smokers were almost all decreased, potentially due to toxic effects of cigarette smoke. The low numbers of overlapping oral and lung microbes suggest that the oral microbiome is not a surrogate for analyzing smoking-related effects in the lung. PREVENTION RELEVANCE The microbiome affects cancer and other disease risk. The effects of e-cig usage on the lung microbiome are essentially unknown. Given the importance of lung microbiome dysbiosis populated by oral species which have been observed to drive lung cancer progression, it is important to study effects of e-cig use on microbiome.
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Affiliation(s)
- Kevin L. Ying
- Comprehensive Cancer Center, The Ohio State University and James Cancer Hospital, Columbus, OH,Molecular, Cellular and Developmental Biology Program, The Ohio State University, Columbus, OH
| | - Theodore M. Brasky
- Comprehensive Cancer Center, The Ohio State University and James Cancer Hospital, Columbus, OH,Department Internal Medicine, The Ohio State University College of Medicine, Columbus, OH
| | - Jo L. Freudenheim
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY
| | - Joseph P. McElroy
- Comprehensive Cancer Center, The Ohio State University and James Cancer Hospital, Columbus, OH,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH
| | - Quentin A. Nickerson
- Comprehensive Cancer Center, The Ohio State University and James Cancer Hospital, Columbus, OH
| | - Min-Ae Song
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH
| | - Daniel Y. Weng
- Comprehensive Cancer Center, The Ohio State University and James Cancer Hospital, Columbus, OH
| | - Mark D. Wewers
- Pulmonary and Critical Care Medicine, Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio
| | - Noah B. Whiteman
- Comprehensive Cancer Center, The Ohio State University and James Cancer Hospital, Columbus, OH
| | - Ewy A. Mathé
- Comprehensive Cancer Center, The Ohio State University and James Cancer Hospital, Columbus, OH,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH,Division of Preclinical Innovation, National Center for Advancing Translational Sciences, National Institute of Health, Rockville, MD
| | - Peter G. Shields
- Comprehensive Cancer Center, The Ohio State University and James Cancer Hospital, Columbus, OH,Department Internal Medicine, The Ohio State University College of Medicine, Columbus, OH
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24
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Xie W, Tackett AP, Berlowitz JB, Harlow AF, Kathuria H, Galiatsatos P, Fetterman JL, Cho J, Blaha MJ, Hamburg NM, Robertson RM, DeFilippis AP, Hall ME, Bhatnagar A, Benjamin EJ, Stokes AC. Association of Electronic Cigarette Use with Respiratory Symptom Development among U.S. Young Adults. Am J Respir Crit Care Med 2022; 205:1320-1329. [PMID: 35089853 PMCID: PMC9873120 DOI: 10.1164/rccm.202107-1718oc] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 01/27/2022] [Indexed: 01/28/2023] Open
Abstract
Rationale: Electronic cigarette (e-cigarette) use is highly prevalent among young adults. However, longitudinal data assessing the association between e-cigarette use and respiratory symptoms are lacking. Objectives: To determine whether e-cigarette use is associated with the development of respiratory symptoms in young adults. Methods: Data are derived from the PATH (Population Assessment of Tobacco and Health) study waves 2 (2014-2015), 3 (2015-2016), 4 (2016-2018), and 5 (2018-2019). Young adults aged 18-24 years at baseline with no prevalent respiratory disease or symptoms were included in the analyses. Binary logistic regression models with a generalized estimating equation were used to estimate time-varying and time-lagged associations of e-cigarette use during waves 2-4, with respiratory symptom development approximately 12 months later at waves 3-5. Measurements and Main Results: The per-wave prevalence of former and current e-cigarette use was 15.2% and 5.6%, respectively. Former e-cigarette use was associated with higher odds of developing any respiratory symptom (adjusted odds ratio [aOR], 1.20; 95% confidence interval [CI], 1.04-1.39) and wheezing in the chest (aOR, 1.41; 95% CI, 1.08-1.83) in multivariable adjusted models. Current e-cigarette use was associated with higher odds for any respiratory symptom (aOR, 1.32; 95% CI, 1.06-1.65) and wheezing in the chest (aOR, 1.51; 95% CI, 1.06-2.14). Associations persisted among participants who never smoked combustible cigarettes. Conclusions: In this nationally representative cohort of young adults, former and current e-cigarette use was associated with higher odds of developing wheezing-related respiratory symptoms, after accounting for cigarette smoking and other combustible tobacco product use.
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Affiliation(s)
| | - Alayna P. Tackett
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | - Alyssa F. Harlow
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts
| | | | - Panagis Galiatsatos
- Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jessica L. Fetterman
- Evans Department of Medicine
- Whitaker Cardiovascular Institute, School of Medicine, Boston University, Boston, Massachusetts
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
| | - Junhan Cho
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Michael J. Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Naomi M. Hamburg
- Evans Department of Medicine
- Whitaker Cardiovascular Institute, School of Medicine, Boston University, Boston, Massachusetts
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
| | - Rose Marie Robertson
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
| | - Andrew P. DeFilippis
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael E. Hall
- Division of Cardiovascular Diseases, School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi; and
| | - Aruni Bhatnagar
- Department of Medicine, University of Louisville, Louisville, Kentucky
| | - Emelia J. Benjamin
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts
- Evans Department of Medicine
- Whitaker Cardiovascular Institute, School of Medicine, Boston University, Boston, Massachusetts
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
| | - Andrew C. Stokes
- Department of Global Health
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
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25
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Merianos AL, Russell AM, Mahabee-Gittens EM, Barry AE, Yang M, Lin HC. Concurrent use of e-cigarettes and cannabis and associated COVID-19 symptoms, testing, and diagnosis among student e-cigarette users at four U.S. Universities. Addict Behav 2022; 126:107170. [PMID: 34776303 PMCID: PMC8570844 DOI: 10.1016/j.addbeh.2021.107170] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 10/15/2021] [Accepted: 10/28/2021] [Indexed: 12/27/2022]
Abstract
Introduction This investigation assessed whether current (past 30-day) electronic cigarette (e-cigarette) and cannabis use was associated with coronavirus disease 2019 (COVID-19) symptomatology, testing, and diagnosis among college student e-cigarette users. Methods Participants were 18–26-year-old college student e-cigarette users attending four geographically diverse, large U.S. public universities during October-December 2020 (N = 800). Multivariable logistic regression models explored associations between exclusive e-cigarette use and concurrent e-cigarette and cannabis use and COVID-19 symptoms, testing, and diagnosis. Models controlled for demographics, university site, and current use of combustible cigarettes, cigars, and smokeless tobacco. Results Over half of student e-cigarette users (52.0%) concurrently used cannabis. Compared to exclusive e-cigarette users, concurrent e-cigarette and cannabis users were 3.53 times more likely (95%CI = 1.96–6.36) to report COVID-19 symptoms, after adjusting for the covariates. Compared to infrequent exclusive e-cigarette users, infrequent concurrent users (AOR = 4.72, 95%CI = 1.31–17.00), intermediate concurrent users (AOR = 5.10, 95%CI = 1.37–18.97), and frequent concurrent users (AOR = 7.44, 95%CI = 2.06–26.84) were at increased odds of reporting COVID-19 symptoms. Compared to exclusive e-cigarette users, concurrent e-cigarette and cannabis users were 1.85 times more likely (95%CI = 1.15–2.98) to report a COVID-19 diagnosis. Intermediate concurrent users (AOR = 2.88, 95%CI = 1.13–7.35) and frequent concurrent users (AOR = 3.22, 95%CI = 1.32–7.87) were at increased odds of reporting a COVID-19 diagnosis, compared to infrequent exclusive e-cigarette users. Conclusions Concurrent use of e-cigarettes and cannabis may be an underlying risk factor of COVID-19 symptomatology and diagnosis, with more pronounced odds found among intermediate and frequent users. Results highlight the need to educate students about the impacts of e-cigarette and cannabis use on respiratory, immune, and overall health.
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26
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Lorkiewicz P, Keith R, Lynch J, Jin L, Theis W, Krivokhizhina T, Riggs D, Bhatnagar A, Srivastava S, Conklin DJ. Electronic Cigarette Solvents, JUUL E-Liquids, and Biomarkers of Exposure: In Vivo Evidence for Acrolein and Glycidol in E-Cig-Derived Aerosols. Chem Res Toxicol 2022; 35:283-292. [PMID: 35044764 PMCID: PMC8864610 DOI: 10.1021/acs.chemrestox.1c00328] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Despite the increasing popularity of e-cigarettes, their long-term health effects remain unknown. In animal models, exposure to e-cigarette has been reported to result in pulmonary and cardiovascular injury, and in humans, the acute use of e-cigarettes increases heart rate and blood pressure and induces endothelial dysfunction. In both animal models and humans, cardiovascular dysfunction associated with e-cigarettes has been linked to reactive aldehydes such as formaldehyde and acrolein generated in e-cigarette aerosols. These aldehydes are known products of heating and degradation of vegetable glycerin (VG) present in e-liquids. Here, we report that in mice, acute exposure to a mixture of propylene glycol:vegetable glycerin (PG:VG) or to e-cigarette-derived aerosols significantly increased the urinary excretion of acrolein and glycidol metabolites─3-hydroxypropylmercapturic acid (3HPMA) and 2,3-dihydroxypropylmercapturic acid (23HPMA)─as measured by UPLC-MS/MS. In humans, the use of e-cigarettes led to an increase in the urinary levels of 23HPMA but not 3HPMA. Acute exposure of mice to aerosols derived from PG:13C3-VG significantly increased the 13C3 enrichment of both urinary metabolites 13C3-3HPMA and 13C3-23HPMA. Our stable isotope tracing experiments provide further evidence that thermal decomposition of vegetable glycerin in the e-cigarette solvent leads to generation of acrolein and glycidol. This suggests that the adverse health effects of e-cigarettes may be attributable in part to these reactive compounds formed through the process of aerosolizing nicotine. Our findings also support the notion that 23HPMA, but not 3HPMA, may be a relatively specific biomarker of e-cigarette use.
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Affiliation(s)
- Pawel Lorkiewicz
- American
Heart Association-Tobacco Regulation and Addiction Center, University of Louisville, Louisville, Kentucky 40202, United States,Christina
Lee Brown Envirome Institute, University
of Louisville, Louisville, Kentucky 40202, United States,Superfund
Research Center, University of Louisville, Louisville, Kentucky 40202, United States,Department
of Chemistry, University of Louisville, Louisville, Kentucky 40202, United States
| | - Rachel Keith
- American
Heart Association-Tobacco Regulation and Addiction Center, University of Louisville, Louisville, Kentucky 40202, United States,Christina
Lee Brown Envirome Institute, University
of Louisville, Louisville, Kentucky 40202, United States,Superfund
Research Center, University of Louisville, Louisville, Kentucky 40202, United States,Division
of Environmental Medicine, Department of Medicine, University of Louisville, Louisville, Kentucky 40202, United States
| | - Jordan Lynch
- Christina
Lee Brown Envirome Institute, University
of Louisville, Louisville, Kentucky 40202, United States,Superfund
Research Center, University of Louisville, Louisville, Kentucky 40202, United States
| | - Lexiao Jin
- American
Heart Association-Tobacco Regulation and Addiction Center, University of Louisville, Louisville, Kentucky 40202, United States,Christina
Lee Brown Envirome Institute, University
of Louisville, Louisville, Kentucky 40202, United States
| | - Whitney Theis
- American
Heart Association-Tobacco Regulation and Addiction Center, University of Louisville, Louisville, Kentucky 40202, United States,Christina
Lee Brown Envirome Institute, University
of Louisville, Louisville, Kentucky 40202, United States
| | - Tatiana Krivokhizhina
- American
Heart Association-Tobacco Regulation and Addiction Center, University of Louisville, Louisville, Kentucky 40202, United States,Christina
Lee Brown Envirome Institute, University
of Louisville, Louisville, Kentucky 40202, United States,Superfund
Research Center, University of Louisville, Louisville, Kentucky 40202, United States
| | - Daniel Riggs
- Christina
Lee Brown Envirome Institute, University
of Louisville, Louisville, Kentucky 40202, United States,Superfund
Research Center, University of Louisville, Louisville, Kentucky 40202, United States,Division
of Environmental Medicine, Department of Medicine, University of Louisville, Louisville, Kentucky 40202, United States
| | - Aruni Bhatnagar
- American
Heart Association-Tobacco Regulation and Addiction Center, University of Louisville, Louisville, Kentucky 40202, United States,Christina
Lee Brown Envirome Institute, University
of Louisville, Louisville, Kentucky 40202, United States,Superfund
Research Center, University of Louisville, Louisville, Kentucky 40202, United States,Division
of Environmental Medicine, Department of Medicine, University of Louisville, Louisville, Kentucky 40202, United States
| | - Sanjay Srivastava
- American
Heart Association-Tobacco Regulation and Addiction Center, University of Louisville, Louisville, Kentucky 40202, United States,Christina
Lee Brown Envirome Institute, University
of Louisville, Louisville, Kentucky 40202, United States,Superfund
Research Center, University of Louisville, Louisville, Kentucky 40202, United States,Division
of Environmental Medicine, Department of Medicine, University of Louisville, Louisville, Kentucky 40202, United States
| | - Daniel J. Conklin
- American
Heart Association-Tobacco Regulation and Addiction Center, University of Louisville, Louisville, Kentucky 40202, United States,Christina
Lee Brown Envirome Institute, University
of Louisville, Louisville, Kentucky 40202, United States,Superfund
Research Center, University of Louisville, Louisville, Kentucky 40202, United States,Division
of Environmental Medicine, Department of Medicine, University of Louisville, Louisville, Kentucky 40202, United States,. Tel.: 502-852-5836
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27
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McLeish AC, Hart JL, Walker KL. College Student E-Cigarette Users' Knowledge about E-Cigarettes: Ingredients, Health Risks, Device Modifications, and Information Sources. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19041962. [PMID: 35206150 PMCID: PMC8871630 DOI: 10.3390/ijerph19041962] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/04/2022] [Accepted: 02/09/2022] [Indexed: 11/26/2022]
Abstract
Although college students represent a growing demographic of e-cigarette users, it is unclear how knowledgeable they are about the product they use. The lack of such knowledge could result in unsafe practices and greater health risks. Therefore, the purpose of the current study was to examine college student e-cigarette users’ knowledge about e-cigarette ingredients and health risks, how often they modify their devices, and whether they utilize reputable sources when searching for information regarding e-cigarettes. The participants were 183 undergraduate e-cigarette users (Mage = 19.98, SD = 1.98; 71.6% female; 85.8% White). Most participants correctly recognized that e-cigarettes increase the risk of cardiovascular disease and lung disease, but fewer than half recognized the increased risk of seizures and depression. Only one-third to one-half of participants correctly identified the toxic compounds commonly found in e-cigarettes, and most indicated that they would consult Google or a friend with questions about e-cigarettes. College student e-cigarette users are well-informed about many health risks associated with e-cigarettes. However, they are relatively unaware of the harmful substances in e-cigarettes and are seeking information from less reliable sources. Targeted public health campaigns educating college students about e-cigarettes, including where to seek reliable information, are needed.
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Affiliation(s)
- Alison C. McLeish
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY 40292, USA
- VapeRace Center, Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY 40202, USA; (J.L.H.); (K.L.W.)
- Tobacco Center for Regulatory Science, American Heart Association, Dallas, TX 75231, USA
- Correspondence:
| | - Joy L. Hart
- VapeRace Center, Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY 40202, USA; (J.L.H.); (K.L.W.)
- Tobacco Center for Regulatory Science, American Heart Association, Dallas, TX 75231, USA
- Department of Communication, University of Louisville, Louisville, KY 40292, USA
| | - Kandi L. Walker
- VapeRace Center, Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY 40202, USA; (J.L.H.); (K.L.W.)
- Tobacco Center for Regulatory Science, American Heart Association, Dallas, TX 75231, USA
- Department of Communication, University of Louisville, Louisville, KY 40292, USA
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28
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Glantz SA. The Perils of Drawing Strong Conclusions Based on Underpowered Analyses. Am J Prev Med 2022; 62:e137-e139. [PMID: 35000691 DOI: 10.1016/j.amepre.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/28/2021] [Indexed: 11/26/2022]
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29
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Besaratinia A. From Tobacco Cigarettes to Electronic Cigarettes: The Two Sides of a Nicotine Coin. FRONTIERS IN ORAL HEALTH 2022; 2:790634. [PMID: 35048076 PMCID: PMC8757837 DOI: 10.3389/froh.2021.790634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/04/2021] [Indexed: 01/31/2023] Open
Abstract
Tobacco smoking-related diseases, including cardiovascular disease, pulmonary disease, stroke, and cancer in multiple organ sites, are the leading causes of preventable death, worldwide. Youth electronic cigarette use (vaping) is an evolving public health problem in the United States and around the world. Many of the same toxicants and carcinogens present in tobacco smoke are also found in electronic cigarette vapor, although mostly at substantially lower levels. The reduced concentrations of these chemicals in electronic cigarette vapor may imply lower health risk; however, they cannot equate to no risk. To date, the long-term health consequences of vaping are largely unknown. This “Perspective” provides a concise chronology of events leading up to an unprecedented global challenge, namely the convergence of global tobacco epidemic and youth vaping epidemic. Current state of knowledge, outstanding questions in the field, present challenges, and future directions in research are highlighted. The existing data show a continued and dynamic evolution of the converged epidemics. The goal should be to prevent youth vaping while improving smoking cessation strategies. In smokers who are unable or unwilling to quit smoking, the objective should be to provide “provably” safe or less-harmful alternatives, which should “completely” or “substantially” substitute tobacco cigarettes.
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Affiliation(s)
- Ahmad Besaratinia
- Department of Population and Public Health Sciences, USC Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
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30
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Hart JL, Payne TJ, Groom A, Tran H, Walker KL, Kesh A, Robertson RM, Vu THT. Association between electronic nicotine delivery systems (ENDS) device and E-liquid alterations and flavor use with clinical and EVALI-like symptoms. Prev Med Rep 2022; 24:101619. [PMID: 34976675 PMCID: PMC8683991 DOI: 10.1016/j.pmedr.2021.101619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 10/18/2021] [Accepted: 10/22/2021] [Indexed: 11/02/2022] Open
Abstract
Studies reporting clinical symptoms related to electronic nicotine delivery systems (ENDS) usage, especially types of devices and e-liquids, are sparse. The sample included 1,432 current ENDS users, ages 18-64, from a nationwide online survey conducted in 2016. ENDS use included device types, nicotine content, flavors, and e-liquid used. Outcomes included any e-cigarette, or vaping, product use-associated lung injury (EVALI)-like symptoms (e.g., cough, shortness of breath, nausea) as well as any clinical symptoms. Of the sample, 50% were female, 23% non-Hispanic (NH) White, 23% NH Black, 54% Hispanic, 18% aged 18-24, 17% LGBTQ, 41% with <$50 K income, 55% 1 + any symptoms, and 33% 1 + any EVALI-like symptoms. Cough and nausea were most prevalent among EVALI-like symptoms (27% and 7.3%, respectively). The proportion having any EVALI-like symptoms was higher in the following groups: younger, Hispanic, current smokers, and current other product users. With multiple adjustments, participants who used refillable devices, varied nicotine content, used flavored products, or made their own e-liquids were more likely to have clinical symptoms than their counterparts. For example, the odds (95% CI) of having 1 + EVALI-like symptoms in participants who used refillable devices with e-liquid pour or e-liquid cartridge replacement were 1.70 (1.13, 2.56) and 1.95 (1.27, 2.99), respectively, compared to the non-refillable group. Use of products (devices and e-liquids) that can be altered and flavored products are associated with higher odds of having clinical symptoms, including EVALI-like symptoms.
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Affiliation(s)
- Joy L Hart
- American Heart Association Tobacco Center for Regulatory Science (A-TRAC), Dallas, TX, USA.,Department of Communication, University of Louisville, Louisville, KY, USA
| | - Thomas J Payne
- American Heart Association Tobacco Center for Regulatory Science (A-TRAC), Dallas, TX, USA.,Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, MS, USA
| | - Allison Groom
- American Heart Association Tobacco Center for Regulatory Science (A-TRAC), Dallas, TX, USA.,American Heart Association, Dallas, TX, USA
| | - Hy Tran
- NORC at the University of Chicago, Chicago, IL, USA
| | - Kandi L Walker
- American Heart Association Tobacco Center for Regulatory Science (A-TRAC), Dallas, TX, USA.,Department of Communication, University of Louisville, Louisville, KY, USA
| | - Anshula Kesh
- American Heart Association Tobacco Center for Regulatory Science (A-TRAC), Dallas, TX, USA.,American Heart Association, Dallas, TX, USA
| | - Rose Marie Robertson
- American Heart Association Tobacco Center for Regulatory Science (A-TRAC), Dallas, TX, USA.,American Heart Association, Dallas, TX, USA
| | - Thanh-Huyen T Vu
- American Heart Association Tobacco Center for Regulatory Science (A-TRAC), Dallas, TX, USA.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Manigrasso M, Protano C, Vitali M, Avino P. Passive Vaping from Sub-Ohm Electronic Cigarette Devices. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111606. [PMID: 34770123 PMCID: PMC8583564 DOI: 10.3390/ijerph182111606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 09/29/2021] [Accepted: 11/01/2021] [Indexed: 11/25/2022]
Abstract
To investigate passive vaping due to sub-ohm electronic cigarettes (e-cigs), aerosol number size distribution measurements (6 nm–10 µm) were performed during volunteer-vaping sessions. E-liquids, with vegetable glycerin (VG) and propylene glycol (PG), with a VG/PG ratio of 50/50 (with nicotine) and 80/20 (without nicotine), were vaped with a double-coil, single aerosol exit hole at 25–80 W electric power, corresponding to 130–365 kW m−2 heat fluxes and with an octa-coil, four aerosol exit holes atomizers, at 50–150 W electric power, corresponding to 133–398 kW m−2 heat fluxes. At the lowest heat flux, lower particle number concentrations (NTot) were observed for the nicotine-liquid than for the nicotine-free liquid, also due to its higher content of PG, more volatile than VG. For the octa-coil atomizer, at 265 and 398 kW m−2, NTot decreased below the first-generation e-cig, whereas volume concentrations greatly increased, due to the formation of super micron droplets. Higher volume concentrations were observed for the 80/20 VG/PG liquid, because of VG vaporization and of its decomposition products, greater than for PG. For the double coil atomizer, increasing the electric power from 40 W (208 kW m−2) to 80 W (365 kW m−2) possibly led to a critical heat flow condition, causing a reduction of the number concentrations for the VG/PG 50/50 liquid, an increase for the 80/20 VG/PG liquid and a decrease of the volume concentrations for both of them. Coherently, the main mode was at about 0.1 µm on both metrics for both liquids. For the other tests, two main modes (1 and 2 µm) were observed in the volume size distributions, the latter becoming wider at 100 and 150 W (265 and 398 kW m−2), suggesting the increased emission of light condensable decomposition products. The lower aerosol emissions observed at 150 W than at 100 W suggest the formation of gas-phase decomposition products. The observation of low-count high-volume aerosols addresses the relevance of the volume metric upon measuring the second-hand concentration of the aerosols released by sub-ohm e-cigarettes.
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Affiliation(s)
- Maurizio Manigrasso
- Department of Technological Innovations, National Institute for Insurance against Accidents at Work (INAIL), 00187 Rome, Italy
- Correspondence: (M.M.); (C.P.)
| | - Carmela Protano
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy;
- Correspondence: (M.M.); (C.P.)
| | - Matteo Vitali
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy;
| | - Pasquale Avino
- Department of Agricultural, Environmental and Food Sciences (DiAAA), University of Molise, 86100 Campobasso, Italy;
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