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Qiu H, Zhang H, Han DD, Derakhshandeh R, Wang X, Goyal N, Navabzadeh M, Rao P, Wilson EE, Mohammadi L, Olgin JE, Springer ML. Increased vulnerability to atrial and ventricular arrhythmias caused by different types of inhaled tobacco or marijuana products. Heart Rhythm 2023; 20:76-86. [PMID: 36603937 PMCID: PMC10006068 DOI: 10.1016/j.hrthm.2022.09.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/01/2022] [Accepted: 09/09/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The emergence of a plethora of new tobacco products marketed as being less harmful than smoking, such as electronic cigarettes and heated tobacco products, and the increased popularity of recreational marijuana have raised concerns about the potential cardiovascular risk associated with their use. OBJECTIVE The purpose of this study was to investigate whether the use of novel tobacco products or marijuana can cause the development of proarrhythmic substrate and eventually lead to arrhythmias. METHODS Rats were exposed to smoke from tobacco, marijuana, or cannabinoid-depleted marijuana, to aerosol from electronic cigarettes or heated tobacco products, or to clean air once per day for 8 weeks, following by assays for blood pressure, cardiac function, ex vivo electrophysiology, and histochemistry. RESULTS The rats exposed to tobacco or marijuana products exhibited progressively increased systolic blood pressure, decreased cardiac systolic function with chamber dilation, and reduced overall heart rate variability, relative to the clean air negative control group. Atrial fibrillation and ventricular tachycardia testing by ex vivo optical mapping revealed a significantly higher susceptibility to each, with a shortened effective refractory period and prolonged calcium transient duration. Histological analysis indicated that in all exposure conditions except for air, exposure to smoke or aerosol from tobacco or marijuana products caused severe fibrosis with decreased microvessel density and higher level of sympathetic nerve innervation. CONCLUSION These pathophysiological results indicate that tobacco and marijuana products can induce arrhythmogenic substrates involved in cardiac electrical, structural, and neural remodeling, facilitating the development of arrhythmias.
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Affiliation(s)
- Huiliang Qiu
- Division of Cardiology, University of California, San Francisco, San Francisco, California
| | - Hao Zhang
- Division of Cardiology, University of California, San Francisco, San Francisco, California
| | - Daniel D Han
- Division of Cardiology, University of California, San Francisco, San Francisco, California
| | - Ronak Derakhshandeh
- Division of Cardiology, University of California, San Francisco, San Francisco, California
| | - Xiaoyin Wang
- Division of Cardiology, University of California, San Francisco, San Francisco, California
| | - Natasha Goyal
- Division of Cardiology, University of California, San Francisco, San Francisco, California
| | - Mina Navabzadeh
- Division of Cardiology, University of California, San Francisco, San Francisco, California
| | - Poonam Rao
- Division of Cardiology, University of California, San Francisco, San Francisco, California
| | - Emily E Wilson
- Division of Cardiology, University of California, San Francisco, San Francisco, California
| | - Leila Mohammadi
- Division of Cardiology, University of California, San Francisco, San Francisco, California
| | - Jeffrey E Olgin
- Division of Cardiology, University of California, San Francisco, San Francisco, California; Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California
| | - Matthew L Springer
- Division of Cardiology, University of California, San Francisco, San Francisco, California; Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California; Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, California.
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Effah F, Taiwo B, Baines D, Bailey A, Marczylo T. Pulmonary effects of e-liquid flavors: a systematic review. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2022; 25:343-371. [PMID: 36154615 PMCID: PMC9590402 DOI: 10.1080/10937404.2022.2124563] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Electronic cigarettes (ECs) are purported to be tobacco harm-reduction products whose degree of harm has been highly debated. EC use is considered less hazardous than smoking but is not expected to be harmless. Following the banning of e-liquid flavors in countries such as the US, Finland, Ukraine, and Hungary, there are growing concerns regarding the safety profile of e-liquid flavors used in ECs. While these are employed extensively in the food industry and are generally regarded as safe (GRAS) when ingested, GRAS status after inhalation is unclear. The aim of this review was to assess evidence from 38 reports on the adverse effects of flavored e-liquids on the respiratory system in both in vitro and in vivo studies published between 2006 and 2021. Data collected demonstrated greater detrimental effects in vitro with cinnamon (9 articles), strawberry (5 articles), and menthol (10 articles), flavors than other flavors. The most reported effects among these investigations were perturbations of pro-inflammatory biomarkers and enhanced cytotoxicity. There is sufficient evidence to support the toxicological impacts of diacetyl- and cinnamaldehyde-containing e-liquids following human inhalation; however, safety profiles on other flavors are elusive. The latter may result from inconsistencies between experimental approaches and uncertainties due to the contributions from other e-liquid constituents. Further, the relevance of the concentration ranges to human exposure levels is uncertain. Evidence indicates that an adequately controlled and consistent, systematic toxicological investigation of a broad spectrum of e-liquid flavors may be required at biologically relevant concentrations to better inform public health authorities on the risk assessment following exposure to EC flavor ingredients.
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Affiliation(s)
- Felix Effah
- Pharmacology Section, St George’s University of London, London, UK
- Radiation, Chemical and Environmental Hazards, UK Health Security Agency, Didcot, UK
| | - Benjamin Taiwo
- Physiology Section, St George’s University of London, London, UK
| | - Deborah Baines
- Infection and Immunity Institute, St George’s University of London, London, UK
| | - Alexis Bailey
- Pharmacology Section, St George’s University of London, London, UK
| | - Tim Marczylo
- Radiation, Chemical and Environmental Hazards, UK Health Security Agency, Didcot, UK
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Haw S, Currie D, Eadie D, Pearce J, MacGregor A, Stead M, Amos A, Best C, Wilson M, Cherrie M, Purves R, Ozakinci G, MacKintosh AM. The impact of the point-of-sale tobacco display ban on young people in Scotland: before-and-after study. PUBLIC HEALTH RESEARCH 2020. [DOI: 10.3310/phr08010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background
Tobacco displays at point of sale have been shown to increase young people’s pro-smoking attitudes, susceptibility to smoking and smoking initiation. In Scotland, legislation that prohibited tobacco point-of-sale displays was implemented in large stores (i.e. those > 280 m2) in April 2013 and in small retailers in April 2015.
Objective
To assess the impact of the point-of-sale tobacco display ban on young people’s exposure to tobacco advertising, their attitudes to smoking and smoking susceptibility, and their risk of smoking initiation.
Design
Multimodal before-and-after study design using mixed methods to collect data at baseline (2013) and then longitudinally for 4 years.
Setting
Four main study communities in the central belt of mainland Scotland, UK, purposively selected to reflect two levels of urbanity (urban vs. small town) and two levels of deprivation (high vs. medium/low). Four matched communities.
Participants
In the main study communities, 94 tobacco retail outlets. All Secondary 2 (aged 13 years) and Secondary 4 (aged 15 years) pupils in 2013 and 2014 together with all Secondary 1 to Secondary 6 (aged 12–17 years) pupils in 2015–17. This included 6612 pupils who completed 14,344 questionnaires over 5 years. Three hundred and eighty-two participants in 80 focus groups who were recruited from Secondary 2 and Secondary 4 in 2013–17. In matched communities, 24 retail panel members in 2013–17.
Main outcome measures
Tobacco product and tobacco storage visibility, density of retail outlets (the number of retailers in a pre-defined area such as a residential neighbourhood), tobacco product exposure, brand awareness, perceived accessibility of tobacco, pro-smoking attitudes, pro-smoking norms, smoking susceptibility and smoking initiation.
Data platform and methods
The study had four components – a mapping and spatial analysis of retail outlets; a tobacco marketing audit, including retail panel interviews in matched communities; school surveys; and focus group discussions with secondary school pupils.
Limitations
The study was based on a small number of communities and did not include communities in remote areas.
Results
Compliance with the point-of-sale legislation in Scotland was high. This led to a large reduction in the visibility of tobacco products in retail outlets. However, when the results were stratified by socioeconomic status, declines in retailer density, weighted by total product visibility, were restricted to the least disadvantaged tertile of participants. Nevertheless, the implementation of the legislation was associated with a reduction in risk of both smoking susceptibility and smoking initiation in young people, as well as a reduction in the perceived accessibility of tobacco and in pro-smoking attitudes after both the partial and the comprehensive bans were introduced.
Conclusions
The Scottish point-of-sale legislation has been successful in reducing the overall visibility of tobacco products and is associated with improvements in attitudinal and behavioural outcomes in young people. However, cues that tobacco is for sale are still highly visible, particularly in retail outlets in areas of deprivation. In addition, the increase in retailer density that was observed after 2015 increased inequalities in product visibility. There was also evidence that the emergence of e-cigarettes may have disrupted the full impact of the legislation.
Future work
Our research indicates that further research is needed to examine the longitudinal relationships between tobacco outlet availability and product visibility inequalities; and the impact of e-cigarettes and standardised packaging on smoking initiation and prevalence.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 1. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Sally Haw
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Dorothy Currie
- Centre for Adolescent and Child Health Research, School of Medicine, University of St Andrews, St Andrews, UK
| | - Douglas Eadie
- Institute for Social Marketing, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Jamie Pearce
- Institute of Geography, School of GeoSciences, University of Edinburgh, Edinburgh, UK
| | | | - Martine Stead
- Institute for Social Marketing, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Amanda Amos
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Catherine Best
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Michael Wilson
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Mark Cherrie
- Institute of Geography, School of GeoSciences, University of Edinburgh, Edinburgh, UK
| | - Richard Purves
- Institute for Social Marketing, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Gozde Ozakinci
- School of Medicine, Medical & Biological Sciences, University of St Andrews, St Andrews, UK
| | - Anne Marie MacKintosh
- Institute for Social Marketing, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
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Popova L, Majeed B, Owusu D, Spears CA, Ashley DL. Who are the smokers who never plan to quit and what do they think about the risks of using tobacco products? Addict Behav 2018; 87:62-68. [PMID: 29958136 PMCID: PMC6109416 DOI: 10.1016/j.addbeh.2018.06.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 06/18/2018] [Accepted: 06/21/2018] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Smoking cigarettes is the most harmful way to use tobacco. Smokers who do not plan to quit present a particular challenge in reducing the morbidity and mortality from tobacco use. Switching to a lower harm product might encourage them to end their use of combusted cigarettes. This study aimed to better understand smokers who do not intend to quit (including their demographic and worldviews as indicators of their social, cultural, and political dispositions) and their perceived risks of cigarettes and possible lower-risk products such as e-cigarettes. METHODS Participants were 2572 current smokers. Data were pooled from 2015 and 2016 cross-sectional surveys of national probability samples of U.S. adults and analyzed with multivariable logistic regressions. RESULTS Smokers who never plan to quit comprise 14.3% of current U.S. smokers and are more likely to be older (24.2% among 65+ years old vs. 9.8% among 18-24) and less likely to have ever used e-cigarettes. A one-unit increase in hierarchical worldview (measured on a 1-6 scale) was associated with a 20% increase in the odds of never planning to quit. Those who denied that cigarettes cause disease or death (aORs between 1.6 and 2.0) or were uncertain (aORs: 2.5-2.7) were more likely to never plan to quit compared to those who agreed. They did not view risks of e-cigarettes substantially different compared to smokers who plan to quit. CONCLUSION One in seven U.S. smokers never plans to quit and might benefit from interventions which reflect their hierarchical worldviews and increase their risk perceptions of combustible cigarettes.
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Affiliation(s)
- Lucy Popova
- School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, Georgia 30302, USA.
| | - Ban Majeed
- Department of Population Health Sciences, Medical College of Georgia, 1120 15th Street, Augusta, Georgia 30912, USA
| | - Daniel Owusu
- School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, Georgia 30302, USA
| | - Claire Adams Spears
- School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, Georgia 30302, USA
| | - David L Ashley
- School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, Georgia 30302, USA
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Zavala-Arciniega L, Reynales-Shigematsu LM, Lozano P, Rodríguez-Andrade MÁ, Arillo-Santillán E, Thrasher JF. Patterns of awareness and use of electronic cigarettes in Mexico, a middle-income country that bans them: Results from a 2016 national survey. Prev Med 2018; 116:211-218. [PMID: 30261244 PMCID: PMC6276365 DOI: 10.1016/j.ypmed.2018.09.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 09/10/2018] [Accepted: 09/22/2018] [Indexed: 12/23/2022]
Abstract
Among high-income countries, awareness and use of e-cigarettes is lower in countries with more restrictive e-cigarette regulations. Little is known about e-cigarettes in middle-income countries, many of which like Mexico, ban e-cigarette sales and marketing. The current study determined the national-level prevalence and correlates of e-cigarette awareness and consumption in Mexico. Data were analyzed from a 2016 nationally representative survey. Prevalence of e-cigarette awareness, trial and current use was estimated separately for adolescents (n = 12,436), adult nonsmokers (n = 36,966), and adult smokers (n = 7347). For each group, crude and adjusted logistic models regressed e-cigarette outcomes on sociodemographic and smoking-related variables, adjusting for the sampling design and weights. Prevalence varied across subgroups for e-cigarette awareness (adolescents = 45.3%; adult nonsmokers = 33.9%; adult smokers = 54.3%), e-cigarette trial (adolescents = 6.5%; adult nonsmokers = 2.6%; adult smokers = 18.2%) and current use of electronic cigarettes (adolescents = 1.1%; adult nonsmokers = 0.3%; adult smokers = 4.5%). Among adolescents and adults, current smoking and higher smoking frequency were significantly associated with e-cigarette awareness, trial and use. Among adolescents and nonsmokers, awareness, trial and use of e-cigarette were significantly lower among females than males. Among adult smokers, however, females were more likely to use e-cigarettes than males (AOR = 1.80; 95% CI = 1.08-3.02). Higher education and greater wealth increased the likelihood of trial of e-cigarettes among adult nonsmokers and smokers. Despite the ban on the distribution and sales of e-cigarettes, a substantial number of Mexicans, have access to e-cigarettes. Decision makers and advocates should consider e-cigarette regulations as recommended by the WHO, at the same time Mexico must invest in the infrastructure needed to enforce these regulations.
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Affiliation(s)
- Luis Zavala-Arciniega
- Tobacco Research Department, National Institute of Public Health, Cuernavaca, Mexico
| | | | - Paula Lozano
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | | | - Edna Arillo-Santillán
- Tobacco Research Department, National Institute of Public Health, Cuernavaca, Mexico
| | - James F Thrasher
- Tobacco Research Department, National Institute of Public Health, Cuernavaca, Mexico; Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, USA
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6
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Wills TA, Soneji SS. Individual-Level and Ecological Studies. J Adolesc Health 2018; 62:507-508. [PMID: 29709223 DOI: 10.1016/j.jadohealth.2018.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 03/01/2018] [Indexed: 01/10/2023]
Affiliation(s)
- Thomas A Wills
- Cancer Prevention in the Pacific Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Samir S Soneji
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, New Hampshire
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Abstract
Since e-cigarettes appeared in the mid-2000s, some practitioners, researchers, and policy makers have embraced them as a safer alternative to conventional cigarettes and an effective way to stop smoking. While e-cigarettes deliver lower levels of carcinogens than do conventional cigarettes, they still expose users to high levels of ultrafine particles and other toxins that may substantially increase cardiovascular and noncancer lung disease risks, which account for more than half of all smoking-caused deaths, at rates similar to conventional cigarettes. Moreover, rather than stimulating smokers to switch from conventional cigarettes to less dangerous e-cigarettes or quitting altogether, e-cigarettes are reducing smoking cessation rates and expanding the nicotine market by attracting youth.
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Affiliation(s)
- Stanton A Glantz
- Center for Tobacco Control Research and Education and Department of Medicine, University of California, San Francisco, California 94143, USA;
| | - David W Bareham
- Lincolnshire Community Health Services NHS Trust, Louth, LN11 0EU, United Kingdom;
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Schweitzer RJ, Wills TA, Tam E, Pagano I, Choi K. E-cigarette use and asthma in a multiethnic sample of adolescents. Prev Med 2017; 105:226-231. [PMID: 28964850 PMCID: PMC5653431 DOI: 10.1016/j.ypmed.2017.09.023] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 09/11/2017] [Accepted: 09/24/2017] [Indexed: 10/18/2022]
Abstract
There is minimal evidence from epidemiological studies on how e-cigarette use is related to health indices in adolescence. We hypothesized that e-cigarette use would be associated with asthma, controlling for demographics and cigarette smoking. The hypothesis was tested with cross-sectional data from a statewide sample of school students. Surveys were administered in classrooms in 2015 to adolescents in 33 high schools throughout the State of Hawaii. The sample (N=6089) was 50% female and mean age was 15.8years. Data were obtained on demographics; ever use and current (past 30days) use of e-cigarettes, combustible cigarettes, and marijuana; ever being diagnosed with asthma; and currently having asthma. Multinomial regression examined the association between e-cigarette use and asthma controlling for cigarette smoking, marijuana use, and six demographic covariates. Current e-cigarette use was associated with currently having (vs. never having) asthma (adjusted odds ratio [aOR]=1.48, CI 1.26-1.74) and with previously having (vs. never having) asthma (aOR=1.22, CI 1.07-1.40). This was independent of cigarette smoking, marijuana use, and other covariates. Smoking and marijuana were nonsignificant in the multivariate analysis. Blacks, Native Hawaiians, other Pacific Islanders, and Filipinos had higher rates of asthma compared with Asian Americans and Caucasians. We conclude that e-cigarette use by adolescents is independently associated with asthma. This finding is consistent with recent laboratory research on pulmonary effects from e-cigarette vapor. Implications for public health should be considered.
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Affiliation(s)
- Rebecca J Schweitzer
- Office of Public Health Studies, University of Hawaii at Manoa, Honolulu, HI, USA.
| | - Thomas A Wills
- Cancer Prevention in the Pacific Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Elizabeth Tam
- Department of Medicine, John A. Burns School of Medicine, Honolulu, HI, USA
| | - Ian Pagano
- Cancer Prevention in the Pacific Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA
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