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Buettner-Schmidt K, Fraase KS, Barnacle M, Peltier A, Saarinen H, Maack B, Turrubiates N. A review of vaping's health effects, treatment, and policy implications: Nursing's call to action. Nurse Pract 2024; 49:36-47. [PMID: 39186124 PMCID: PMC11343445 DOI: 10.1097/01.npr.0000000000000221] [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] [Indexed: 08/27/2024]
Abstract
ABSTRACT The emergence and subsequent surge in popularity of electronic nicotine delivery systems (ENDS), especially among adolescents and young adults, have reshaped the landscape of tobacco consumption, including use patterns and beliefs as well as therapeutic approaches to the condition. The health implications of ENDS are a cause for concern among NPs, as they include severe nicotine dependence, mental health consequences, and adverse effects on respiratory and cardiac systems, among other issues. This article focuses on the health implications of vaping across the lifespan and emphasizes the need for NPs to evaluate ENDS use consistently across age groups and offer age-appropriate treatment within the clinical setting. Importantly, although vaping is prevalent among various age groups, most tobacco use, including vaping, begins and becomes established during adolescence. This back-to-school season therefore marks an ideal time for NPs to educate their pediatric patients, along with their parents or caregivers, about the widespread effects of vaping on health, and it also serves as a reminder to screen for the condition in adults, regardless of smoking history. To combat this trend on a larger scale, NPs can further advocate for community health by promoting youth prevention programs and supporting policy initiatives aimed at curbing ENDS use.
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Li X, Yuan L, Wang F. Health outcomes of electronic cigarettes. Chin Med J (Engl) 2024; 137:1903-1911. [PMID: 38973260 PMCID: PMC11332784 DOI: 10.1097/cm9.0000000000003098] [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: 12/23/2023] [Indexed: 07/09/2024] Open
Abstract
ABSTRACT The usage of electronic cigarettes (e-cigarettes) sparked an outbreak of unidentified vaping-related lung disease in the US during late 2019. With e-cigarettes becoming more and more popular, smokers have more options other than conventional cigarettes. Under these circumstances, a comprehensive evaluation of the general safety of new tobacco and tobacco-related products, represented by e-cigarettes, to human health is necessary. In this review, we summarize the current research on potential negative impacts of e-cigarette exposure on human health. In particular, studies detailing the relationship between e-cigarettes and the digestive system are summarized, with mechanisms mainly including hepatic metabolic dysfunction, impaired gut barrier, and worsened outcomes of inflammatory bowel disease (IBD). Although believed to be safer than traditional cigarettes, e-cigarettes exert adverse effects on systemic health and induce the development of multiple diseases including asthma, cardiovascular disease, and IBD. Moreover, nicotine-containing e-cigarettes have a negative impact on the childhood development and increase the risk of arterial stiffness compared to the non-nicotine e-cigarettes. However, non-nicotine e-cigarette components have detrimental effects including promoting liver damage and metabolic disorders.
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Affiliation(s)
- Xinmeng Li
- Department of Gastroenterology, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
- Hunan Key Laboratory of Non-resolving Inflammation and Cancer, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
| | - Lingzhi Yuan
- Department of Gastroenterology, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
| | - Fen Wang
- Department of Gastroenterology, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
- Hunan Key Laboratory of Non-resolving Inflammation and Cancer, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
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Buettner-Schmidt K, Steward K, Goniewicz ML, Schaeffer Fraase K, Orr M, Miller DR. Development of a Flavor Ingredient Wheel Linking E-Liquid Additives to the Labeled Flavor of Vaping Products. TOXICS 2024; 12:372. [PMID: 38787151 PMCID: PMC11125894 DOI: 10.3390/toxics12050372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 05/11/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
E-liquids contain combinations of chemicals, with many enhancing the sensory attractiveness of the product. Studies are needed to understand and characterize e-liquid ingredients, particularly flavorings, to inform future research and regulations of these products. We identified common flavor ingredients in a convenience sample of commercial e-liquids using gas chromatography-mass spectrometry. E-liquid flavors were categorized by flavor descriptors provided on the product packaging. A Flavor Ingredient Wheel was developed to link e-liquid flavor ingredients with flavor categories. An analysis of 109 samples identified 48 flavor ingredients. Consistency between the labeled flavor and ingredients used to produce such flavor was found. Our novel Flavor Ingredient Wheel organizes e-liquids by flavor and ingredients, enabling efficient analysis of the link between ingredients and their flavor profiles and allowing for quick assessment of an e-liquid ingredient's flavor profile. Investigating ingredient profiles and identifying and classifying commonly used chemicals in e-liquids may assist with future studies and improve the ability to regulate these products.
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Affiliation(s)
- Kelly Buettner-Schmidt
- School of Nursing, North Dakota State University, Fargo, ND 58108, USA; (K.S.F.); (M.O.); (D.R.M.)
| | - Katherine Steward
- Department of Chemistry and Biochemistry, Montana State University, Bozeman, MT 59717, USA;
| | - Maciej L. Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA;
| | - Kolby Schaeffer Fraase
- School of Nursing, North Dakota State University, Fargo, ND 58108, USA; (K.S.F.); (M.O.); (D.R.M.)
| | - Megan Orr
- School of Nursing, North Dakota State University, Fargo, ND 58108, USA; (K.S.F.); (M.O.); (D.R.M.)
| | - Donald R. Miller
- School of Nursing, North Dakota State University, Fargo, ND 58108, USA; (K.S.F.); (M.O.); (D.R.M.)
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Tweet MS, Wilson M, Rosario JM, Duong M. Acute Pediatric Liquid Nicotine Ingestions. Pediatr Ann 2023; 52:e187-e191. [PMID: 37159065 DOI: 10.3928/19382359-20230307-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Electronic cigarette and vaping device use in the household represents a possible source of unintentional nicotine exposure to pediatric patients. Although most ingestions of nicotine may be mild, there is a potential for significant toxicity. Nicotine toxicity can present similarly to many other types of ingestions, which makes the history an important piece of the encounter. Treatment of nicotine toxicity is primarily supportive care directed at the presenting signs and symptoms. There is no antidotal therapy for nicotine toxicity. This review covers information that can assist clinicians who might treat a pediatric patient presenting with significant nicotine toxicity after the accidental ingestion of liquid nicotine products. [Pediatr Ann. 2023;52(5):e187-e191.].
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Soule EK, Mayne S, Snipes W, Do EK, Theall T, Höchsmann C, Talih S, Martin CK, Eissenberg T, Fuemmeler BF. Electronic Cigarette Nicotine Flux, Nicotine Yield, and Particulate Matter Emissions: Impact of Device and Liquid Heterogeneity. Nicotine Tob Res 2023; 25:412-420. [PMID: 35965260 PMCID: PMC9910146 DOI: 10.1093/ntr/ntac196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 07/29/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Electronic cigarettes (ECIGs) heat a nicotine-containing liquid to produce an inhalable aerosol. ECIG power (wattage) and liquid nicotine concentration are two factors that predict nicotine emission rate ("flux"). These factors can vary greatly across devices and users. AIMS AND METHODS The purpose of this study was to examine ECIG device and liquid heterogeneity in "real world" settings and the association with predicted nicotine flux, nicotine yield, and total particulate matter (TPM) emissions. Past 30-day ECIG users (n = 84; mean age = 23.8 years [SD = 9.6]) reported device and liquid characteristics. Device power was measured via multimeter, device display screens, or obtained via labeling. Liquid nicotine concentration was obtained via labeling or through chemical analysis. Predicted nicotine flux, nicotine yield, and TPM associated with 10 4-second puffs were calculated for participants' primary devices. RESULTS Participants' primary devices were box mods (42.9%), disposable vapes (20.2%), and pod mods (36.9%). Most participants (65.5%) reported not knowing their primary device wattage. Rebuildable/box mods had the greatest power range (11.1-120.0 W); pod mod power also varied considerably (4.1-21.7 W). Unlike device wattage, most participants (95.2%) reported knowing their liquid nicotine concentration, which ranged from 3.0 to 86.9 mg/ml (M = 36.0, SD = 29.3). Predicted nicotine flux varied greatly across products (range =12.0-160.1 μg/s, M = 85.6 μg/s, SD = 34.3). Box mods had the greatest variability in wattage and predicted nicotine flux, nicotine yield, and TPM yield. CONCLUSIONS ECIG device and liquid heterogeneity influence nicotine and other toxicant emissions. Better measurement of ECIG device and liquid characteristics is needed to understand nicotine and toxicant emissions and to inform regulatory policy. IMPLICATIONS ECIG device and liquid heterogeneity cause great variability in nicotine flux and toxicants emitted. These data demonstrate the need to examine device and liquid characteristics to develop empirically informed, health-promoting regulatory policies. Policies may include setting product standards such that ECIG products cannot (1) have nicotine fluxes much greater than that of a cigarette to decrease the risk of dependence, (2) have nicotine fluxes that are very low and thus would have minimal appeal to cigarette smokers and may serve as starter products for youth or nontobacco users, and (3) emit large amounts of particulate matter and other toxicants.
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Affiliation(s)
- Eric K Soule
- Department of Health Education and Promotion, East Carolina University, Greenville, NC, USA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
| | - Shannon Mayne
- Department of Health Education and Promotion, East Carolina University, Greenville, NC, USA
| | - William Snipes
- Department of Health Education and Promotion, East Carolina University, Greenville, NC, USA
| | - Elizabeth K Do
- Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, USA
- Schroeder Institute, Truth Initiative, Washington, DC, USA
| | - Travis Theall
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA
| | - Christoph Höchsmann
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA
| | - Soha Talih
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
- Mechanical Engineering Department, Maroun Semaan Faculty of Engineering and Architecture, American University of Beirut, Beirut, Lebanon
| | - Corby K Martin
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA
| | - Thomas Eissenberg
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
| | - Bernard F Fuemmeler
- Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, USA
- Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
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Mattingly DT, Patel A, Hirschtick JL, Fleischer NL. Sociodemographic differences in patterns of nicotine and cannabis vaping among US adults. Prev Med Rep 2022; 26:101715. [PMID: 35141121 PMCID: PMC8814645 DOI: 10.1016/j.pmedr.2022.101715] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 01/08/2022] [Accepted: 01/23/2022] [Indexed: 11/26/2022] Open
Abstract
About half (54.2%) of adults who used electronic vapor products (EVPs) vaped nicotine only. Only 7.4% of adults who used EVPs vaped cannabis only, while one-fourth (23.8%) vaped nicotine and cannabis. Patterns of nicotine and cannabis vaping differed by age, race/ethnicity, education, and sexual orientation. Vaping nicotine and cannabis and cannabis only was more common among young adults. Vaping cannabis only was more common among Hispanic and non-Hispanic Black adults.
Nicotine and cannabis vaping has increased over the past several years. While patterns of cigarette and cannabis co-use are well-documented, less is known about the intersection between nicotine and cannabis vaping, especially among adults. Thus, we categorized nicotine and cannabis vaping among adults (18+) who currently (past 30-day) used electronic vapor products (EVPs) from Wave 4 of the Population Assessment of Tobacco and Health Study (n = 3795) as: 1) nicotine only, 2) cannabis only, 3) nicotine and cannabis, and 4) non-nicotine/non-cannabis e-liquid. We calculated vaping pattern proportions overall and by sociodemographic characteristics. Adjusted multinomial logistic regression models assessed associations between sociodemographic characteristics and vaping categories relative to nicotine-only vaping. Approximately half (54.2%) of adults who currently used EVPs vaped nicotine only, 7.4% vaped cannabis only, 23.8% vaped nicotine and cannabis, and 14.6% vaped non-nicotine/non-cannabis e-liquid. Young adults (aged 18–24) (vs. adults aged 35+) had at least three-fold greater odds of vaping cannabis only, nicotine and cannabis, and non-nicotine/non-cannabis e-liquid, compared to nicotine only. Hispanic and non-Hispanic Black (vs. non-Hispanic White) adults had 2.5–3 times greater odds of vaping cannabis only and non-nicotine/non-cannabis e-liquid, compared to nicotine only. Sexual minority adults (vs. heterosexual adults) had 1.5 times greater odds of vaping nicotine and cannabis, compared to nicotine only. Nearly half of adults who vaped EVPs consumed something other than nicotine only, and nicotine/cannabis vaping patterns differed by sociodemographic groups. Vaping and nicotine reduction efforts must recognize that adults who currently vape may be vaping cannabis, or neither nicotine nor cannabis.
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Buettner-Schmidt K, Swanson K, Maack B, Barnacle M, Miller D, Orr M, Gag MH. E-cigarettes for tobacco cessation: Not the solution. Nurse Pract 2021; 46:7-11. [PMID: 34808639 DOI: 10.1097/01.npr.0000798228.69915.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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