FDA's regulatory shift on tobacco control

“Vaping”- a Trojan Horse Against Fight Toward Tobacco Use and Cancer: A Systematic Review of the Existing Evidence

The purpose of this systematic review is to understand many aspects of vaping, like what is vaping, why it is more enticing to adolescents and young adults, what makes it more harmful than regular smoked tobacco products, subsequent health consequences, and what measures are currently being taken against this activity. A literature search was conducted in online database PubMed using search string “(((((Lung injury*[Title/Abstract]) AND Vaping[Title/Abstract]) OR electronic nicotine delivery device[Title/Abstract]) OR electronic cigarette*[Title/Abstract]) AND e-cigarettes liquid) AND electronic cigars and search filter used were “published in the last 5 years” and “Human Studies.” Similar search terms were used to search EMBASE, Web of Science, Google Scholar, and the CENTRAL database of the Cochrane Library with the help of Boolean terms. Thirty-six articles were included for a final systematic review. Many of the known brands use additives such as flavoring and thickening agents that, when used even for the short term, can cause toxicity to human lung tissues. This toxicity depends not only on the extent of the habit, but also on the variable susceptibility to lung damage, dual use with cigarettes, variability in the product design of different brands, and the liquid content used in them. Vaping may be linked with significant health issues, including respiratory diseases such as asthma, very severe forms of bronchitis such as popcorn lung, or E-cigarette, or vaping, product use-associated lung injury, and cardiovascular illnesses such as atherosclerotic plaque and myocardial ischemia. From the current systematic review, we would like to emphasize that no long-term toxicological and health studies have been carried out in humans using these vaping products and their constituents to date. Although cessation should be strongly encouraged in smokers for better quality of life, it is uncertain whether it is a universally safer option to replace cigarettes with these vaping devices.

Cognitive performance effects of nicotine and industry affiliation: a systematic review

BACKGROUND AND AIMS

Studies assessing the cognitive performance effects of nicotine show inconsistent results and tobacco industry funding has been correlated with study outcomes. We conducted a systematic review of the primary literature assessing the cognitive performance effects of nicotine and assessed potential associations between tobacco and pharmaceutical industry affiliation and reported study conclusions.

METHODS

We searched PubMed, EMBASE, PsycINFO, BIOSIS, and Web of Science for peer-reviewed journal articles published between 2009 and 2016 that: (1) were randomized controlled trials; (2) investigated the effects of nicotine on cognitive performance in a laboratory setting; (3) administered nicotine to healthy adults (18-60 years); and (4) included participants were nonsmokers or minimally deprived smokers (⩽2 hours of abstaining from smoking). Study disclosures and tobacco industry documents were reviewed to determine industry funding.

RESULTS

Searches yielded 3,771 abstracts; 32 studies were included in the review. The majority of studies investigated the effects of nicotine on attention (n = 22). Nicotine had a non-uniform effect on attention: studies reported positive (41%; n = 9), mixed (41%; n = 9), and no effect (18%; n = 4). The majority of study authors had received prior tobacco industry funding (59%; n = 19), however over half of tobacco-industry funded authors did not report this (53%; n = 10).

CONCLUSIONS

Nicotine does not appear to be associated with consistent cognitive performance effects. Although no association was found between reported outcomes and tobacco or pharmaceutical industry funding, findings likely underestimate the influence of industry funding due to strict inclusion criteria and incomplete data on pharmaceutical industry funding.

CLINICAL TRIAL REGISTRATION

Not applicable.

JUUL and other stealth vaporisers: hiding the habit from parents and teachers

BACKGROUND

Some consumers wish to use vapour devices discreetly so that family members, teachers and coworkers do not recognise their use of nicotine ortetrahydrocannabinol (THC) laden vapour.

METHODS

Stealthy vapour devices, as well as low-odour and low-vapour e-juices, were identified via a comprehensive online search between March and June 2018.

RESULTS

As evidence of their popularity, a search for 'stealth vaping' on YouTube found 18 200 videos. A variety of cleverly designed vapour devices disguised as USB sticks, pens, remote controls, car fobs, smart phones, sweatshirt drawstrings and even asthma inhalers are on the market. JUUL, which resembles a USB stick, is the archetype of these devices and is especially popular among youth. A search of 'JUUL' on YouTube yielded 148 000 videos with 57 videos having >100 000 views. Searches on 'JUUL at school' (15 500), 'JUUL in class' (6840), 'hiding JUUL in school' (2030) and 'JUUL in school bathroom' (1040) illustrate the product's popularity among students. Some e-juices promote themselves as having low visibility plumes while others profess to be of subtle odour to avoid detection. Numerous techniques have been described to hide the exhaled vapour plume such as by swallowing it or blowing it into one's clothing or into a backpack.

CONCLUSIONS

The vaping industry has demonstrated much ingenuity in devising discreet vaporisers and de-emphasising exhaled vapour plumes and their aroma. The US market for vaping devices with stealthy characteristics is anything but inconspicuous, with JUUL alone accounting for 70.5% of sales (July 2018).