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Bagdas D, Zepei AM, Harris L, Minanov K, Jimenez JL, Addy NA. Impact of vanilla flavor on nicotine taste, choice, intake, and seeking behaviors. Psychopharmacology (Berl) 2024:10.1007/s00213-024-06630-9. [PMID: 38839631 DOI: 10.1007/s00213-024-06630-9] [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: 10/14/2023] [Accepted: 05/31/2024] [Indexed: 06/07/2024]
Abstract
RATIONALE Flavors can alter the orosensory properties of tobacco products. Specifically, flavors can serve as an oral cue for smokeless tobacco products. OBJECTIVES We aimed to investigate the impact of oral vanillin, the principal chemical of vanilla flavor in tobacco products, on nicotine's taste, and nicotine choice, intake, and seeking behaviors. METHODS Experiments were performed in young adult Sprague Dawley rats. We employed a two-bottle free-choice test (2BC) to measure the preference for different concentrations of vanillin and its effect on nicotine preference. To explore the long-term effects of early exposure to sweetened vanillin, we utilized a combined 2BC and intraoral self-administration (IOSA) model. We assessed the nicotine taking and seeking behaviors in the presence or absence of vanillin. We performed a taste reactivity test (TRT) to quantify liking (ingestive) and disliking (aversive) taste responses to oral nicotine with or without vanillin. RESULTS In 2BC, female rats preferred vanillin containing solutions more than their male counterparts. In IOSA, vanillin alone and in combination with nicotine led to greater IOSA compared to water. Female rats self-administered vanillin plus nicotine more than male rats. Vanillin increased motivation to nicotine taking, but only in females. In TRT, vanillin increased nicotine's ingestive responses but blocked aversive responses in both sexes. CONCLUSIONS These results indicate that vanilla flavor can increase oral nicotine intake. It can also increase liking and decrease disliking of nicotine's taste. Furthermore, the impact of vanilla flavor on nicotine taste and nicotine choice, intake, and seeking behaviors is concentration and sex dependent.
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Affiliation(s)
- Deniz Bagdas
- Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA.
- Yale Tobacco Center of Regulatory Science, Yale School of Medicine, New Haven, CT, USA.
| | - Andy Ma Zepei
- Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA
| | - Lilley Harris
- Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA
| | - Karina Minanov
- Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA
| | - Jaysen Lara Jimenez
- Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA
| | - Nii A Addy
- Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA
- Yale Tobacco Center of Regulatory Science, Yale School of Medicine, New Haven, CT, USA
- Department of Cellular and Molecular Physiology, Yale School of Medicine, New Haven, CT, USA
- Interdepartmental Neuroscience Program, Yale University, New Haven, CT, USA
- Wu Tsai Institute at Yale University, New Haven, CT, USA
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Shruti T, Sharma P, Budukh A, Khanna D. Electronic nicotine delivery system: a narrative review on growing threat to tobacco control and health of the young Indian population. Int J Adolesc Med Health 2024; 36:17-24. [PMID: 38369380 DOI: 10.1515/ijamh-2023-0008] [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: 01/17/2023] [Accepted: 01/30/2024] [Indexed: 02/20/2024]
Abstract
The electronic cigarette (EC) was developed as an alternative to cigarette smoking. In less than a decade, the prevalence of past-month EC usage increased from 1.5 to 27.5 % among US high-school students. In the coming years, Asia-Pacific countries will have the highest sales of electronic nicotine/non-nicotine delivery systems (ENDS/ENNDS) after Western Europe. Based on the World Health Organization and Indian Council of Medical Research recommendations, India approved a complete ban on EC in 2019. Even though it has been three years since the ban, EC is still being sold in India's grey markets, where marketing is not regulated. In this narrative review, we discuss that vaping is not just a harm reduction strategy for tobacco smoking cessation but poses a serious threat to India's existing tobacco control efforts as well as the health of the country's young people.
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Affiliation(s)
- Tulika Shruti
- Department of Preventive Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) and Homi Bhabha Cancer Hospital (HBCH), Tata Memorial Centres, Varanasi, India
| | - Priyanka Sharma
- Department of Preventive Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) and Homi Bhabha Cancer Hospital (HBCH), Tata Memorial Centres, Varanasi, India
| | - Atul Budukh
- Centre for Cancer Epidemiology, ACTREC, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Divya Khanna
- Department of Preventive Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) and Homi Bhabha Cancer Hospital (HBCH), Tata Memorial Centres, Varanasi, India
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Weng X, Song CY, Liu K, Wu YS, Lee JJ, Guo N, Wang MP. Perceptions of and responses of young adults who use e-cigarettes to flavour bans in China: a qualitative study. Tob Control 2024:tc-2023-058312. [PMID: 38267214 DOI: 10.1136/tc-2023-058312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 01/13/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND China has banned all flavoured e-cigarettes to reduce e-cigarette use among young people, but little is known about the views and reactions of people who use e-cigarettes. This study explored the perceptions of, and responses by, young adults who use e-cigarettes to the flavour ban. METHODS Semistructured interviews were conducted with 25 Chinese young adults aged 18-25 years who had used e-cigarettes daily in the past 3 months. Thematic analysis was used to analyse the interview data. FINDINGS Four themes were identified from the data: (1) understanding of the public health benefits, (2) resistance to and misperceptions of the flavour ban, (3) circumvention of the flavour ban and (4) acceptance of the flavour ban. Some participants expressed support for the ban due to perceived public health benefits, while others who resisted the ban emphasised their right to choose preferred flavours and questioned the rationale behind the policy. Participants responded to the flavour ban by utilising a variety of adaptive strategies, including purchasing flavoured e-cigarettes through illegal channels or exploring alternative ways to obtain flavours. Those who complied with the ban responded with different strategies, including switching back to combustible cigarettes, using tobacco-flavoured e-cigarettes, or quitting vaping. CONCLUSIONS The findings suggest the need for comprehensive regulatory measures, including stringent enforcement measures, transparent health communication and vigilant monitoring of e-cigarette manufacturers' tactics, to reduce e-cigarette use among young adults.
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Affiliation(s)
- Xue Weng
- Institute of Advanced Studies in Humanities and Social Sciences, Beijing Normal University, Zhuhai, China
| | - Chu Yu Song
- School of Social Development and Public Policy, Beijing Normal University, Beijing, China
| | - Kefeng Liu
- Department of Pulmonary and Critical Care Medicine, Guangdong Provincial Hospital of Traditional Chinese Medicine, Zhuhai, Guangdong, China
| | - Yongda Socrates Wu
- LKS Faculty of Medicine, School of Nursing, The University of Hong Kong, Hong Kong, China
| | - Jung Jae Lee
- LKS Faculty of Medicine, School of Nursing, The University of Hong Kong, Hong Kong, China
| | - Ningyuan Guo
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Man Ping Wang
- LKS Faculty of Medicine, School of Nursing, The University of Hong Kong, Hong Kong, China
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Peterson ML, Clark CT, Lynch CJ, Cooper JT, Gelfman N, Blumenstein J, Hansen R, Porter JH, Hillhouse TM. Preliminary assessment of the subjective effects of electronic-cigarettes in young-adult low-dose electronic-cigarette users: Effects of nicotine dose and e-liquid flavor. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:1887-1896. [PMID: 34283707 DOI: 10.1080/07448481.2021.1950162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 06/20/2021] [Accepted: 06/25/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The present study evaluated the effects of nicotine concentration (0-10 mg/ml) and flavor (gummy bear vs unflavored) on the subjective experiences of vaporized nicotine in young adult low-dose nicotine (3 mg/ml) ECIG users. PARTICIPANTS Eight young adult ECIG users were recruited. METHODS A single blinded crossover study was used. Participants were instructed to take ten 1.5 second puffs, each separated by 20 seconds. After self-administration, heart rate was recorded, and participants completed the Drug Effects, Direct Effects of Nicotine, and Direct Effects of ECIG questionnaires. RESULTS ECIG user's standard daily nicotine dose influenced the rewarding and aversive effects of nicotine as the 10 mg/ml dose was found to be aversive in this user group. The combination of flavor and nicotine increased the subjective effects of ECIGs. CONCLUSIONS Flavored e-liquids contribute to the reinforcing properties of nicotine by enhancing the subjective effects, which may lead to continued ECIG use.
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Affiliation(s)
- Makenzie L Peterson
- Department of Psychological Science, Weber State University, Ogden, Utah, USA
| | - Carson T Clark
- Department of Psychological Science, Weber State University, Ogden, Utah, USA
| | - Cayla J Lynch
- Department of Psychological Science, Weber State University, Ogden, Utah, USA
| | - James T Cooper
- Department of Psychological Science, Weber State University, Ogden, Utah, USA
| | - Noah Gelfman
- Department of Psychological Science, Weber State University, Ogden, Utah, USA
| | - Julia Blumenstein
- Department of Exercise and Nutrition Sciences, Weber State University, Ogden, Utah, USA
| | - Rodney Hansen
- Department of Exercise and Nutrition Sciences, Weber State University, Ogden, Utah, USA
| | - Joseph H Porter
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Todd M Hillhouse
- Department of Psychological Science, Weber State University, Ogden, Utah, USA
- Department of Psychology, University of Wisconsin Green Bay, Green Bay, Wisconsin, USA
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Tackett AP, Dai HD, Han DH, Vogel EA, Coreas SI, Jafarzadeh N, Gonzalez Anaya MJ, Patel D, Peraza N, Mason TB, Leventhal AM. Appeal of e-cigarette flavors: Differences between never and ever use of combustible cigarettes. Drug Alcohol Depend 2023; 246:109849. [PMID: 37028103 PMCID: PMC10161874 DOI: 10.1016/j.drugalcdep.2023.109849] [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] [Received: 10/27/2022] [Revised: 02/28/2023] [Accepted: 03/08/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Characterizing the appeal of flavored e-cigarette solutions by tobacco product use status can inform regulations to reduce vaping in those who never smoked without discouraging adopting e-cigarettes as a quit-smoking aid. METHODS Adults aged 21+ who currently use tobacco products (N = 119) self-administered standardized puffs of eight non-tobacco flavored and two tobacco-flavored e-cigarette solutions using a pod-style device. Participants rated appeal (0-100 scale) following each administration. Mean differences in flavor appeal ratings were compared between four groups: people who never smoked/currently vape, formerly smoked/currently vape, currently smoke/currently vape, and currently smoke/do not vape (with interest in vaping). RESULTS The Global Flavor (all non-tobacco vs. tobacco)×Group interaction (p = .028) revealed higher appeal for non-tobacco vs. tobacco flavors in adults who never smoked/currently vape (B[95 %CI] = 13.6[4.1-23.1]), formerly smoked/currently vape (B[95 %CI] = 11.6[4.2-18.9]), and currently smoke/currently vape (B[95 %CI] = 9.3[2.5-11.6]), but not adults who currently smoke/never vaped (B[95 %CI] = -0.1[-5.1 to 4.9]). In flavor-specific analyses, adults who never smoked/currently vape rated strawberry (p = .022), peppermint (p = .028), and menthol (p = .028) more appealing than tobacco flavors. Among adults who formerly smoked/currently vape, strawberry (p < .001), peppermint (p = .009), and vanilla (p = .009), were more appealing than tobacco. Adults who currently smoked/currently vape rated peppermint (p = .022) and vanilla (p = .009) as more appealing than tobacco. No non-tobacco flavors were more appealing than tobacco in adults who currently smoke/never vaped. CONCLUSIONS E-cigarette sales restrictions on non-tobacco flavors, including menthol, may eliminate products preferred by adults who vape, including those who never smoked, without discouraging adults who currently smoke and never vaped from trying e-cigarettes.
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Affiliation(s)
- Alayna P Tackett
- Department of Internal Medicine, The Ohio State University, Columbus, OH, United States; Center for Tobacco Research, The Ohio State University, Columbus, OH, United States
| | - Hongying Daisy Dai
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, United States
| | - Dae-Hee Han
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, CA, United States; Institute for Addiction Science, University of Southern California, Los Angeles, CA, United States
| | - Erin A Vogel
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Saida I Coreas
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Nikki Jafarzadeh
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, CA, United States; Institute for Addiction Science, University of Southern California, Los Angeles, CA, United States
| | - Maria J Gonzalez Anaya
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Devaki Patel
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, CA, United States; Institute for Addiction Science, University of Southern California, Los Angeles, CA, United States
| | - Natalia Peraza
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, CA, United States; Institute for Addiction Science, University of Southern California, Los Angeles, CA, United States
| | - Tyler B Mason
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, CA, United States; Institute for Addiction Science, University of Southern California, Los Angeles, CA, United States
| | - Adam M Leventhal
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, CA, United States; Institute for Addiction Science, University of Southern California, Los Angeles, CA, United States; Department of Psychology, University of Southern California, Los Angeles, CA, United States.
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6
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Alhadyan SK, Sivaraman V, Onyenwoke RU. E-cigarette Flavors, Sensory Perception, and Evoked Responses. Chem Res Toxicol 2022; 35:2194-2209. [PMID: 36480683 DOI: 10.1021/acs.chemrestox.2c00268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The chemosensory experiences evoked by flavors encompass a number of unique sensations that include olfactory stimuli (smell), gustatory stimuli (taste, i.e., salty, sweet, sour, bitter, and umami (also known as "savoriness")), and chemesthesis (touch). As such, the responses evoked by flavors are complex and, as briefly stated above, involve multiple perceptive mechanisms. The practice of adding flavorings to tobacco products dates back to the 17th century but is likely much older. More recently, the electronic cigarette or "e-cigarette" and its accompanying flavored e-liquids emerged on to the global market. These new products contain no combustible tobacco but often contain large concentrations (reported from 0 to more than 50 mg/mL) of nicotine as well as numerous flavorings and/or flavor chemicals. At present, there are more than 400 e-cigarette brands available along with potentially >15,000 different/unique flavored products. However, surprisingly little is known about the flavors/flavor chemicals added to these products, which can account for >1% by weight of some e-liquids, and their resultant chemosensory experiences, and the US FDA has done relatively little, until recently, to regulate these products. This article will discuss e-cigarette flavors and flavor chemicals, their elicited responses, and their sensory effects in some detail.
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Affiliation(s)
- Shatha K Alhadyan
- Department of Pharmaceutical Sciences, North Carolina Central University, Durham, North Carolina 27707, United States
| | - Vijay Sivaraman
- Department of Biological and Biomedical Sciences, North Carolina Central University, Durham, North Carolina 27707, United States
| | - Rob U Onyenwoke
- Department of Pharmaceutical Sciences, North Carolina Central University, Durham, North Carolina 27707, United States.,Biomanufacturing Research Institute and Technology Enterprise (BRITE), North Carolina Central University, Durham, North Carolina 27707, United States
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Schneller LM, Kasza KA, Hammond D, Bansal-Travers M, O'Connor R, Hyland A. E-cigarette and tobacco product use among NYS youth before and after a state-wide vaping flavour restriction policy, 2020-2021. Tob Control 2022; 31:s161-s166. [PMID: 36328470 PMCID: PMC9664109 DOI: 10.1136/tobaccocontrol-2022-057450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/08/2022] [Indexed: 11/22/2022]
Abstract
Significance Reducing youth e-cigarette use is a New York State (NYS) public health priority. In May 2020, a state-wide restriction on flavoured e-cigarettes, except tobacco flavour, was passed. This study examines changes in nicotine product use behaviour among youth around the time of the state-wide vaping flavour restriction. Methods NYS data from the US International Tobacco Control Policy Evaluation Project Youth Tobacco and E-cigarette Tobacco and Vaping Survey were analysed cross-sectionally from February 2020 (n=955), August 2020 (n=946), February 2021 (n=1030) and August 2021 (n=753). Online surveys were conducted among youth 16–19 years. Weighted descriptive statistics and regression models were used to describe changes in nicotine product use behaviour. Models were adjusted for age, sex, race/ethnicity and perceived family socioeconomic status. Results Significant decreases in past 30-day e-cigarette use (20%–11%), cigarette (7%-4%), and dual use of e-cigarettes and cigarettes (5%–2%) were observed over the 2-year period in NYS. Over 95% of vapers still reported using a non-tobacco-flavoured e-cigarette following the restriction, with fruit-flavoured being the most popular at each time point. Conclusions Nearly all NYS youth continued to vape flavours that were restricted in NYS. While youth past 30-day vaping prevalence decreased significantly from 2020 to 2021, increased flavour restriction compliance could result in an even greater decrease. Continuous monitoring is important to better understand perceptions, use patterns and access at the individual level, retail level and population level to inform future enforcement and restrictions.
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Affiliation(s)
- Liane M Schneller
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Karin A Kasza
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Maansi Bansal-Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Richard O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
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Asfar T, Jebai R, Li W, Oluwole OJ, Ferdous T, Gautam P, Schmidt M, Noar SM, Lindblom EN, Eissenberg T, Bursac Z, Vallone D, Maziak W. Risk and safety profile of electronic nicotine delivery systems (ENDS): an umbrella review to inform ENDS health communication strategies. Tob Control 2022:tobaccocontrol-2022-057495. [PMID: 36252567 PMCID: PMC10043882 DOI: 10.1136/tc-2022-057495] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/30/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This umbrella review aims to summarise the evidence about electronic nicotine delivery systems' (ENDS) risk and safety health profile to inform ENDS health communication strategies. DATA SOURCES AND STUDY SELECTION Six databases were searched for systematic reviews presenting evidence on ENDS-related health effects. Ninety reviews divided into five categories were included: toxicity=20, health effects=40, role in smoking cessation=24, role in transition to combustible cigarettes (CCs)=13 and industry marketing claims=4. DATA EXTRACTION Findings were synthesised in narrative summaries. Meta-analyses were conducted by study type when appropriate. Quality assessment was conducted using the Measurement Tool to Assess Systematic Reviews. The Institute of Medicine's Levels of Evidence Framework was used to classify the evidence into high-level, moderate, limited-suggestive and limited-not-conclusive. DATA SYNTHESIS We found high-level evidence that ENDS exposes users to toxic substances; increases the risk of respiratory disease; leads to nicotine dependence; causes serious injuries due to explosion or poisoning; increases smoking cessation in clinical trials but not in observational studies; increases CC initiation; and exposure to ENDS marketing increases its use/intention to use. Evidence was moderate for ENDS association with mental health and substance use, limited-suggestive for cardiovascular, and limited-not-conclusive for cancer, ear, ocular and oral diseases, and pregnancy outcomes. CONCLUSIONS As evidence is accumulating, ENDS communication can focus on high-level evidence on ENDS association with toxicity, nicotine addiction, respiratory disease, ENDS-specific harm (explosion, poisoning) and anti-ENDS industry sentiment. Direct comparison between the harm of CCs and ENDS should be avoided. PROSPERO REGISTRATION NUMBER CRD42021241630.
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Affiliation(s)
- Taghrid Asfar
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Rime Jebai
- Robert Stempel College of Public Health and Social Work, Department of Epidemiology, Florida International University, Miami, FL, USA
| | - Wei Li
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Olusanya Joshua Oluwole
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tarana Ferdous
- Robert Stempel College of Public Health and Social Work, Department of Epidemiology, Florida International University, Miami, FL, USA
| | - Prem Gautam
- Robert Stempel College of Public Health and Social Work, Department of Epidemiology, Florida International University, Miami, FL, USA
| | - Michael Schmidt
- Department of Art, The University of Memphis, Memphis, TN, USA
| | - Seth M Noar
- Hussman School of Journalism and Media, University of North Carolina System, Chapel Hill, NC, USA
| | - Eric N Lindblom
- O'Neill Institute for National & Global Health Law, Georgetown University Law Center, Washington, DC, USA
| | - Thomas Eissenberg
- Psychology and Institute for Drug/Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA
| | - Zoran Bursac
- Biostatistics, Florida International University, Robert Stempel College of Public Health and Social Work, Miami, FL, USA
| | - Donna Vallone
- Schroeder Institute, Truth Initiative, Washington, DC, USA
- Truth Initiative Schroeder Institute, New York University College of Global Public Health, New York, NY, USA
| | - Wasim Maziak
- Epidemiology, Florida International University, Robert Stempel College of Public Health and Social Work, Miami, FL, USA
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Harlow AF, Fetterman JL, Ross CS, Robertson RM, Bhatnagar A, Benjamin EJ, Stokes AC. Association of device type, flavours and vaping behaviour with tobacco product transitions among adult electronic cigarette users in the USA. Tob Control 2022; 31:e10-e17. [PMID: 33479031 PMCID: PMC8292448 DOI: 10.1136/tobaccocontrol-2020-055999] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 11/23/2020] [Accepted: 12/11/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Few studies assess whether electronic cigarette (e-cigarette) device characteristics or flavours impact longitudinal patterns of cigarette and e-cigarette use. DESIGN We examined data from waves 2-4 of the Population Assessment of Tobacco and Health Study (2014-2018). Among adult (≥18 years) current e-cigarette users at wave 2 who were current smokers (dual users; n=1759) and former smokers (exclusive e-cigarette users; n=470), we classified participants into four use patterns at wave 3 (~12 months later) and wave 4 (~24 months later): (1) dual use of e-cigarettes and cigarettes; (2) exclusive cigarette smoking; (3) exclusive e-cigarette use; (4) non-use of both products. We used multinomial logistic regression to assess correlates of changing use patterns at 24 months, relative to no change, adjusting for sociodemographic factors. RESULTS At 24 months, 26.5% of baseline exclusive e-cigarette users, and 9% of baseline dual users, abstained from both vaping and smoking. Participants who vaped non-tobacco flavours (vs tobacco flavours), and used refillable tank or modifiable devices (vs disposable, cartridges and other devices) were less likely to transition to non-use of both products and to exclusive cigarette smoking. Baseline daily vaping (vs non-daily) was positively associated with exclusive e-cigarette use at 24 months for baseline daily cigarette smokers, but negatively associated with exclusive e-cigarette use and non-use of both products at 24 months for baseline non-daily smokers. CONCLUSIONS Non-tobacco flavours, daily vaping and modifiable e-cigarette devices may help some smokers abstain from cigarette smoking via transitioning to exclusive e-cigarette use, but are also associated with ongoing exclusive e-cigarette use.
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Affiliation(s)
- Alyssa F Harlow
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Jessica L Fetterman
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Craig S Ross
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Rose Marie Robertson
- Tobacco Regulation and Addiction Center, American Heart Association, Dallas, Texas, USA
| | - Aruni Bhatnagar
- Department of Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Emelia J Benjamin
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Andrew C Stokes
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
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10
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Hayes JE, Baker AN. Flavor science in the context of research on electronic cigarettes. Front Neurosci 2022; 16:918082. [PMID: 35968379 PMCID: PMC9365686 DOI: 10.3389/fnins.2022.918082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/01/2022] [Indexed: 11/13/2022] Open
Abstract
Thousands start smoking or vaping daily, despite long-standing efforts by public health authorities to curb initiation and use of nicotine containing products. Over the last 15 years, use of electronic nicotine delivery systems has increased dramatically, with a diverse range of products on the market, including pod-based, disposable, and refillable electronic cigarettes (eCigs). Originally intended for harm reduction and smoking cessation, eCigs may encourage nicotine use among never smokers, given the vast range of appealing flavors that are available. To better understand abuse liability and to facilitate appropriate regulations, it is crucial to understand the science of flavor, and flavor perception within the context of eCig use. Here, we (a) provide a brief primer on chemosensory perception and flavor science for addiction and nicotine researchers, and (b) highlight existing some literature regarding flavor and nicotine use, with specific attention given to individual differences in perception, and interaction between different sensory modalities that contribute to flavor. Dramatic increases in use of eCigs highlights the importance of flavor science in contemporary addiction research, both with regards to public health and regulatory efforts. Other recent work summarizes findings on flavored e-liquids and eCig use, but none have focused explicitly on chemosensory processes or flavor perception as they relate to appeal and use of such products. We argue flavor science needs to be considered as perceptual and behavioral phenomena, and not merely from analytical, toxicological and pharmacological perspectives; we help address this gap here.
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Affiliation(s)
- John E. Hayes
- Sensory Evaluation Center, College of Agricultural Sciences, The Pennsylvania State University, State College, PA, United States
- Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, State College, PA, United States
- Interdepartmental Neuroscience Program, Huck Institutes of Life Sciences, The Pennsylvania State University, State College, PA, United States
| | - Allison N. Baker
- Sensory Evaluation Center, College of Agricultural Sciences, The Pennsylvania State University, State College, PA, United States
- Interdepartmental Neuroscience Program, Huck Institutes of Life Sciences, The Pennsylvania State University, State College, PA, United States
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11
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Vaping-Associated Lung Injury: A Review. Medicina (B Aires) 2022; 58:medicina58030412. [PMID: 35334588 PMCID: PMC8949983 DOI: 10.3390/medicina58030412] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/01/2022] [Accepted: 03/07/2022] [Indexed: 11/16/2022] Open
Abstract
Since commercial development in 2003, the usage of modern electronic cigarette (e-cigarette) continues to increase amongst people who have never smoked, ex-smokers who have switched to e-cigarettes, and dual-users of both conventional cigarettes and e-cigarettes. With such an increase in use, knowledge of the irritative, toxic and potential carcinogenic effects on the lungs is increasing. This review article will discuss the background of e-cigarettes, vaping devices and explore their popularity. We will further summarise the available literature describing the mechanism of lung injury caused by e-cigarette or vaping use.
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12
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Stevens ER, Sherman SE. A targeted approach to using e-cigarettes for harm reduction in adults. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2022; 48:128-132. [PMID: 35130449 DOI: 10.1080/00952990.2021.2007938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/12/2021] [Accepted: 11/14/2021] [Indexed: 06/14/2023]
Abstract
Smoking remains the leading preventable cause of death and disease in the US. While e-cigarettes (EC) are undeniably harmful when used by adolescents and nonsmokers, the perpetuation of the increasing negative perceptions of EC and widespread false belief that EC are equal or more harmful than combustible cigarettes (CC) represents a significant missed public health opportunity. EC have great potential to serve as a mechanism for smoking harm reduction among hard-to-treat populations of smokers who have failed to quit with currently available treatments. In this paper, we outline why we need to overcome the hostile EC research environment to explore the potential use of EC as a harm-reduction strategy in hard-to-treat populations.
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Affiliation(s)
- Elizabeth R Stevens
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Scott E Sherman
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
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13
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Stevens ER, Lei L, Cleland CM, Vojjala M, El-Shahawy O, Berger KI, Kirchner TR, Sherman SE. Electronic cigarettes as a harm reduction strategy among patients with COPD: protocol for an open-label two arm randomized controlled pilot trial. Addict Sci Clin Pract 2022; 17:2. [PMID: 34991693 PMCID: PMC8734340 DOI: 10.1186/s13722-021-00284-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/16/2021] [Indexed: 11/17/2022] Open
Abstract
Background Smoking cessation is the most effective means of slowing the decline of lung function associated with chronic obstructive pulmonary disease (COPD). While effective smoking cessation treatments are available, they are underutilized and nearly half of people with COPD continue to smoke. By addressing both nicotine and behavioral dependence, electronic cigarettes (EC) could help people with COPD reduce the harm of combustible cigarettes (CC) through reductions in number of Cigarettes per Day (CPD) or quitting CC completely. The purpose of this pilot study is to identify barriers and facilitators to the use of and assess the preliminary effectiveness of EC as a harm reduction strategy among people with COPD. Methods In an open-label two-arm randomized controlled trial pilot study, 60 patients identified as smokers with a COPD diagnosis via electronic health records from a large urban health center are randomized in a 1:1 ratio to either standard care [counseling + nicotine replacement therapy (NRT)] or counseling + EC. The NRT arm will receive nicotine patches and nicotine lozenges for 12 weeks. The EC arm will receive EC for 12 weeks. Both cohorts will receive counseling from a licensed mental health counselor. Using ecological momentary assessment, participants will report their use of CC in both arms and EC use in the EC arm daily via text message. Primary outcomes will be feasibility and acceptability of intervention, and secondary outcomes will be reduction in CPD and change in COPD symptoms as measured by COPD Assessment Tool (CAT) score at 12-weeks. EC displacement of CC. To explore attitudes towards the use of EC as a harm-reduction strategy for patients with COPD, interviews will be performed with a sample of participants from both study arms. Discussion Despite decades of availability of smoking cessation medications, nearly half of people with COPD still smoke. This study aims to address the unmet need for feasible and effective strategies for reducing CC use among those with COPD, which has the potential to significantly improve the health of people with COPD who smoke. Trial Registration ClinicalTrials.gov Identifier: NCT04465318.
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Affiliation(s)
| | - Lei Lei
- New York University Langone Health, New York, NY, USA
| | | | - Mahathi Vojjala
- New York University Langone Health, New York, NY, USA.,New York University School of Global Public Health, New York, USA
| | - Omar El-Shahawy
- New York University Langone Health, New York, NY, USA.,New York University School of Global Public Health, New York, USA
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14
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MacLean RR, Gueorguieva R, DeVito EE, Peltier MR, Parida S, Sofuoglu M. The effects of inhaled flavors on intravenous nicotine. Exp Clin Psychopharmacol 2021; 29:615-624. [PMID: 32463279 PMCID: PMC7704548 DOI: 10.1037/pha0000394] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Menthol is the only available flavor in combusted tobacco cigarettes; however, e-cigarettes are available in thousands of flavors. Research on flavors and rewarding properties of nicotine is limited. The present study sought to examine the acute rewarding effects of flavors inhaled from an e-cigarette, in combination with intravenous (IV) nicotine among cigarette smokers. In the present study, 24 menthol-preferring young adult (aged 18 to 30) cigarette smokers were tested under 3 different e-cigarette flavor conditions (menthol, green apple, or menthol + green apple) in a within-subject cross-over design. During each test session, each participant received 3 IV infusions (saline, 0.25 mg/70 kg nicotine, 0.5 mg/70 kg nicotine) administered 1 hr apart. The main outcome measures assessed cardiovascular, subjective, and cognitive domains. Compared with green apple or green apple + menthol, menthol produced higher ratings of "cooling" (ps < 0.01). Craving was rated higher following administration of green apple and the combined menthol + apple flavor compared to menthol alone (ps < 0.05). As expected, IV-nicotine dose-dependently increased the ratings of subjective liking/disliking and peak heart rate, improved cognitive performance, and reduced smoking urges (all ps < 0.05). These subjective, cognitive, and physiological effects of nicotine were not affected by any flavor condition. The present findings did not support an interaction between IV-nicotine dose and inhaled flavor for acute effects of nicotine. Green apple flavor, alone or in combination with menthol, could result in higher craving or insufficiently alleviate craving, relative to menthol flavor alone. Additional research is warranted to examine extended exposure to inhaled flavors on the rewarding and addictive effects of nicotine. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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15
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Tannous S, Darlot F, Cador M, Caille S. Flavor additives facilitate oral self-administration of nicotine solution in mice. Psychopharmacology (Berl) 2021; 238:2235-2247. [PMID: 33890131 DOI: 10.1007/s00213-021-05848-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 04/12/2021] [Indexed: 01/05/2023]
Abstract
RATIONALE Tobacco products are very addictive, partly because they contain nicotine which is reinforcing, but also because they include appealing aromas and tastes. Flavor additives are such sensory stimuli which enhance attractiveness, as well as use and abuse of tobacco and vaping products. Yet, the interaction between these flavor additives and nicotine remains poorly understood. OBJECTIVES We want to understand how flavors may reduce nicotine' aversive taste and how it may enhance its voluntary oral self-administration in mice. METHODS We first studied the effect of flavor additives on nicotine solution palatability in a free bottle choice paradigm. Second, we investigated the effect of vanilla flavoring on the different stages of nicotine (40 μg/ml) oral self-administration in mice. RESULTS We show that adding flavors increase nicotine palatability and facilitate acquisition and maintenance of oral self-administration when compared to nicotine-alone group. Mice adapt their operant behavior depending on changes in nicotine concentration. All mice reinstate nicotine seeking upon presentation of associated cues. Nevertheless, vanilla-flavored nicotine was not more reinforcing than vanilla-flavored water which was reinforcing enough to drive similar operant response rates. CONCLUSIONS Flavor additives increase nicotine oral consumption and help maintaining operant behavior in mice. Moreover, flavors can be very attractive and can have high reinforcing value by themselves. Thus, it is crucial that the investigation on how taste signals play an important role in modulating oral nicotine intake in rodent models remains explored.
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Affiliation(s)
- Salma Tannous
- Université de Bordeaux, CNRS, EPHE, INCIA, UMR5287, F-33000, Bordeaux, France
| | - Florence Darlot
- Université de Bordeaux, CNRS, EPHE, INCIA, UMR5287, F-33000, Bordeaux, France
| | - Martine Cador
- Université de Bordeaux, CNRS, EPHE, INCIA, UMR5287, F-33000, Bordeaux, France
| | - Stephanie Caille
- Université de Bordeaux, CNRS, EPHE, INCIA, UMR5287, F-33000, Bordeaux, France.
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16
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Toxicology of flavoring- and cannabis-containing e-liquids used in electronic delivery systems. Pharmacol Ther 2021; 224:107838. [PMID: 33746051 DOI: 10.1016/j.pharmthera.2021.107838] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/11/2021] [Indexed: 12/15/2022]
Abstract
Electronic cigarettes (e-cigarettes) were introduced in the United States in 2007 and by 2014 they were the most popular tobacco product amongst youth and had overtaken use of regular tobacco cigarettes. E-cigarettes are used to aerosolize a liquid (e-liquid) that the user inhales. Flavorings in e-liquids is a primary reason for youth to initiate use of e-cigarettes. Evidence is growing in the scientific literature that inhalation of some flavorings is not without risk of harm. In this review, 67 original articles (primarily cellular in vitro) on the toxicity of flavored e-liquids were identified in the PubMed and Scopus databases and evaluated critically. At least 65 individual flavoring ingredients in e-liquids or aerosols from e-cigarettes induced toxicity in the respiratory tract, cardiovascular and circulatory systems, skeletal system, and skin. Cinnamaldehyde was most frequently reported to be cytotoxic, followed by vanillin, menthol, ethyl maltol, ethyl vanillin, benzaldehyde and linalool. Additionally, modern e-cigarettes can be modified to aerosolize cannabis as dried plant material or a concentrated extract. The U.S. experienced an outbreak of lung injuries, termed e-cigarette, or vaping, product use-associated lung injury (EVALI) that began in 2019; among 2,022 hospitalized patients who had data on substance use (as of January 14, 2020), 82% reported using a delta-9-tetrahydrocannabinol (main psychoactive component in cannabis) containing e-cigarette, or vaping, product. Our literature search identified 33 articles related to EVALI. Vitamin E acetate, a diluent and thickening agent in cannabis-based products, was strongly linked to the EVALI outbreak in epidemiologic and laboratory studies; however, e-liquid chemistry is highly complex, and more than one mechanism of lung injury, ingredient, or thermal breakdown product may be responsible for toxicity. More research is needed, particularly with regard to e-cigarettes (generation, power settings, etc.), e-liquids (composition, bulk or vaped form), modeled systems (cell type, culture type, and dosimetry metrics), biological monitoring, secondhand exposures and contact with residues that contain nicotine and flavorings, and causative agents and mechanisms of EVALI toxicity.
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17
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Abadi MH, Lipperman-Kreda S, Shamblen SR, Thompson K, Grube JW, Leventhal AM, Luseno W, Aramburu C. The impact of flavored ENDS use among adolescents on daily use occasions and number of puffs, and next day intentions and willingness to vape. Addict Behav 2021; 114:106773. [PMID: 33338905 DOI: 10.1016/j.addbeh.2020.106773] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/24/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The FDA's policies restricting sale of sweet flavored cartridge-based and disposable electronic nicotine delivery systems (ENDS) comprise important steps toward curbing adolescent ENDS use. However, additional evidence is needed about the contribution of specific flavors to adolescents' ENDS use. This study investigated the effects of flavor use on same day vaping behaviors, and next day intentions and willingness. METHODS We collected ecological momentary assessments (EMA) from 50 adolescent past two-week vapers (ages 14-17) over 14 days. Daily EMA data were collected on vaping occasions, total puffs, vaping intentions, vaping willingness, and flavor used. RESULTS On average, data were obtained on 13.4 days per participant (670 observations). Participants vaped flavors on 87% of days (fruit = 55%; mint = 30%; tobacco = 6%; menthol = 5%, and candy, sweets, or chocolate = 5%). On days when participants vaped fruit flavors, they took more puffs (r = 0.13, p = .030). On days when they vaped tobacco flavor, they reported more vaping occasions (r = 0.20, p = .005) and more puffs (r = 0.15, p = .033). On days when they vaped because of flavor appeal, they reported more vaping occasions (r = 0.19, p = .001) and more puffs (r = 0.24, p < .001). On days when they vaped menthol flavor, they were less likely to report willingness to vape the next day (r = -0.14, p = .042). Adolescents who reported vaping due to flavor appeal were more likely to report intentions (OR = 5.63, p = .035) and willingness to vape the next day (r = 0.23, p < .001) CONCLUSION: These findings provide additional support for policies restricting the sale of flavored ENDS products to adolescents.
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18
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Flavor and product messaging are the two most important drivers of electronic cigarette selection in a choice-based task. Sci Rep 2021; 11:4689. [PMID: 33633330 PMCID: PMC7907091 DOI: 10.1038/s41598-021-84332-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 02/15/2021] [Indexed: 11/25/2022] Open
Abstract
Electronic cigarette use—vaping—is increasingly popular. Various product factors may influence an individual’s choice of e-cigarette. To provide an evidence base for e-cigarette regulation, a better understanding of the role different product attributes play in product preferences is needed. Here, we used conjoint analysis to quantify different factors that influence e-cigarettes choices, including flavors, nicotine level, customizability, or use of e-cigarettes to manage appetite/food craving. Young adults completed a set of choice-based conjoint tasks online. Choice Based Conjoint analysis (CBC) was used to determine utility scores for each attribute. Young adults (n = 587) who vaped at least once per week were included in analyses; gender differences were explored. Flavor was the most important attribute (48.1%), followed by product messaging (21.0%) and nicotine level (15.3%). Within flavor, confectionery and fruit flavors had the highest utility scores, while classic menthol and tobacco flavors had the lowest. Men and women differed in flavors, nicotine levels, and product messaging that appealed most. Among young adults who vape weekly, flavor is the most important factor in e-cigarette preferences. Gender also factors into e-cigarette preferences, especially for preferred nicotine level. Understanding why individuals choose particular e-cigarette products will help inform public health efforts and policy making.
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19
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Agaku IT, Egbe CO, Ayo-Yusuf OA. Geospatial spread of e-cigarette vape shops in South Africa and the relationship with tobacco product use among adults. Health Place 2021; 68:102507. [PMID: 33486331 DOI: 10.1016/j.healthplace.2021.102507] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/21/2020] [Accepted: 01/05/2021] [Indexed: 12/01/2022]
Abstract
We estimated the spatial distribution of e-cigarette vape shops in South Africa and measured associations with tobacco use among adults. We linked geocoordinates of identified vape shops to internet protocol addresses of individual participants in the 2018 Health 24 survey (n = 18,208). We used logistic regression to measure the associations between proximity to vape shops and tobacco-related behaviors. In total, we identified 240 vape shops; 49.6% of these were within a 5 km radius of a higher educational institution. Proximity to vape shops was associated with ever e-cigarette use among young adults aged 18-29 years (AOR = 1.33, 95%CI = 1.16-1.54). Efforts to regulate e-cigarette marketing can benefit public health.
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Affiliation(s)
- Israel T Agaku
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa; Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA.
| | - Catherine O Egbe
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Pretoria, South Africa; Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Olalekan A Ayo-Yusuf
- Africa Centre for Tobacco Industry Monitoring and Policy Research, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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20
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Navas-Acien A, Martinez-Morata I, Hilpert M, Rule A, Shimbo D, LoIacono NJ. Early Cardiovascular Risk in E-cigarette Users: the Potential Role of Metals. Curr Environ Health Rep 2020; 7:353-361. [PMID: 33242201 DOI: 10.1007/s40572-020-00297-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2020] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW Electronic cigarettes (e-cigs) are a source of metals. Epidemiologic and experimental evidence support that metals are toxic to the cardiovascular system. Little is known, however, about the role that e-cig metals may play as toxicants for the possible cardiovascular effects of e-cig use. The goal of this narrative review is to summarize the evidence on e-cig use and metal exposure and on e-cig use and cardiovascular toxicity and discuss the research needs. RECENT FINDINGS In vitro studies show cytotoxicity and increased oxidative stress in myocardial cells and vascular endothelial cells exposed to e-liquids and e-cig aerosols, with effects partially reversed with antioxidant treatment. There is some evidence that the heating coil plays a role in cell toxicity. Mice exposed to e-cigs for several weeks showed higher levels of oxidative stress, inflammation, platelet activation, and thrombogenesis. Cross-over clinical experiments show e-cig use alters nitric oxide-mediated flow-mediated dilation, endothelial progenitor cells, and arterial stiffness. Cross-sectional evidence from large nationally representative samples in the USA support that e-cig use is associated with self-reported myocardial infarction. Smaller studies found associations of e-cig use with higher oxidized low-density protein and heart variability compared to healthy controls. Numerous studies have measured elevated levels of toxic metals in e-cig aerosols including lead, nickel, chromium, and manganese. Arsenic has been measured in some e-liquids. Several of these metals are well known to be cardiotoxic. Numerous studies show that e-cigs are a source of cardiotoxic metals. Experimental studies (in vitro, in vivo, and clinical studies) show acute toxicity of e-cigs to the vascular system. Studies of long-term toxicity in animals and humans are missing. Longitudinal studies with repeated measures of metal exposure and subclinical cardiovascular outcomes (e.g., coronary artery calcification) could contribute to determine the long-term cardiovascular effects of e-cigs and the potential role of metals in those effects.
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Affiliation(s)
- Ana Navas-Acien
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, 722 W 168th Street, New York, NY, 10032, USA
| | - Irene Martinez-Morata
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, 722 W 168th Street, New York, NY, 10032, USA
| | - Markus Hilpert
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, 722 W 168th Street, New York, NY, 10032, USA
| | - Ana Rule
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Daichi Shimbo
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Nancy J LoIacono
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, 722 W 168th Street, New York, NY, 10032, USA.
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21
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Piper ME, Baker TB, Benowitz NL, Smith SS, Jorenby DE. E-cigarette Dependence Measures in Dual Users: Reliability and Relations With Dependence Criteria and E-cigarette Cessation. Nicotine Tob Res 2020; 22:756-763. [PMID: 30874804 DOI: 10.1093/ntr/ntz040] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 03/08/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Electronic cigarettes (e-cigarettes) have drastically changed the nicotine and tobacco product landscape. However, their potential public health impact is still unclear. A reliable and valid measure of e-cigarette dependence would likely advance assessment and prognostication of the public health impact of e-cigarettes. The aim of this research was to examine the internal consistency, structure, and validity of three e-cigarette dependence scales. METHODS Adult dual users (smokers who also vape, N = 256) enrolled in an observational cohort study (45.1% women, 70.7% white). At baseline, participants completed the e-cigarette Fagerström Test of Cigarette Dependence (e-FTCD), the e-cigarette Wisconsin Inventory of Smoking Dependence Motives (e-WISDM), and the Penn State Electronic Cigarette Dependence Index (PS-ECDI). All participants provided a urine sample for cotinine analysis and reported e-cigarette use at 1 year. RESULTS The e-WISDM subscales had the highest internal consistency (α = .81-.96), then the PS-ECDI (α = .74) and e-FTCD (α = .51). A single-factor structure for the e-FTCD and an 11-factor structure for the e-WISDM were supported, but the PS-ECDI did not have a single-factor structure. All three e-cigarette dependence scales were highly correlated with validation criteria including continued e-cigarette use at 1 year, but not with e-liquid nicotine concentration or cotinine. CONCLUSIONS The e-WISDM and PS-ECDI had stronger internal consistency than did the e-FTCD, despite the e-FTCD's single-factor structure, but all 3 measures appear to be valid measures of e-cigarette dependence as suggested by their significant relations with self-perceived addiction, heavy use, early use after overnight deprivation, and continued use over time. IMPLICATIONS This research provides empirical support for three e-cigarette dependence measures: the e-FTCD, the PS-ECDI, and the e-WISDM among dual users of e-cigarettes and combustible cigarettes. The PS-ECDI and e-WISDM are more reliable, but all three measures were strongly correlated with key dependence constructs such as heavy use and continued use over time.
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Affiliation(s)
- Megan E Piper
- Department of Medicine, Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Timothy B Baker
- Department of Medicine, Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Neal L Benowitz
- Department of Medicine and Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA
| | - Stevens S Smith
- Department of Medicine, Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Douglas E Jorenby
- Department of Medicine, Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, WI
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22
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Schneller LM, Li D, Tavárez ZQ, Goniewicz ML, Quisenberry AJ, Xie Z, Rahman I, McIntosh S, O'Connor RJ, Ossip DJ. Flavor Inconsistencies between Flavored Tobacco Products among US Adults. Am J Health Behav 2020; 44:617-630. [PMID: 33121580 DOI: 10.5993/ajhb.44.5.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective: Banning flavors in some tobacco products, while allowing them in others, may shift consumer preferences towards products in which flavors are still allowed. In this study, we examine flavor popularity and inconsistencies in flavor preference across non-cigarette tobacco products among US adults. Methods: We used data from the Population Assessment of Tobacco and Health Study Wave 3 to assess the prevalence of flavor preference for users of non-cigarette tobacco products (N = 9037), as well as flavor inconsistencies between products among polyusers (N = 3183). Results: Most users of flavored tobacco products reported using one flavor category per product. Fruit and tobacco were among the most commonly used flavor categories of ENDS, hookah, traditional cigars, and cigarillo/filtered cigars. Menthol/mint was the most common flavor among snus/smokeless users. Polyusers of ENDS and traditional cigars had the largest inconsistency, where about 68%-76% used different flavors across products. Conversely, polyusers of traditional cigars and cigarillos/filtered cigars had the lowest inconsistency (25%-28%). Conclusions: Flavor preferences differed according to product, suggesting that consumers are not likely to switch across products to maintain a flavor preference. Future research should assess flavor preferences prospectively to improve understanding of the potential benefits of flavor bans.
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Affiliation(s)
- Liane M. Schneller
- Postdoctoral Fellow, the Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, NY;,
| | - Dongmei Li
- Associate Professor, the Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, NY
| | - Zahíra Quiñones Tavárez
- Doctorate Student, Translational Biomedical Science, University of Rochester Medical Center, Rochester, NY
| | - Maciej L. Goniewicz
- Associate Professor of Oncology, Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Amanda J. Quisenberry
- Assistant Professor of Oncology, Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Zidian Xie
- Senior Analyst and Programmer, the Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, NY
| | - Irfan Rahman
- Professor, Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY
| | - Scott McIntosh
- Associate Professor, Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
| | - Richard J. O'Connor
- Professor of Oncology, Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Deborah J. Ossip
- Professor, Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
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23
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Patten T, De Biasi M. History repeats itself: Role of characterizing flavors on nicotine use and abuse. Neuropharmacology 2020; 177:108162. [PMID: 32497589 DOI: 10.1016/j.neuropharm.2020.108162] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/22/2020] [Accepted: 05/24/2020] [Indexed: 12/13/2022]
Abstract
The popularity of e-cigarettes has skyrocketed in recent years, and most vapers use flavored e-cigarette products. Consumption of flavored e-cigarettes exceeds that of combustible cigarettes and other tobacco products among adolescents, who are particularly vulnerable to becoming nicotine dependent. Flavorings have been used by the tobacco industry since the 17th century, but the use of flavors by the e-cigarette industry to create products with "characterizing" flavors (i.e. flavors other than tobacco or menthol) has sparked a public health debate. This review addresses the possibility that characterizing flavors make nicotine more appealing, rewarding and addictive. It also discusses ways in which preclinical and clinical studies could improve our understanding of the mechanisms by which flavors may alter nicotine reward and reinforcement. This article is part of the special issue on 'Contemporary Advances in Nicotine Neuropharmacology'.
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Affiliation(s)
- Theresa Patten
- Pharmacology Graduate Group, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Mariella De Biasi
- Pharmacology Graduate Group, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
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Guy MC, Helt J, Palafox S, Green K, Soule EK, Maloney SF, Eissenberg T, Fagan P. Orthodox and Unorthodox Uses of Electronic Cigarettes: A Surveillance of YouTube Video Content. Nicotine Tob Res 2020; 21:1378-1384. [PMID: 29961828 DOI: 10.1093/ntr/nty132] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/25/2018] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Open electronic cigarette (e-cigarette) systems are customizable by consumers and often allow for potential "unorthodox" use of the product; that is, use not as intended by the manufacturer. Little is known about the types and prevalence of unorthodox uses and how these practices are transmitted via popular social media. METHODS Monthly searches of YouTube were conducted from June through November 2016 using the following search terms: "e-cigarettes," "vaping," and "e-juice." After collecting static and dynamic data on the 150 videos identified, two coders independently coded videos for general information, unorthodox use behaviors, health claims, and production quality and characteristics for orthodox and unorthodox use. Intercoder reliability was high (Cohen's κ 0.81, p < .001). RESULTS One hundred fifty videos were included in the study with a total of 115 551 563 views. We identified nine categories of unorthodox uses of e-cigarettes. Unorthodox use was three times as prevalent as orthodox use. Seventy-seven percent of the unorthodox use videos included recreational e-cigarette use, 57% included modification of mechanical parts and components, and 44.6% included unorthodox substance application (dripping). There were more than twice as many social media links in videos depicting unorthodox compared to orthodox use, but the level of engagement was lower for unorthodox use. CONCLUSIONS E-cigarette unorthodox use on YouTube is more prevalent than orthodox use, suggesting the need to further investigate the prevalence of unorthodox use among e-cigarette users and the influence of social media on consumer uptake of unorthodox and orthodox uses of e-cigarettes. IMPLICATIONS The US Food and Drug Administration has regulatory authority over e-cigarettes, parts and components. Many e-cigarettes currently marketed are open systems. Closed systems may allow less manipulation and may influence the safety of these products. This study provides valuable information on ways that open system e-cigarettes are used and it can inform safety tests that can be conducted by the US Food and Drug Administration to determine whether or not these products should remain on the market. In addition, our definitions of unorthodox use can be incorporated into the Population Assessment of Tobacco on Health Study to better understand the prevalence of these behaviors.
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Affiliation(s)
- Mignonne C Guy
- Department of African American Studies, Virginia Commonwealth University, Richmond, VA.,Center for the Study of Tobacco Products, College of Humanities and Sciences, Virginia Commonwealth University, Richmond, VA
| | - Jacob Helt
- Department of African American Studies, Virginia Commonwealth University, Richmond, VA
| | - Sherilyn Palafox
- University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, HI.,Center for the Study of Tobacco, Department Health Behavior and Health Education, Fay Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Kellie Green
- Department of African American Studies, Virginia Commonwealth University, Richmond, VA
| | - Eric K Soule
- Department of Psychology, Virginia Commonwealth University, Richmond, VA.,Center for the Study of Tobacco Products, College of Humanities and Sciences, Virginia Commonwealth University, Richmond, VA
| | - Sarah F Maloney
- Department of Psychology, Virginia Commonwealth University, Richmond, VA.,Center for the Study of Tobacco Products, College of Humanities and Sciences, Virginia Commonwealth University, Richmond, VA
| | - Thomas Eissenberg
- Department of Psychology, Virginia Commonwealth University, Richmond, VA.,Center for the Study of Tobacco Products, College of Humanities and Sciences, Virginia Commonwealth University, Richmond, VA
| | - Pebbles Fagan
- Center for the Study of Tobacco Products, College of Humanities and Sciences, Virginia Commonwealth University, Richmond, VA.,Center for the Study of Tobacco, Department Health Behavior and Health Education, Fay Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR
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Krüsemann EJZ, Boesveldt S, de Graaf K, Talhout R. An E-Liquid Flavor Wheel: A Shared Vocabulary Based on Systematically Reviewing E-Liquid Flavor Classifications in Literature. Nicotine Tob Res 2020; 21:1310-1319. [PMID: 29788484 PMCID: PMC6751518 DOI: 10.1093/ntr/nty101] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 05/16/2018] [Indexed: 01/03/2023]
Abstract
Introduction E-liquids are available in a high variety of flavors. A systematic classification of e-liquid flavors is necessary to increase comparability of research results. In the food, alcohol, and fragrance industry, flavors are classified using flavor wheels. We systematically reviewed literature on flavors related to electronic cigarette use, to investigate how e-liquid flavors have been classified in research, and propose an e-liquid flavor wheel to classify e-liquids based on marketing descriptions. Methods The search was conducted in May 2017 using PubMed and Embase databases. Keywords included terms associated with electronic cigarette, flavors, liking, learning, and wanting in articles. Results were independently screened and reviewed. Flavor categories used in the articles reviewed were extracted. Results Searches yielded 386 unique articles of which 28 were included. Forty-three main flavor categories were reported in these articles (eg, tobacco, menthol, mint, fruit, bakery/dessert, alcohol, nuts, spice, candy, coffee/tea, beverages, chocolate, sweet flavors, vanilla, and unflavored). Flavor classifications of e-liquids in literature showed similarities and differences across studies. Our proposed e-liquid flavor wheel contains 13 main categories and 90 subcategories, which summarize flavor categories from literature to find a shared vocabulary. For classification of e-liquids using our flavor wheel, marketing descriptions should be used. Conclusions We have proposed a flavor wheel for classification of e-liquids. Further research is needed to test the flavor wheels’ empirical value. Consistently classifying e-liquid flavors using our flavor wheel in research (eg, experimental, marketing, or qualitative studies) minimizes interpretation differences and increases comparability of results. Implications We reviewed e-liquid flavors and flavor categories used in research. A large variation in the naming of flavor categories was found and e-liquid flavors were not consistently classified. We developed an e-liquid flavor wheel and provided a guideline for systematic classification of e-liquids based on marketing descriptions. Our flavor wheel summarizes e-liquid flavors and categories used in literature in order to create a shared vocabulary. Applying our flavor wheel in research on e-liquids will improve data interpretation, increase comparability across studies, and support policy makers in developing rules for regulation of e-liquid flavors.
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Affiliation(s)
- Erna J Z Krüsemann
- National Institute for Public Health and the Environment (RIVM), Centre for Health Protection, Antonie van Leeuwenhoeklaan, MA Bilthoven, The Netherlands.,Division of Human Nutrition and Health, Wageningen University, Stippeneng, WE Wageningen, The Netherlands
| | - Sanne Boesveldt
- Division of Human Nutrition and Health, Wageningen University, Stippeneng, WE Wageningen, The Netherlands
| | - Kees de Graaf
- Division of Human Nutrition and Health, Wageningen University, Stippeneng, WE Wageningen, The Netherlands
| | - Reinskje Talhout
- National Institute for Public Health and the Environment (RIVM), Centre for Health Protection, Antonie van Leeuwenhoeklaan, MA Bilthoven, The Netherlands
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26
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Napolitano MA, Lynch SB, Stanton CA. Young adult e-cigarette users: perceptions of stress, body image, and weight control. Eat Weight Disord 2020; 25:487-495. [PMID: 30554326 DOI: 10.1007/s40519-018-0627-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 12/10/2018] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE With the rise in electronic cigarette (ENDS) use among US young adults, more research is needed on expectations for use and perceptions related to body image, weight control, and stress relief. METHODS College students (N = 230; modal age 21 years; 68% female) completed an online survey assessing cigarette smoking and ENDS, dieting and body image, perceptions about flavors, stress, weight gain prevention, and appetite regulation. SAMPLE CHARACTERISTICS Dual use (cigarette and ENDS) was reported by n = 69 (30.0%). Exclusive cigarette smoking was endorsed by n = 53 (23%) with exclusive ENDS use reported by n = 15 (6.5%). Ninety-three participants (40.5%) reported not using either product. RESULTS Among those using ENDS, < 33% reported using as a stress management tool, < 15% reported using ENDS to control appetite, and > 70% reported using cartridges that tasked like sweets. There was a positive correlation between dieting behaviors and body concern, suggesting those who reported higher use of ENDS for weight and appetite regulation also had higher pathological eating scores and concern over body shape and size. CONCLUSION Prevention and education related to weight, body image, and tobacco are needed to address misperceptions of tobacco products. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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Affiliation(s)
- Melissa A Napolitano
- Department of Prevention and Community Health, The George Washington University Milken Institute School of Public Health, 950 New Hampshire Avenue, Washington, DC, 20052, USA.
- Department of Exercise and Nutrition Sciences, The George Washington University Milken Institute School of Public Health, 950 New Hampshire Avenue, Washington, DC, 20052, USA.
| | - Sarah Beth Lynch
- University of Texas at Austin School of Nursing, 1710 Red River Street, Austin, TX, 78712, USA
| | - Cassandra A Stanton
- Westat Cancer Prevention and Control Program, Georgetown University Medical Center, 1600 Research Boulevard, Rockville, MD, 20850-3129, USA
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27
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Effect of e-cigarette flavors on nicotine delivery and puffing topography: results from a randomized clinical trial of daily smokers. Psychopharmacology (Berl) 2020; 237:491-502. [PMID: 31773209 PMCID: PMC7691130 DOI: 10.1007/s00213-019-05386-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 10/25/2019] [Indexed: 10/25/2022]
Abstract
RATIONALE There is limited understanding regarding how various e-cigarette flavorings may influence the behavior of non-regular e-cigarette users who are regular cigarette smokers. OBJECTIVES To assess differences in nicotine delivery, puffing topography, subjective effects, and user satisfaction from different flavored e-liquids. METHODS Eighteen daily smokers (average age, 44.1 ± 7.0; 9 males; average CPD, 13.0 ± 5.8) smoked their tobacco cigarettes during an initial visit and returned five times to try an e-cigarette (eGo type) refilled with a nicotine solution (24 mg/ml) of five different flavors: cherry, tobacco, espresso, menthol, and vanilla (randomized order). Assessments at each visit included puffing topography, blood samples for nicotine analysis, and subjective reports of nicotine effects and flavor satisfaction. RESULTS Vaping different flavors resulted in different levels of plasma nicotine. The flavor producing the highest plasma nicotine concentration (Cmax) was cherry (median 21.2 ng/ml), which was not significantly different than nicotine delivery from a combustible cigarette (29.2 ng/ml, p > .05). Vanilla e-liquid produced the lowest Cmax (9.7 ng/ml), and participants tended to puff less frequently on vanilla compared to tobacco flavor (p = .013). Flavors did not differ significantly in the speed of nicotine delivery (Tmax). During controlled use, puff duration for all flavors was significantly longer than a combustible cigarette (p < 0.05). After controlling for nicotine delivery, significant differences in flavor enjoyment were detected. Menthol flavored e-liquid was rated as more enjoyable than vanilla and tobacco flavored e-liquids (p < 0.05). CONCLUSIONS Flavors tested in this study yielded different patterns of nicotine delivery and led to differences in reduction in smoking urges. TRIAL REGISTRATION ClinicalTrials.gov Identifier: #NCT02575885.
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28
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Hiler M, Spindle TR, Dick D, Eissenberg T, Breland A, Soule E. Reasons for Transition From Electronic Cigarette Use to Cigarette Smoking Among Young Adult College Students. J Adolesc Health 2020; 66:56-63. [PMID: 31699605 PMCID: PMC6935466 DOI: 10.1016/j.jadohealth.2019.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/04/2019] [Accepted: 09/05/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Longitudinal studies indicate that e-cigarette use among youth and young adults is associated with cigarette smoking initiation. The purpose of this study was to identify reasons why nonsmoking young adults transition from e-cigarette use to cigarette smoking. METHODS The study used concept mapping (CM), a mixed-method participatory approach. Fifty-five college students who endorsed initiation of e-cigarettes before cigarettes (lifetime e-cigarette uses ≥ 100 and ≥ 100 cigarettes in lifetime) completed at least one part of the study. In an online program, participants brainstormed (n = 54) statements describing reasons for transition from e-cigarette use to cigarette smoking, sorted statements (n = 46) into conceptually similar categories, and rated (n = 47) how true each statement was for them. RESULTS Participants generated 60 unique statements, and multidimensional scaling analysis generated eight thematic clusters characterizing reasons for transition which included the following: "Sharing with Others," "Psychological Coping," "Cigarette Appeal," "Reinforcing Effects of Cigarettes," "Accessibility," "Social Influence," "Vaping Stigma," and "Vaping Deficiencies." Participants rated "Sharing with Others" and "Psychological Coping" highest (most true) and "Vaping Deficiencies" lowest (least true). For college students, the ability to share cigarettes with peers and access cigarettes from peers and smoking for stress/anxiety management were among the top reasons for transition. CONCLUSIONS Results suggest that tailored prevention efforts aimed at reducing cigarette smoking uptake among college students who use tobacco as a means for psychological coping or social facilitation may be warranted. Furthermore, regulatory decisions aimed at limiting cigarette appeal, reinforcing effects, and accessibility may be relevant to reducing transition.
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Affiliation(s)
- Marzena Hiler
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia; Department of Psychology, Virginia Commonwealth University, Richmond, Virginia.
| | - Tory R Spindle
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Danielle Dick
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia; Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, Virginia
| | - Thomas Eissenberg
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia; Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Alison Breland
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia; Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Eric Soule
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia; Department of Health Education and Promotion, East Carolina University, Greenville, North Carolina.
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29
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Allem JP, Majmundar A, Dharmapuri L, Cruz TB, Unger JB. E-liquid-related posts to Twitter in 2018: Thematic analysis. Addict Behav Rep 2019; 10:100196. [PMID: 31431917 PMCID: PMC6579902 DOI: 10.1016/j.abrep.2019.100196] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/03/2019] [Accepted: 06/05/2019] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION E-liquid is the solution aerosolized by e-cigarette devices to produce vapor. Continuously evolving e-liquids, and corresponding devices, can affect user experiences associated with these products. Twitter conversations about e-liquids can capture salient behavioral, social, and communicative cues associated with e-liquids. We analyzed Twitter data to characterize key topics of conversation about e-liquids to inform surveillance, and regulatory efforts. METHODS Twitter posts containing e-liquid-related terms ("e-liquid(s)," "e-juice(s)") were obtained from 1 January 2018 to 31 December 2018. Text classifiers were used to identify topics of the posts (n = 15,927). RESULTS The most prevalent topic was Promotional at 29.35% followed by Flavors at 24.22%, and Person Tagging at 21.47%. Juice Composition was next most prevalent at 17.61% followed by Cannabis at 16.83%, and Nicotine Health Risks at 6.39%. Quit Smoking was rare at 0.57%. CONCLUSION These results suggest that flavors, cannabis, health risks of nicotine, and composition warrant consideration as targets in future surveillance, public policy, and interventions addressing the use of e-liquids. Twitter provides ample opportunity to influence the normalization, and uptake, of e-cigarette-related products among non-smokers and youth, unless regulatory restrictions, and counter messaging campaigns are developed to reduce this risk.
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Affiliation(s)
- Jon-Patrick Allem
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Anuja Majmundar
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Likhit Dharmapuri
- Department of Computer Science, University of Southern California, Los Angeles, CA, USA
| | - Tess Boley Cruz
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jennifer B. Unger
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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30
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The role of flavors in vaping initiation and satisfaction among U.S. adults. Addict Behav 2019; 99:106077. [PMID: 31437770 DOI: 10.1016/j.addbeh.2019.106077] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND The prevalence of electronic cigarette use has grown over the past decade, with some users reportedly initiating e-cigarette use primarily due to flavors. This study examined the role of flavors in initiation among adult e-cigarette users, as well as the association of flavors with satisfaction and perceived addiction to vaping. METHODS The analysis sample consisted of 1492 current e-cigarette users aged 18 or older, drawn from an online quantitative survey conducted in 2016. Multivariable logistic regression and general linear models were used. RESULTS Most current e-cigarette users (62.9%) typically used flavors other than tobacco (including fruit, mint/menthol, sweet, candy, coffee and other), 24.2% typically used tobacco flavors, and 12.9% typically used non-flavored e-cigarettes. Flavor was a common reason for vaping initiation, selected by 29.5% of the sample. Flavor, particularly fruit flavor, was more likely to motivate young adults 18-24 to initiate vaping compared adults 35-44. Those who used flavors, particularly mint/menthol and flavors other than tobacco flavor, had higher odds of reporting high satisfaction with vaping and had higher odds of perceived addiction to vaping than respondents who did not use flavored e-cigarettes. CONCLUSIONS Users of flavored e-cigarettes reported greater satisfaction and self-perceived addiction than users of non-flavored e-cigarettes. The appeal of flavors, particularly among young adults, has implications for regulatory policy regarding the marketing and promotion of flavored products. These findings may provide direction for the Food and Drug Administration's plans to restrict flavors other than menthol, mint, and tobacco.
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31
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Cobb CO, Lopez AA, Soule EK, Yen MS, Rumsey H, Lester-Schotles R, Rudy AK, Lipato T, Guy M, Eissenberg T. Influence of electronic cigarette liquid flavors and nicotine concentration on subjective measures of abuse liability in young adult cigarette smokers. Drug Alcohol Depend 2019; 203:27-34. [PMID: 31401532 PMCID: PMC9307062 DOI: 10.1016/j.drugalcdep.2019.05.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 05/17/2019] [Accepted: 05/21/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND A rapidly evolving tobacco marketplace highlights the timeliness of the FDA's authority to regulate tobacco, specifically the role that flavorings in nicotine-containing electronic cigarette (ECIG) liquids have on public health. This study aimed to evaluate the extent to which ECIG liquid flavor and nicotine concentration influenced subjective measures of abuse liability among young adult cigarette (cig) smokers. METHODS Young adult (18-21 y.o.) smokers (M = 10.1 cig/day, no regular ECIG use history) completed 7 Latin-square ordered conditions each preceded by 12 h. nicotine/tobacco abstinence. Conditions were own brand cig (OB) and eGo-style ECIG paired with three liquid flavors (cream, tropical fruit, tobacco/menthol) varying in nicotine concentration (0 or 36 mg/ml). Products were administered in two 10-puff bouts in each condition. Heart rate/blood pressure (HR/BP) and tobacco/nicotine abstinence symptoms, nicotine/general drug effects, and acceptability measures were assessed repeatedly throughout sessions. Mixed linear models were followed-up with Tukey's HSD t-tests. RESULTS HR/BP indicated nicotine exposure during nicotine-containing conditions. OB and tobacco/menthol 36 mg/ml conditions produced significant decreases in ratings of cig smoking urges. Nicotine/drug effects were elevated significantly for OB and 36 mg/ml ECIG conditions with one exception noted for the tobacco/menthol 0 mg/ml condition. OB had the highest acceptability ratings, and ECIG condition results varied by acceptability item. CONCLUSIONS Among young adult smokers, ECIG conditions containing nicotine were positively associated with several subjective measures of abuse liability but not all. Flavors did not consistently mask/enhance effects observed. Results reinforce continued examination of ECIG-delivered nicotine and liquid flavors in relationship to abuse liability.
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Affiliation(s)
- Caroline O. Cobb
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA,Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA,Correspondence: Caroline O. Cobb, Virginia Commonwealth University, 808 W Franklin, Room 304, P.O. Box 842018, Richmond, VA 23284-2018 Phone: 804-828-8687
| | - Alexa A. Lopez
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA,Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Eric K. Soule
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA,Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Miao-Shan Yen
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA,Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Hannah Rumsey
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA,Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Rebecca Lester-Schotles
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA,Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Alyssa K. Rudy
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA,Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Thokozeni Lipato
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA,Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Mignonne Guy
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA,Department of African American Studies, Virginia Commonwealth University, Richmond, VA, USA
| | - Thomas Eissenberg
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA,Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
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Use of Flavored E-Cigarettes and the Type of E-Cigarette Devices Used among Adults and Youth in the US-Results from Wave 3 of the Population Assessment of Tobacco and Health Study (2015-2016). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16162991. [PMID: 31434229 PMCID: PMC6720922 DOI: 10.3390/ijerph16162991] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 08/13/2019] [Accepted: 08/18/2019] [Indexed: 11/16/2022]
Abstract
The United States (U.S.) Food and Drug Administration has expressed concern about flavored e-cigarettes (e.g., JUUL brand) because they are appealing to youth who may be unaware that the product is addictive. The Population Assessment of Tobacco and Health Study Wave 3 provided data on flavor categories, type of e-cigarette product, and smoking status among past 30-day youth and adult e-cigarette users in the US. Most past 30-day youth and adult users reported using only one flavor category, with fruit (53% youth, 31% adult) being the most commonly reported category. Adults were far more likely to report using tobacco flavor alone, compared to any other individual flavor category or flavor category combinations (OR: 21.08, 95%CI: 5.92, 75.12). Whereas, youth were more likely to report using multiple flavor categories (OR: 2.03, 95%CI: 1.55, 2.65), with the most reported pairing being fruit and candy (36%). The variety of flavors on the market appeals to consumers of all ages. Although most past 30-day e-cigarette users reported only one flavor category, non-tobacco flavors were far more common among youth. Differences in flavor preferences among adult versus youth vapers may have implications for the role of flavors in both the initiation of youth vaping and adult vaping for smoking cessation.
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Voos N, Kaiser L, Mahoney MC, Bradizza CM, Kozlowski LT, Benowitz NL, O'Connor RJ, Goniewicz ML. Randomized within-subject trial to evaluate smokers' initial perceptions, subjective effects and nicotine delivery across six vaporized nicotine products. Addiction 2019; 114:1236-1248. [PMID: 30851137 PMCID: PMC6646880 DOI: 10.1111/add.14602] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/08/2019] [Accepted: 03/04/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Vaporized nicotine products (VNPs) can vary in important characteristics including size, shape, flavor and nicotine yield. We examined whether complex interactions among these characteristics could affect smokers' VNP perceptions and usage patterns. DESIGN A within-subject randomized cross-over trial. SETTING Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA. PARTICIPANTS Eighteen daily cigarette smokers. MEASUREMENTS Participants attended eight weekly visits during which they sampled six different VNPs (disposable, rechargeable, eGO, mod, e-Cigar and e-Pipe) with tobacco-flavored e-liquid. Prior to device use, participants completed product-ranking questionnaires. Participants completed controlled puffing sessions during each of the six trials, after which satisfaction questionnaires were completed and blood samples were taken. FINDINGS Initial perceptions showed that the smallest device (disposable) was ranked as safer compared with a larger device (e-Pipe) (P < 0.05). Participants rated the eGO and mod devices higher on satisfaction and enjoyment from use, taste, pleasantness, harshness ('throat hit') and speed of effect, but lower on perceived health risk and embarrassment from use (P < 0.05). All devices had a lower Cmax than the combustible cigarette (P < 0.05), but there were differences among devices (P < 0.05). The mod, e-Pipe and eGO provided the highest amount of perceived smoking urge relief, and this correlated strongly with Cmax across all devices (R2 = 0.8614, P = 0.007). The perceived speed of urge relief was not correlated with Tmax (R2 = 0.0035, P = 0.911) CONCLUSIONS: Daily cigarette smokers testing six types of vaporized nicotine products (VNPs) reported that they varied in taste, amount of withdrawal relief, harshness, embarrassment from use, perceived health risk and subjective and objective nicotine delivery. The eGO and mod models have properties that may make them most effective for cigarette substitution among smokers who intend to switch to a VNP.
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Affiliation(s)
- Natalie Voos
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, USA
| | - Lisa Kaiser
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, USA
| | - Martin C Mahoney
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, USA
| | | | - Lynn T Kozlowski
- School of Public Health and Health Professions, University at Buffalo, NY, USA
| | - Neal L Benowitz
- Division of Clinical Pharmacology, Department of Medicine and Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, USA
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, USA
| | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, USA
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Tokle R, Pedersen W. "Cloud chasers" and "substitutes": e-cigarettes, vaping subcultures and vaper identities. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41:917-932. [PMID: 30677161 DOI: 10.1111/1467-9566.12854] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The use of e-cigarettes is increasing, a practice denoted as vaping. We explore user motives, self-identity as vapers and involvement in vaping subcultures, drawing on sociological theory of stigma, subcultures and symbolic boundaries. Based on analyses of semi-structured interviews with 30 Norwegian vapers, we find that there is a vaping subculture in Norway. We identify two dominant vaper identities. The first is labelled cloud chasers. These were dedicated vapers who identified with symbols and values in the subculture. Many were politically engaged in improving vaping regulation regimes and felt a sense of belonging to a vaping community. The second group is labelled substitutes. These were former daily smokers who used e-cigarettes for smoking cessation in a more pragmatic and defensive manner, to avoid health risks, to escape the stigma of smoking and to manage nicotine addiction. In this group, self-identity as a vaper was generally lacking. Vaping was often symbolically linked to the stigmatised smoker identity they wanted to escape, and was restricted to private contexts. The perceived symbolic meaning of e-cigarettes varies: for some, they are a symbol of pleasure and community. For others, they connote the stigmatised status of the addicted smoker seeking an alternative to cigarettes.
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Affiliation(s)
- Rikke Tokle
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
| | - Willy Pedersen
- Department of Sociology and Human Geography, University of Oslo, Oslo, Norway
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Soneji SS, Knutzen KE, Villanti AC. Use of Flavored E-Cigarettes Among Adolescents, Young Adults, and Older Adults: Findings From the Population Assessment for Tobacco and Health Study. Public Health Rep 2019; 134:282-292. [PMID: 30857471 DOI: 10.1177/0033354919830967] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES The use of flavored electronic cigarettes (e-cigarettes) is common among e-cigarette users, but little is known about the potential harms of flavorings, the extent to which the concurrent use of multiple flavor types occurs, and the correlates of flavor type use. The objective of this study was to assess the types of e-cigarette flavors used by adolescent (aged 12-17), young adult (aged 18-24), and older adult (aged ≥25) e-cigarette users. METHODS We assessed the prevalence of flavored e-cigarette use within the past month by flavor types and concurrent use of multiple flavor types among past-month e-cigarette users sampled during Wave 2 (2014-2015) of the Population Assessment for Tobacco and Health Study among 414 adolescents, 961 young adults, and 1711 older adults. We used weighted logistic regression models for the use of fruit-, candy-, mint/menthol-, tobacco-, or other-flavored e-cigarettes and concurrent use of multiple flavor types. Covariates included demographic characteristics, e-cigarette use frequency, cigarette smoking status, current use of other tobacco products, and reasons for e-cigarette use. RESULTS The leading e-cigarette flavor types among adolescents were fruit, candy, and other flavors; among young adults were fruit, candy, and mint/menthol; and among older adults were tobacco or other flavors, fruit, and mint/menthol. Compared with older adults, adolescents and young adults were more likely to use fruit-flavored e-cigarettes (adjusted odds ratio [aOR] = 3.35; 95% confidence interval [CI], 2.56-4.38; and aOR = 2.31; 95% CI, 1.77-3.01, respectively) and candy-flavored e-cigarettes (aOR = 3.81; 95% CI, 2.74-5.28; and aOR = 2.95; 95% CI, 2.29-3.80, respectively) and concurrently use multiple flavor types (aOR = 4.58; 95% CI, 3.39-6.17; and aOR = 2.28; 95% CI, 1.78-2.91, respectively). CONCLUSIONS Regulation of sweet e-cigarette flavors (eg, fruit and candy) may help reduce the use of e-cigarettes among young persons without substantially burdening adult e-cigarette users.
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Affiliation(s)
- Samir S Soneji
- 1 Dartmouth Geisel School of Medicine, Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, NH, USA.,2 Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Geisel School of Medicine, Lebanon, NH, USA
| | - Kristin E Knutzen
- 2 Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Geisel School of Medicine, Lebanon, NH, USA
| | - Andrea C Villanti
- 3 Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington, VT, USA
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McCausland K, Maycock B, Leaver T, Jancey J. The Messages Presented in Electronic Cigarette-Related Social Media Promotions and Discussion: Scoping Review. J Med Internet Res 2019; 21:e11953. [PMID: 30720440 PMCID: PMC6379814 DOI: 10.2196/11953] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/24/2018] [Accepted: 10/25/2018] [Indexed: 02/06/2023] Open
Abstract
Background There has been a rapid rise in the popularity of electronic cigarettes (e-cigarettes) over the last decade, with growth predicted to continue. The uptake of these devices has escalated despite inconclusive evidence of their efficacy as a smoking cessation device and unknown long-term health consequences. As smoking rates continue to drop or plateau in many well-developed countries, transnational tobacco companies have transitioned into the vaping industry and are now using social media to promote their products. Evidence indicates e-cigarettes are being marketed on social media as a harm reduction alternative, with retailers and manufacturers utilizing marketing techniques historically used by the tobacco industry. Objective This study aimed to identify and describe the messages presented in e-cigarette–related social media (Twitter, YouTube, Instagram, and Pinterest) promotions and discussions and identify future directions for research, surveillance, and regulation. Methods Data sources included MEDLINE, Scopus, ProQuest, Informit, the Journal of Medical Internet Research, and Google Scholar. Included studies were published in English between 2007 and 2017, analyzed content captured from e-cigarette–related social media promotions or discussions, and reported results for e-cigarettes separately from other forms of tobacco and nicotine delivery. Database search ceased in October 2017. Initial searches identified 536 studies. Two reviewers screened studies by title and abstract. One reviewer examined 71 full-text articles to determine eligibility and identified 25 studies for inclusion. This process was undertaken with the assistance of the Web-based screening and data extraction tool—Covidence. The review was registered with the Joanna Briggs Institute (JBI) Systematic Reviews database and followed the methodology for JBI Scoping Reviews. Results Several key messages are being used to promote e-cigarettes including as a safer alternative to cigarettes, efficacy as a smoking cessation aid, and for use where smoking is prohibited. Other major marketing efforts aimed at capturing a larger market involve promotion of innovative flavoring and highlighting the public performance of vaping. Discussion and promotion of these devices appear to be predominantly occurring among the general public and those with vested interests such as retailers and manufacturers. There is a noticeable silence from the public health and government sector in these discussions on social media. Conclusions The social media landscape is dominated by pro-vaping messages disseminated by the vaping industry and vaping proponents. The uncertainty surrounding e-cigarette regulation expressed within the public health field appears not to be reflected in ongoing social media dialogues and highlights the need for public health professionals to interact with the public to actively influence social media conversations and create a more balanced discussion. With the vaping industry changing so rapidly, real-time monitoring and surveillance of how these devices are discussed, promoted, and used on social media is necessary in conjunction with evidence published in academic journals.
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Affiliation(s)
- Kahlia McCausland
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Bentley, Australia
| | - Bruce Maycock
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Bentley, Australia
| | - Tama Leaver
- School of Media, Creative Arts and Social Inquiry, Curtin University, Bentley, Australia
| | - Jonine Jancey
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Bentley, Australia
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Larsen BA, Litt MD, Huedo-Medina TB, Duffy VB. Modeling Associations between Chemosensation, Liking for Fats and Sweets, Dietary Behaviors and Body Mass Index in Chronic Smokers. Nutrients 2019; 11:E271. [PMID: 30691090 PMCID: PMC6412709 DOI: 10.3390/nu11020271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 01/19/2019] [Accepted: 01/22/2019] [Indexed: 01/31/2023] Open
Abstract
Chronic smokers have a greater risk for altered chemosensation, unhealthy dietary patterns, and excessive adiposity. In an observational study of chronic smokers, we modeled relationships between chemosensation, fat/carbohydrate liking, smoking-associated dietary behaviors, and body mass index (BMI). Also tested in the model was liking for sweet electronic cigarette juice (e-juice). Smokers (n = 135, 37 ± 11 years) were measured for: Taste genetics (intensity of 6-n-propylthiouracil-PROP); taste (NaCl and quinine intensities) and olfactory (odor identification) function; liking for cherry e-juice; and weight/height to calculate BMI. Smokers survey-reported their food liking and use of smoking for appetite/weight control. Structural equation models tested direct and indirect relationships between chemosensation, fat/carbohydrate liking, dietary behaviors, and BMI. In good-fitting models, taste intensity was linked to BMI variation through fat/carbohydrate liking (greater PROP intensity→greater NaCl intensity→greater food liking→higher BMI). Olfactory function tended to predict sweet e-juice liking, which, in turn, partially mediated the food liking and BMI association. The path between smoking-associated dietary behaviors and BMI was direct and independent of chemosensation or liking. These findings indicate that taste associates with BMI in chronic smokers through liking of fats/carbohydrates. Future research should determine if vaping sweet e-juice could improve diet quality and adiposity for smokers.
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Affiliation(s)
- Brittany A Larsen
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA.
| | - Mark D Litt
- Division of Behavioral Sciences & Community Health, University of Connecticut Health Center, Farmington, CT 06030, USA.
| | - Tania B Huedo-Medina
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA.
| | - Valerie B Duffy
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA.
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Goldberg RL, Cataldo JK. Using an e-Cigarette is Like Eating Tofu When You Really Want Meat. Am J Health Behav 2018; 42:54-64. [PMID: 30688641 DOI: 10.5993/ajhb.42.5.5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective Whereas controversy about the e-cigarette's effectiveness and safety as a smoking cessation tool continues, e-cigarette use prevalence continues rising. In this study, we sought to describe experiences of adult e-cigarette users and to examine their motivations, beliefs, and use patterns. Methods This qualitative study included one-on-one semi-structured phone interviews with 20 current California e-cigarette users (mean age = 38 ± 9.44 years). Interviews were transcribed and thematically analyzed using MAXQDA. Results E-cigarettes initially addressed participants' problems related to smoking; they no longer smelled like cigarette smoke and could avoid smoke-free regulations. Participants highlighted the importance of e-cigarette flavors and of "receiving moral credit" for harm reduction by using e-cigarettes to quit smoking cigarettes. Many described eventual dissatisfaction with e-cigarettes, which resulted in relapse to cigarette smoking and/or dual use with cigarettes. The convenience of e-cigarettes coupled with the pattern of constant use left participants increasingly reliant on e-cigarettes. Conclusion Ultimately, failed cessation and dual use exposes smokers to greater levels of nicotine, while still exposing them to cigarette smoke. Public health campaigns should promote awareness of the risks of using e-cigarettes, including failed cessation attempts, dual use, addiction, and other health consequences.
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Affiliation(s)
- Rachel L Goldberg
- Clinical Research Coordinator, Department of Physiological Nursing, University of California San Francisco, San Francisco, CA, USA
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Schneller LM, Bansal-Travers M, Goniewicz ML, McIntosh S, Ossip D, O’Connor RJ. Use of flavored electronic cigarette refill liquids among adults and youth in the US-Results from Wave 2 of the Population Assessment of Tobacco and Health Study (2014-2015). PLoS One 2018; 13:e0202744. [PMID: 30138412 PMCID: PMC6107209 DOI: 10.1371/journal.pone.0202744] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 08/08/2018] [Indexed: 11/18/2022] Open
Abstract
Introduction Flavored e-cigarettes are enticing to new users and established cigarette smokers using e-cigarettes to quit smoking due to the wide variety of flavor options. However, specific flavor combinations that are popular among e-cigarette users are understudied. Recently, the Deeming rule extended the US Food and Drug Administration’s authority over all tobacco products, including e-cigarettes. Methods The Population Assessment of Tobacco and Health Study Wave 2 data were analyzed to assess the prevalence of self-reported flavor categories that are used individually and in combination with other flavor categories among past 30-day youth and adult e-cigarette users in the US. Results Most youth and adult participants reported using a flavored e-cigarette. Reporting an individual flavor category was more common than reporting a combination of flavor categories. Fruit flavor was the most common flavor category reported among youth, and ‘menthol/mint’ was most common among adults. Fruit and candy/other sweets were the most common flavor categories reported together among both youth and adult past 30-day e-cigarette users. Conclusions The use of flavored e-cigarettes is very popular among youth and adults. Most consumers reported using a single flavor category, although some consumers did use a combination of flavor categories. Preference for menthol/mint among adults may represent a carryover from associations with tobacco cigarettes. Typically, sweeter flavors, such as fruit, were among the most popular flavor categories reported, both individually and in combination with other flavors, while more bitter flavors (i.e.: clove/spice) were less common. Implications This study identified predominant flavor categories among past 30-day youth and adult e-cigarette users. Findings indicate that the wide variety of flavors available and the freedom to “mix-and-match” flavors may maintain use of e-cigarettes among youth and adults, and future research should focus on the composition of the ENDS liquid/vapor to disentangle the contributions of sweeteners and flavorants.
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Affiliation(s)
- Liane M. Schneller
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America
| | - Maansi Bansal-Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America
| | - Maciej L. Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America
| | - Scott McIntosh
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Deborah Ossip
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Richard J. O’Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America
- * E-mail:
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Abstract
Tobacco use and exposure to tobacco smoke remain major but avoidable causes of premature mortality and disease worldwide. Although the age-standardized prevalence of daily smoking has declined for both men and women in many countries, the number of smokers continues to increase because of global population growth. Although cigarettes are the most commonly used tobacco product, the tobacco epidemic has become tremendously complex with the emergence and popularity of alternative products such as waterpipes and electronic cigarettes (also known as e-cigarettes). Exposure sciences play a major role in characterizing the tobacco epidemic as well as in the promotion, enactment, and implementation of tobacco control initiatives including legislation and voluntary measures in countries worldwide. We reviewed several studies in Latin America and other regions, showing how high-quality exposure assessment has contributed to smoke-free policies. Although there are many toxicants in tobacco products, metals could be playing an important role in tobacco-related disease. Tobacco plants accumulate cadmium and lead from soil. In e-cigarettes, a metallic coil heats the e-liquid to produce the aerosol that is inhaled by the vaper, and studies have found high aerosol levels of nickel, chromium, lead, and zinc. Despite many tobacco control successes, including the enactment of the Framework Convention on Tobacco Control, which has been ratified by 181 countries, tobacco control faces many challenges globally. Given the continuing increase in the number of smokers worldwide and the rapid emergence of new tobacco products, additional creative efforts are needed to achieve a smoke-free world, help smokers to quit, and protect youth from initiating tobacco use.
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Affiliation(s)
- Ana Navas-Acien
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York
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Gibson LA, Creamer MR, Breland AB, Giachello AL, Kaufman A, Kong G, Pechacek TF, Pepper JK, Soule EK, Halpern-Felsher B. Measuring perceptions related to e-cigarettes: Important principles and next steps to enhance study validity. Addict Behav 2018; 79:219-225. [PMID: 29175027 DOI: 10.1016/j.addbeh.2017.11.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 09/26/2017] [Accepted: 11/09/2017] [Indexed: 12/28/2022]
Abstract
Measuring perceptions associated with e-cigarette use can provide valuable information to help explain why youth and adults initiate and continue to use e-cigarettes. However, given the complexity of e-cigarette devices and their continuing evolution, measures of perceptions of this product have varied greatly. Our goal, as members of the working group on e-cigarette measurement within the Tobacco Centers of Regulatory Science (TCORS) network, is to provide guidance to researchers developing surveys concerning e-cigarette perceptions. We surveyed the 14 TCORS sites and received and reviewed 371 e-cigarette perception items from seven sites. We categorized the items based on types of perceptions asked, and identified measurement approaches that could enhance data validity and approaches that researchers may consider avoiding. The committee provides suggestions in four areas: (1) perceptions of benefits, (2) harm perceptions, (3) addiction perceptions, and (4) perceptions of social norms. Across these 4 areas, the most appropriate way to assess e-cigarette perceptions depends largely on study aims. The type and number of items used to examine e-cigarette perceptions will also vary depending on respondents' e-cigarette experience (i.e., user vs. non-user), level of experience (e.g., experimental vs. established), type of e-cigarette device (e.g., cig-a-like, mod), and age. Continuous formative work is critical to adequately capture perceptions in response to the rapidly changing e-cigarette landscape. Most important, it is imperative to consider the unique perceptual aspects of e-cigarettes, building on the conventional cigarette literature as appropriate, but not relying on existing conventional cigarette perception items without adjustment.
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Affiliation(s)
| | - MeLisa R Creamer
- University of Texas Health Science Center, Houston School of Public Health, Austin, Regional Campus, TX, USA
| | | | | | - Annette Kaufman
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control & Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Grace Kong
- Yale University School of Medicine, New Haven, CT, USA
| | | | - Jessica K Pepper
- University of North Carolina at Chapel Hill, NC, USA; RTI International, Research Triangle Park, NC, USA
| | - Eric K Soule
- Virginia Commonwealth University, Richmond, VA, USA
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Soule EK, Maloney SF, Guy MC, Eissenberg T, Fagan P. User-identified electronic cigarette behavioral strategies and device characteristics for cigarette smoking reduction. Addict Behav 2018; 79:93-101. [PMID: 29272713 DOI: 10.1016/j.addbeh.2017.12.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/01/2017] [Accepted: 12/07/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND There is limited evidence on how cigarette smokers use electronic cigarettes (ECIGs) for smoking cessation and reduction. This study used concept mapping, a participatory mixed-methods research approach, to identify ECIG use behaviors and device characteristics perceived to be associated with cigarette smoking cessation or reduction. METHODS Current ECIG users aged 18-64 were recruited from seven cities selected randomly from U.S. census tract regions. Participants were invited to complete concept mapping tasks: brainstorming, sorting and rating (n=72). During brainstorming, participants generated statements in response to a focus prompt ("A SPECIFIC WAY I HAVE USED electronic cigarettes to reduce my cigarette smoking or a SPECIFIC WAY electronic cigarettes help me reduce my cigarette smoking is…") and then sorted and rated the statements. Multidimensional scaling and hierarchical cluster analyses were used to generate a cluster map that was interpreted by the research team. RESULTS Eight thematic clusters were identified: Convenience, Perceived Health Effects, Ease of Use, Versatility and Variety, Advantages of ECIGs over Cigarettes, Cigarette Substitutability, Reducing Harms to Self and Others, and Social Benefits. Participants generated several statements that related to specific behavioral strategies used when using ECIGs for smoking reduction/complete switching behaviors such as making rapid transitions from smoking to ECIG use or using certain ECIG liquids or devices. Former smokers rated the Perceived Health Effects cluster and several behavioral strategy statements higher than current smokers. CONCLUSIONS These results help to identify ECIG use behaviors and characteristics perceived by ECIG users to aid in cigarette smoking cessation or reduction.
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Affiliation(s)
- Eric K Soule
- Center for the Study of Tobacco Products, Virginia Commonwealth University, United States; Virginia Commonwealth University, Department of Psychology, PO Box 980205, Richmond, VA 23298, United States.
| | - Sarah F Maloney
- Center for the Study of Tobacco Products, Virginia Commonwealth University, United States; Virginia Commonwealth University, Department of Psychology, PO Box 980205, Richmond, VA 23298, United States.
| | - Mignonne C Guy
- Center for the Study of Tobacco Products, Virginia Commonwealth University, United States; Virginia Commonwealth University, Department of African American Studies, PO Box 842509, Richmond, VA 23284, United States.
| | - Thomas Eissenberg
- Center for the Study of Tobacco Products, Virginia Commonwealth University, United States; Virginia Commonwealth University, Department of Psychology, PO Box 980205, Richmond, VA 23298, United States.
| | - Pebbles Fagan
- Center for the Study of Tobacco Products, Virginia Commonwealth University, United States; University of Arkansas for Medical Sciences, Fay W. Boozman College of Public Health, Department of Health Behavior and Health Education, 4301 West Markham Street #820, Little Rock, AR 72205, United States.
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Zare S, Nemati M, Zheng Y. A systematic review of consumer preference for e-cigarette attributes: Flavor, nicotine strength, and type. PLoS One 2018; 13:e0194145. [PMID: 29543907 PMCID: PMC5854347 DOI: 10.1371/journal.pone.0194145] [Citation(s) in RCA: 155] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 02/26/2018] [Indexed: 12/13/2022] Open
Abstract
Objective Systematic review of research examining consumer preference for the main electronic cigarette (e-cigarette) attributes namely flavor, nicotine strength, and type. Method A systematic search of peer-reviewed articles resulted in a pool of 12,933 articles. We included only articles that meet all the selection criteria: (1) peer-reviewed, (2) written in English, and (3) addressed consumer preference for one or more of the e-cigarette attributes including flavor, strength, and type. Results 66 articles met the inclusion criteria for this review. Consumers preferred flavored e-cigarettes, and such preference varied with age groups and smoking status. We also found that several flavors were associated with decreased harm perception while tobacco flavor was associated with increased harm perception. In addition, some flavor chemicals and sweeteners used in e-cigarettes could be of toxicological concern. Finally, consumer preference for nicotine strength and types depended on smoking status, e-cigarette use history, and gender. Conclusion Adolescents could consider flavor the most important factor trying e-cigarettes and were more likely to initiate vaping through flavored e-cigarettes. Young adults overall preferred sweet, menthol, and cherry flavors, while non-smokers in particular preferred coffee and menthol flavors. Adults in general also preferred sweet flavors (though smokers like tobacco flavor the most) and disliked flavors that elicit bitterness or harshness. In terms of whether flavored e-cigarettes assisted quitting smoking, we found inconclusive evidence. E-cigarette users likely initiated use with a cigarette like product and transitioned to an advanced system with more features. Non-smokers and inexperienced e-cigarettes users tended to prefer no nicotine or low nicotine e-cigarettes while smokers and experienced e-cigarettes users preferred medium and high nicotine e-cigarettes. Weak evidence exists regarding a positive interaction between menthol flavor and nicotine strength.
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Affiliation(s)
- Samane Zare
- Department of Agricultural Economics, University of Kentucky, Lexington, Kentucky, United States of America
- * E-mail:
| | - Mehdi Nemati
- Department of Agricultural Economics, University of Kentucky, Lexington, Kentucky, United States of America
| | - Yuqing Zheng
- Department of Agricultural Economics, University of Kentucky, Lexington, Kentucky, United States of America
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Hendricks PS, Thorne CB, Lappan SN, Sweat NW, Cheong J, Ramachandran R, Kohler CL, Bailey WC, Harrington KF. The Relationships of Expectancies With E-cigarette Use Among Hospitalized Smokers: A Prospective Longitudinal Study. Nicotine Tob Res 2018; 20:224-230. [PMID: 28199715 PMCID: PMC5896545 DOI: 10.1093/ntr/ntx043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 02/07/2017] [Indexed: 01/01/2023]
Abstract
Background Expectancies demonstrate cross-sectional associations with e-cigarette use, but the prospective relationships between expectancies and e-cigarette use are unknown. This study examined the longitudinal associations of expectancies with e-cigarette use among hospitalized tobacco cigarette smokers. Methods E-cigarette expectancies (e-cigarette-specific Brief Smoking Consequences Questionnaire-Adult [BSCQ-A]), tobacco cigarette expectancies (tobacco-specific BSCQ-A), and number of days used e-cigarettes in the past 30 days were assessed at baseline hospitalization, 6-months post-hospitalization, and 12-months post-hospitalization among 978 hospitalized tobacco cigarette smokers. Expectancy difference scores (e-cigarette-specific expectancies minus tobacco-specific expectancies) were computed for each of the 10 BSCQ-A scales. Cross-lagged panel models tested the relationships between expectancy difference scores and number of days used e-cigarettes in the past 30 days for each of the 10 BSCQ-A scales. Results Though some models revealed partial associations between expectancies and e-cigarette use, only one yielded results consistent with hypotheses. Greater e-cigarette use at baseline predicted greater expectancies that e-cigarettes taste pleasant as compared to tobacco cigarettes at 6 months, which then predicted greater e-cigarette use at 12 months. To a lesser degree greater expectancies that e-cigarettes taste pleasant as compared to tobacco cigarettes at baseline predicted greater e-cigarette use at 6 months, which then predicted greater expectancies that e-cigarettes taste pleasant as compared to tobacco cigarettes at 12 months. Conclusions Expectancies that e-cigarettes provide similar or more pleasant taste sensations as compared to tobacco cigarettes may be both a cause and consequence of e-cigarette use. Focusing on the taste experience may prove most effective in modifying e-cigarette use behavior. Implications The current study offers the first longitudinal examination of expectancies and e-cigarette use. Results suggest expectancies that e-cigarettes provide similar or more pleasant taste sensations relative to tobacco cigarettes are both a cause and consequence of e-cigarette use. Efforts that focus on the e-cigarette taste experience may prove most effective in modifying e-cigarette use behavior.
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Affiliation(s)
- Peter S Hendricks
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Christopher B Thorne
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Sara N Lappan
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Noah W Sweat
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - JeeWon Cheong
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL
| | - Rekha Ramachandran
- Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Connie L Kohler
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - William C Bailey
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Kathleen F Harrington
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
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DeVito EE, Krishnan-Sarin S. E-cigarettes: Impact of E-Liquid Components and Device Characteristics on Nicotine Exposure. Curr Neuropharmacol 2018; 16:438-459. [PMID: 29046158 PMCID: PMC6018193 DOI: 10.2174/1570159x15666171016164430] [Citation(s) in RCA: 154] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/09/2017] [Accepted: 10/13/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Electronic cigarette (e-cigarette) use has increased substantially in recent years. While e-cigarettes have been proposed as a potentially effective smoking cessation tool, dualuse in smokers is common and e-cigarettes are widely used by non-smokers, including youth and young-adult non-smokers. Nicotine, the primary addictive component in cigarettes, is present at varying levels in many e-liquids. E-cigarettes may lead to initiation of nicotine use in adult and youth non-smokers, re-initiation of nicotine dependence in ex-smokers or increased severity of nicotine dependence in dual-users of cigarettes and e-cigarettes. As such, there are important clinical and policy implications to understanding factors impacting nicotine exposure from e-cigarettes. However, the broad and rapidly changing range of e-liquid constituents and e-cigarette hardware which could impact nicotine exposure presents a challenge. Recent changes in regulatory oversight of e-cigarettes underscore the importance of synthesizing current knowledge on common factors which may impact nicotine exposure. METHODS This review focuses on factors which may impact nicotine exposure by changing e-cigarette use behavior, puff topography, altering the nicotine yield (amount of nicotine exiting the e-cigarette mouth piece including nicotine exhaled as vapor) or more directly by altering nicotine absorption and bioavailability. RESULTS Topics reviewed include e-liquid components or characteristics including flavor additives (e.g., menthol), base e-liquid ingredients (propylene glycol, vegetable glycerin), components commonly used to dissolve flavorants (e.g., ethanol), and resulting properties of the e-liquid (e.g., pH), e-cigarette device characteristics (e.g., wattage, temperature, model) and user behavior (e.g., puff topography) which may impact nicotine exposure. CONCLUSION E-liquid characteristics and components, e-cigarette hardware and settings, and user behavior can all contribute substantially to nicotine exposure from e-cigarettes.
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Affiliation(s)
- Elise E. DeVito
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA
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Bowler RP, Hansel NN, Jacobson S, Graham Barr R, Make BJ, Han MK, O'Neal WK, Oelsner EC, Casaburi R, Barjaktarevic I, Cooper C, Foreman M, Wise RA, DeMeo DL, Silverman EK, Bailey W, Harrington KF, Woodruff PG, Drummond MB. Electronic Cigarette Use in US Adults at Risk for or with COPD: Analysis from Two Observational Cohorts. J Gen Intern Med 2017; 32:1315-1322. [PMID: 28884423 PMCID: PMC5698219 DOI: 10.1007/s11606-017-4150-7] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 06/28/2017] [Accepted: 07/21/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Electronic cigarettes (e-cigarettes) are battery-operated nicotine-delivery devices used by some smokers as a cessation tool as well as by never smokers. OBJECTIVE To determine the usage of e-cigarettes in older adults at risk for or with chronic obstructive pulmonary disease (COPD). DESIGN Prospective cohorts. PARTICIPANTS COPDGene (N = 3536) and SPIROMICS (N = 1060) subjects who were current or former smokers aged 45-80. MAIN MEASURES Participants were surveyed to determine whether e-cigarette use was associated with longitudinal changes in COPD progression or smoking habits. KEY RESULTS From 2010 to 2016, participants who had ever used e-cigarettes steadily increased to 12-16%, but from 2014 to 2016 current use was stable at ~5%. E-cigarette use in African-Americans (AA) and whites was similar; however, AA were 1.8-2.9 times as likely to use menthol-flavored e-cigarettes. Current e-cigarette and conventional cigarette users had higher nicotine dependence and consumed more nicotine than those who smoked only conventional cigarettes. E-cigarette users had a heavier conventional cigarette smoking history and worse respiratory health, were less likely to reduce or quit conventional cigarette smoking, had higher nicotine dependence, and were more likely to report chronic bronchitis and exacerbations. Ever e-cigarette users had more rapid decline in lung function, but this trend did not persist after adjustment for persistent conventional cigarette smoking. CONCLUSIONS E-cigarette use, which is common in adults with or at risk for COPD, was associated with worse pulmonary-related health outcomes, but not with cessation of smoking conventional cigarettes. Although this was an observational study, we find no evidence supporting the use of e-cigarettes as a harm reduction strategy among current smokers with or at risk for COPD.
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Affiliation(s)
- Russell P Bowler
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
- National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA.
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sean Jacobson
- National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA
| | - R Graham Barr
- Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY, USA
| | - Barry J Make
- National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI, USA
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Wanda K O'Neal
- Department of Medicine, Marsico Lung Institute/Cystic Fibrosis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Elizabeth C Oelsner
- Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY, USA
| | - Richard Casaburi
- Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Igor Barjaktarevic
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, California, Los Angeles, USA
| | - Chris Cooper
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, California, Los Angeles, USA
| | - Marilyn Foreman
- Department of Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Robert A Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dawn L DeMeo
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Edwin K Silverman
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - William Bailey
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kathleen F Harrington
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Prescott G Woodruff
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine and Cardiovascular Research Institute, University of California San Francisco, School of Medicine, San Francisco, CA, USA
| | - M Bradley Drummond
- Department of Medicine, Marsico Lung Institute/Cystic Fibrosis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Mead EL, Johnson SL, Siddiqui J, Butler J, Kirchner T, Feldman RH. Beyond blunts: Reasons for cigarette and cigar use among African American young adult dual users. ADDICTION RESEARCH & THEORY 2017; 26:349-360. [PMID: 30344466 PMCID: PMC6191202 DOI: 10.1080/16066359.2017.1366456] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND African American young adults are at high risk for dual use of cigarettes and cigars. Limited work has explored and characterized the reasons for use in this population and their relative importance for initiation and current smoking of these products. METHOD Reasons for cigarette and cigar use were systematically explored and categorized using a mixed methods participatory approach called concept mapping. A series of in-person group sessions were held with 30 African American young adult (ages 18-29) current smokers of both cigarettes and cigars in Prince George's County, MD and Washington, DC. Participants brainstormed, sorted, rated, and interpreted their reasons for initiation and past 30-day use of cigarettes and cigars. A cluster map was generated using multi-dimensional scaling, and t-tests were used to explore differences in ratings by background characteristics. RESULTS Participants generated 64 reasons for smoking cigarettes and cigars, and categorized these reasons into six groups: emotions, urges, access, product characteristics, lifestyle, and outside pressure. Emotions and urges were the most important motivations for initiation and current smoking of both products. Product characteristics were significantly more important for cigar initiation and smoking than for cigarettes, and outside pressure was more important for current smoking of cigars than cigarettes. Ratings differed by gender, socioeconomic status, and smoking characteristics. CONCLUSIONS Cigarette and cigar smoking have several overlapping motivations, but key differences were also found, most notably for product characteristics. The FDA's regulation of cigars and cigarettes should focus on addressing key characteristics appealing to young adults to curb dual use.
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Affiliation(s)
- Erin L Mead
- School of Medicine, University of Connecticut Health, 263 Farmington Avenue, Farmington, CT 06030, US, Tel: (860) 679-2456,
| | - Sarah Lindstrom Johnson
- T. Denny Sanford School of Social and Family Dynamics, Arizona State University, PO Box 873701, Tempe, AZ 85287, US. Tel: (480) 965-9975,
| | - Junaed Siddiqui
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, 4200 Valley Drive, College Park, MD 20742, US,
| | - James Butler
- Department of Behavioral and Community Health, Maryland Center for Healthy Equity, School of Public Health, University of Maryland, 4200 Valley Drive, College Park, MD 20742, US, Tel: (301) 405-0757,
| | - Thomas Kirchner
- College of Global Public Health, New York University, 41 E. 11st Street, New York, NY 10003, US, Tel: (646) 997-0548,
| | - Robert H Feldman
- Department of Behavioral and Community Health, Tobacco Center of Regulatory Science, School of Public Health, University of Maryland, 4200 Valley Drive, College Park, MD 20742, US,
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Soule EK, Maloney SF, Guy MC, Eissenberg T, Fagan P. User identified positive outcome expectancies of electronic cigarette use: A concept mapping study. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2017; 31:343-353. [PMID: 28277706 DOI: 10.1037/adb0000263] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Electronic cigarette (ECIG) use is growing in popularity, but little is known about the perceived positive outcomes of ECIG use. This study used concept mapping (CM) to examine positive ECIG outcome expectancies. Sixty-three past 30-day ECIG users (38.1% female) between the ages of 18 and 64 (M = 37.8, SD = 13.3) completed a CM module. In an online program, participants provided statements that completed a prompt: "A specific positive, enjoyable, or exciting effect (i.e., physical or psychological) that I have experienced WHILE USING or IMMEDIATELY AFTER USING an electronic cigarette/electronic vaping device is. . . ." Participants (n = 35) sorted 123 statements into "piles" of similar content and rated (n = 43) each statement on a 7-point scale (1 = Definitely NOT a positive effect to 7 = Definitely a positive effect). A cluster map was created using data from the sorting task, and analysis indicated a 7 cluster model of positive ECIG use outcome expectancies: Therapeutic/Affect Regulation, High/Euphoria, Sensation Enjoyment, Perceived Health Effects, Benefits of Decreased Cigarette Use, Convenience, and Social Impacts. The Perceived Health Effects cluster was rated highest, although all mean ratings were greater than 4.69. Mean cluster ratings were compared, and females, younger adults, past 30-day cigarette smokers, users of more "advanced" ECIG devices, and nonlifetime (less than 100 lifetime cigarettes) participants rated certain clusters higher than comparison groups (ps < 0.05). ECIG users associate positive outcomes with ECIG use. ECIG outcome expectancies may affect product appeal and tobacco use behaviors and should be examined further to inform regulatory policies. (PsycINFO Database Record
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Affiliation(s)
- Eric K Soule
- Department of Psychology, Virginia Commonwealth University
| | | | - Mignonne C Guy
- Department of African American Studies, Virginia Commonwealth University
| | | | - Pebbles Fagan
- Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences
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