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Sánchez-Romero LM, Li Y, Zavala-Arciniega L, Gallegos-Carrillo K, Thrasher JF, Meza R, Levy DT. The potential impact of removing a ban on electronic nicotine delivery systems using the Mexico smoking and vaping model (SAVM). MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.28.24306511. [PMID: 38746147 PMCID: PMC11092684 DOI: 10.1101/2024.04.28.24306511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Objective To develop the Mexico Smoking and Vaping Model (Mexico SAVM) to estimate cigarette and electronic nicotine delivery systems (ENDS) prevalence and the public health impact of legalizing ENDS use. Methods SAVM, a cohort-based discrete-time simulation model, compares two scenarios. The ENDS-Restricted Scenario estimates smoking prevalence and associated mortality outcomes under the current policy of an ENDS ban, using Mexico-specific population projections, death rates, life expectancy, and smoking and e-cigarette prevalence. The ENDS-Unrestricted Scenario projects smoking and vaping prevalence under a hypothetical scenario where ENDS use is allowed. The impact of legalizing ENDS use is estimated as the difference in smoking- and vaping-attributable deaths (SVADs) and life-years lost (LYLs) between the ENDS-Restricted and Unrestricted scenarios. Results Compared to a national ENDS ban, The Mexico SAVM projects that legalizing ENDS use could decrease smoking prevalence by 40.1% in males and 30.9% in females by 2049 compared to continuing the national ENDS ban. This reduction in prevalence would save 2.9 (2.5 males and 0.4 females) million life-years and avert almost 106 (91.0 males and 15.5 females) thousand deaths between 2025 and 2049. Public health gains decline by 43% to 59,748 SVADs averted when the switching rate is reduced by half and by 24.3% (92,806 SVADs averted) with a 25% ENDS risk level from that of cigarettes but increased by 24.3% (121,375 SVADs averted) with the 5% ENDS risk. Conclusions Mexico SAVM suggests that greater access to ENDS and a more permissive ENDS regulation, simultaneous with strong cigarette policies, would reduce smoking prevalence and decrease smoking-related mortality. The unanticipated effects of an ENDS ban merit closer scrutiny, with further consideration of how specific ENDS restrictions may maximize public health benefits.
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Affiliation(s)
- Luz María Sánchez-Romero
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC. United States of America
| | - Yameng Li
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC. United States of America
| | - Luis Zavala-Arciniega
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Katia Gallegos-Carrillo
- Epidemiology and Health Services Research Unit, Morelos, Mexican Institute of Social Security, Mexico
- Evaluation and Surveys Research Center, National Institute of Public Health, Cuernavaca, Mexico
| | - James F Thrasher
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, United States of America
| | - Rafael Meza
- Department of Integrative Oncology, BC Cancer Research Institute, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Canada
| | - David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC. United States of America
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Jaswal N, Bhatt G, Goel S. Awareness of electronic cigarettes in India: Findings from the 2016-2017 Global Adult Tobacco Survey (GATS). Tob Prev Cessat 2023; 9:03. [PMID: 36743405 PMCID: PMC9875595 DOI: 10.18332/tpc/156446] [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: 04/11/2022] [Revised: 11/01/2022] [Accepted: 11/10/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Electronic nicotine delivery systems (ENDS) have recently emerged as a public health threat globally. Despite the low proportion of e-cigarette users (1.22%) reported in the Global Adult Tobacco Survey-2, the Government of India enacted the Prohibition of E-cigarettes Act 2019 (PECA), prohibiting all forms of ENDS/ENNDS. The current analysis presents nationally representative findings on the level of awareness of e-cigarettes in India and its correlates and characteristics of those aware of e-cigarettes. METHODS The current secondary analysis from GATS-2 among adults aged ≥15 years from all states and Union Territories of India used a standard protocol for data collection and management. A multi-stage cluster sampling design was used. The respondents who were aware of e-cigarettes were included (n=2524). Binomial logistic regression analysis was conducted, and adjusted odds ratios (AORs) with 95% CI, were calculated to measure the associations between independent and dependent variables. RESULTS Only 3.4% of the respondents were aware (either heard or seen) of e-cigarettes and their awareness was found significantly higher among males (AOR=2.07; 95% CI: 1.90-2.24), urban population (AOR=2.83; 95% CI: 2.61-3.07), and higher education (AOR=0.41; 95% CI: 0.38-0.45). CONCLUSIONS Public awareness campaigns about the harms of e-cigarettes and the law (PECA) need to be rolled out in urban and rural areas. Capacity-building exercises of implementers and enforcers at the grassroots level could also support communicating the harms to hard-to-reach groups. Further, regular compliance monitoring of the legislation and prosecution of violators would facilitate its effective implementation at the national and sub-national levels.
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Affiliation(s)
- Nidhi Jaswal
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Garima Bhatt
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sonu Goel
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India,School of Medicine, University of Limerick, Limerick, Ireland,Faculty of Human and Health Sciences, Swansea University, Swansea, United Kingdom
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Mus S, Monzon J, Islam F, Thrasher JF, Barnoya J. First tobacco product tried and current use of cigarettes and electronic cigarettes among adolescents from Guatemala City. SALUD PUBLICA DE MEXICO 2023; 65:46-53. [PMID: 36750072 PMCID: PMC11091932 DOI: 10.21149/13972] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/13/2022] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To assess how first experimenting with ciga-rettes or e-cigarettes is associated with current use in Gua-temala, a middle-income country with weak tobacco control and no e-cigarette regulations. MATERIALS AND METHODS We surveyed students from private schools in Guatemala City, limiting analyses to ever users (n=1 026). Multinomial logistic models regressed current product use on first product used, adjusting for sociodemographics and friends and family use. RESULTS The most common first product used was e-cigarettes (56%), followed by flavored cigarettes (24%) and regular cigarettes (20%). At the time of the survey, 4% were exclusive smokers, 37% were exclusive e-cigarette users, 18% dual users, and 40% had ever tried either but were not current users. Compared to those who first tried cigarettes, students who first tried e-cigarettes were less likely to be current smokers (RR=0.19 [CI: 0.11,0.31]) or dual users (RR=0.26 [CI: 0.14,0.49]) and students who first tried flavored cigarettes were more likely to be current smokers (RR=1.66 [CI=1.13,2.42]). CONCLUSIONS In our sample, Guatemalan adolescents from private schools more frequently experiment and continue to use e-cigarettes than cigarettes. There is urgent need to implement e-cigarette restrictions in addition to tobacco control policy implementation.
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Affiliation(s)
- Sophia Mus
- Departamento de Investigación, Unidad de Cirugía Cardiovascular de Guatemala. Guatemala City, Guatemala.
| | - Jose Monzon
- Departamento de Investigación, Unidad de Cirugía Cardiovascular de Guatemala. Guatemala City, Guatemala.
| | - Farahnaz Islam
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina. Columbia, South Carolina, USA.
| | - James F Thrasher
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina. Columbia, South Carolina, USA/Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, Mexico.
| | - Joaquin Barnoya
- Departamento de Investigación, Unidad de Cirugía Cardiovascular de Guatemala/Integra Cancer Institute. Guatemala City, Guatemala.
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Tehrani H, Rajabi A, Ghelichi- Ghojogh M, Nejatian M, Jafari A. The prevalence of electronic cigarettes vaping globally: a systematic review and meta-analysis. Arch Public Health 2022; 80:240. [DOI: 10.1186/s13690-022-00998-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 11/07/2022] [Indexed: 11/23/2022] Open
Abstract
Abstract
Background
The purpose of this systematic review study was to determine the national, regional, and global prevalence of electronic cigarettes (e-cigarettes) vaping.
Method
The articles were searched in July 2020 without a time limit in Web of Science (ISI), Scopus, PubMed, and Ovid-MEDLINE. At first, the titles and abstracts of the articles were reviewed, and if they were appropriate, they entered the second stage of screening. In the second stage, the whole articles were reviewed and articles that met the inclusion criteria were selected. In this study, search, selection of studies, qualitative evaluation, and data extraction were performed by two authors independently, and any disagreement between the two authors was reviewed and corrected by a third author.
Results
In this study, the lifetime and current prevalence of e-cigarettes vaping globally were 23% and 11%, respectively. Lifetime and current prevalence of e-cigarettes vaping in women were 16% and 8%, respectively. Also, lifetime and current prevalence of e-cigarettes vaping in men were 22% and 12%, respectively. In this study, the current prevalence of e-cigarettes vaping in who had lifetime smoked conventional cigarette was 39%, and in current smokers was 43%. The lifetime prevalence of e-cigarettes vaping in the Continents of America, Europe, Asia, and Oceania were 24%, 26%, 16%, and 25%, respectively. The current prevalence of e-cigarettes vaping in the Continents of America, Europe, Asia, and Oceania were 10%, 14%, 11%, and 6%, respectively.
Conclusions
Based on the results of this study, it can be concluded that the popularity of e-cigarettes is increasing globally. Therefore, it is necessary for countries to have more control over the consumption and distribution of e-cigarettes, as well as to formulate the laws prohibiting about the e-cigarettes vaping in public places. There is also a need to design and conduct information campaigns to increase community awareness about e-cigarettes vaping.
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Martins BNFL, Normando AGC, Rodrigues-Fernandes CI, Wagner VP, Kowalski LP, Marques SS, Marta GN, Júnior GDC, Ruiz BII, Vargas PA, Lopes MA, Santos-Silva AR. Global frequency and epidemiological profile of electronic cigarette users: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:548-561. [PMID: 36182650 DOI: 10.1016/j.oooo.2022.07.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/19/2022] [Accepted: 07/26/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Electronic cigarette (e-cigarette) use is growing significantly worldwide, especially among young people. This product has been associated with renormalizing smoking and hindering quit attempts in smokers. Moreover, among nonsmokers, it can lead to subsequent cigarette smoking and nicotine dependence. The present study aimed to assess the epidemiological profile of e-cigarette users worldwide. STUDY DESIGN A systematic review was performed using 3 main electronic databases (Medline/PubMed, SCOPUS, and EMBASE). Studies were independently assessed by 2 reviewers based on established eligibility criteria. The risk of bias was assessed using the MAStARI critical appraisal instrument. RESULTS From 4,496 records, 43 were included. Among the 1,238,392 participants, 132,786 (10.72%) were e-cigarette users. The age range with the highest percentage of e-cigarette users was 18-24 years old, with 40,989 (30.86%) males, 34,875 (26.26%) females, and 33.6% being current cigarette smokers. The highest prevalence of users was 52.88% in Croatia and 49.62% in New Zealand. Other possible correlations were observed with e-cigarette use, such as a high level of education. CONCLUSION Overall, e-cigarette users tended to be male young adults with a higher level of education. The highest prevalence of use was found in Croatia. This systematic review provides valuable information to improve the development of appropriate intervention strategies targeting e-cigarette users for more accurate anti-smoking actions.
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Affiliation(s)
| | | | | | - Vivian Petersen Wagner
- Academic Unit of Oral and Maxillofacial Medicine and Pathology, Department of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery, University of Sao Paulo Medical School and Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Sandra Silva Marques
- São Paulo State Reference Centre on Alcohol, Tobacco and Other Drugs, Secretary of Health, São Paulo, Brazil; State Coordination of the Tobacco Program, São Paulo, Brazil
| | - Gustavo Nader Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês São Paulo, São Paulo, Brazil
| | - Gilberto de Castro Júnior
- Clinical Oncology Service, São Paulo State Cancer Institute (ICESP-FMUSP), São Paulo, São Paulo, Brazil
| | | | - Pablo Agustin Vargas
- University of Campinas (UNICAMP), Oral Diagnosis Department, Piracicaba Dental School, São Paulo, Brazil
| | - Marcio Ajudarte Lopes
- University of Campinas (UNICAMP), Oral Diagnosis Department, Piracicaba Dental School, São Paulo, Brazil
| | - Alan Roger Santos-Silva
- University of Campinas (UNICAMP), Oral Diagnosis Department, Piracicaba Dental School, São Paulo, Brazil.
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Gallegos-Carrillo K, Barrientos-Gutiérrez I, Arillo-Santillán E, Rodríguez-Bolaños R, Cruz-Jiménez L, Desirée VP, Cho YJ, Thrasher JF. Transitions between tobacco products: Correlates of changes in cigarette smoking and e-cigarette use among exclusive adult smokers and dual users in Mexico. Prev Med Rep 2022; 29:101869. [PMID: 35911576 PMCID: PMC9326312 DOI: 10.1016/j.pmedr.2022.101869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 06/24/2022] [Indexed: 11/05/2022] Open
Abstract
This study examined transitions in tobacco products use among Mexican smokers and dual users. Data were analyzed from exclusive smokers (n = 2,946) and dual users (n = 1,643) recruited from an online consumer research panel and surveyed every-four months from November 2018 to April 2021. For exclusive smokers, estimated transitions were (time "t + 1" four months after prior survey): a) remain as exclusive smokers; b) dual use; c) exclusive e-cigarette use or quit both products. Among dual users, transitions analyzed were: a) remain as dual user; b) exclusive smoker; c) exclusive e-cigarette user or quit both products. Multinomial models regressed transitions at "t + 1" on time "t" for control variables. Most exclusive smokers (81%) remained as such, 12.6% transitioned to dual use, 2.3% to exclusive e-cigarette use, and 4% quitted both products. Exclusive smokers were more likely to transition to dual use if they recently attempted to quit (AOR = 1.45) or had partners/family or friends who used e-cigarettes (AOR = 2.47 & 2.56 respectively). Most dual users (74.8%) remained as dual users, 20.4% transitioned to exclusive smoking, 1.6% transitioned to exclusive e-cigarette use, and 3.2% quitted both products. Dual users were more likely to transition to exclusive smoking if they had lower educational attainment, recently attempted to quit e-cigarettes (AOR = 1.70). Having friends who use e-cigarettes (AOR = 0.29) and higher smoking dependence (AOR = 0.55) were associated with a lower likelihood of quitting. Recent quit attempts and e-cigarette use among close social network members may explain the short-term transitions, though longer follow-up is needed to assess sustained smoking cessation.
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Affiliation(s)
- Katia Gallegos-Carrillo
- Epidemiology and Health Services Research Unit, Morelos, Mexican Institute of Social Security, Mexico
- Evaluation and Surveys Research Center, National Institute of Public Health, Cuernavaca, Mexico
| | | | - Edna Arillo-Santillán
- Tobacco Research Department, National Institute of Public Health, Cuernavaca, Mexico
| | | | - Lizeth Cruz-Jiménez
- Evaluation and Surveys Research Center, National Institute of Public Health, Cuernavaca, Mexico
| | - Vidaña-Pérez Desirée
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Yoo Jin Cho
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - James F. Thrasher
- Tobacco Research Department, National Institute of Public Health, Cuernavaca, Mexico
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, USA
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Sreeramareddy CT, Manoharan A. Awareness About and E-Cigarette Use Among Adults in 15 Low- and Middle-Income Countries, 2014-2018 Estimates From Global Adult Tobacco Surveys. Nicotine Tob Res 2022; 24:1095-1103. [PMID: 35596725 DOI: 10.1093/ntr/ntab269] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/27/2021] [Accepted: 12/22/2021] [Indexed: 12/17/2023]
Abstract
INTRODUCTION E-cigarette (EC) use is seldom reported from low- and middle-income countries (LMICs). We report the prevalence of "awareness" about EC, its use, and distribution of EC use by sociodemographic factors and cigarette smoking (CS) status. AIMS AND METHODS We analyzed Global Adult Tobacco Survey data in Bangladesh, China, Costa Rica, Ethiopia, India, Kazakhstan, Mexico, Philippines, Romania, Russia, Senegal, Ukraine, Turkey, Uruguay, and Viet Nam during 2014-2018. The weighted prevalence of "awareness" (heard about), "ever" (even once), and "current" (daily/nondaily) EC use among never, current, and former cigarette smokers and quit ratios (past smokers/ever smokers) was estimated. Association of EC use with sociodemographic, and CS, was explored by multilevel regression. RESULTS Overall, prevalence of "awareness," "ever," and "current" ECs use was 19.3% (95% confidence interval [CI] 27.4, 31.1), 2.6% (95% CI 2.4, 2.8), and 0.7% (95% CI 0.6, 0.8), respectively. In most countries, "ever use" <10%, and "current use" was about 1% except Romania (4.4%) and Russia (3.5%). "Current use" was 0.1%, 2.9%, and 3.1% among never, current, and former smokers, respectively. "Current" and "ever" EC use was higher among current and former than never smokers (2.8% and 3.1% vs. 0.1%; 9.9% and 10.9% vs. 0.7%), respectively. Current EC use was associated with male sex, urban residence and younger age, higher education, and wealth. "Quit attempts" (aOR 1.3, 95% CI 1.2, 1.5) and cigarettes smoked per day (aOR 1.6, 95% CI 1.4, 1.9) were associated with "ever use." CONCLUSIONS EC use was low in most countries. "Dual use" was common among current smokers and the quit ratio was higher among ECs users. IMPLICATIONS EC use is increasing in high-income countries (HICs) where regulations on ECs are usually permissive. Evidence on the individual- or population-level impact of ECs on CS cessation is inconclusive. Little is known about the prevalence of EC use in LMICs where regulations are nonexistent or less restrictive. Studying the distribution of EC use rates by population subgroups, CS status, and quit ratios for CS among EC users will assist the formulation of EC regulatory policies. We provide comparable nationally representative prevalence estimates of "awareness" about and, use of ECs to serve as a benchmark for future monitoring. EC use was associated with the attempt to quit CS and smoking >10 cigarettes per day. However, "dual use" was common, and the quit ratio for CS was higher among EC users. EC use was very low relative to HICs. Nevertheless, comprehensive EC regulatory policies should be implemented to prevent the escalation of EC use by targeting population subgroups such as young adults, educated and wealthier individuals.
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Affiliation(s)
| | - Anusha Manoharan
- Primary Care Medicine, Botanic Health Clinic, Ministry of Health, Selangor, Malaysia
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Sóñora G, Reynales-Shigematsu LM, Barnoya J, Llorente B, Szklo AS, Thrasher JF. Achievements, challenges, priorities and needs to address the current tobacco epidemic in Latin America. Tob Control 2022; 31:138-141. [PMID: 35241577 PMCID: PMC8908794 DOI: 10.1136/tobaccocontrol-2021-057007] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/22/2021] [Indexed: 01/01/2023]
Abstract
Most Latin American countries have signed and ratified the FCTC, although implementation has been uneven. Countries across the region were relatively quick to adopt mandatory smoke-free workplace policies, but regional progress in other areas has been slower. In taxation, for example, Uruguay and Brazil have made considerable progress while Paraguay and Bolivia have relatively weak policies. More recently, the region is grappling with challenges regulating novel tobacco and nicotine products. Market share for flavor capsule cigarettes in Latin America is the highest in the world; electronic cigarettes and heated tobacco products are, for the most part, dissimilarly regulated; and uptake of these emerging products by adolescents and young adults is on the rise. In examining the needs and challenges in the region, we conclude that the adoption of a strong regulatory framework based on the FCTC and its Protocols is needed to accelerate a positive public health impact. In particular, countries in the region need more consistent progress in implementing FCTC provisions while strengthening regulation of flavored tobacco products, electronic cigarettes and heated tobacco products. Failing to do so threatens to undermine the progress Latin America has made in tobacco use prevention and control.
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Affiliation(s)
- Gustavo Sóñora
- Tobacco Control, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Luz Myriam Reynales-Shigematsu
- Departamento de Investigación sobre Tabaco, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - Joaquin Barnoya
- Departamento de Investigacion, Unidad de Cirugia Cardiovascular, Guatemala, Guatemala
| | | | - André Salem Szklo
- Population Research Unit, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - James F Thrasher
- Health Promotion, Education, and Behavior, School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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Kavousi M, Pisinger C, Barthelemy JC, De Smedt D, Koskinas K, Marques-Vidal P, Panagiotakos D, Prescott EB, Tiberi M, Vassiliou VS, Løchen ML. Electronic cigarettes and health with special focus on cardiovascular effects: position paper of the European Association of Preventive Cardiology (EAPC). Eur J Prev Cardiol 2021; 28:1552-1566. [PMID: 32726563 DOI: 10.1177/2047487320941993] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/23/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Tobacco use is the single largest preventable risk factor for premature death of non-communicable diseases and the second leading cause of cardiovascular disease. In response to the harmful effects of tobacco smoking, the use of electronic cigarettes (e-cigarettes) has emerged and gained significant popularity over the past 15 years. E-cigarettes are promoted as safe alternatives for traditional tobacco smoking and are often suggested as a way to reduce or quit smoking. However, evidence suggests they are not harmless. DISCUSSION The rapid evolution of the e-cigarette market has outpaced the legislator's regulatory capacity, leading to mixed regulations. The increasing use of e-cigarettes in adolescents and young individuals is of concern. While the long-term direct cardiovascular effects of e-cigarettes remain largely unknown, the existing evidence suggests that the e-cigarette should not be regarded as a cardiovascular safe product. The contribution of e-cigarette use to reducing conventional cigarette use and smoking cessation is complex, and the impact of e-cigarette use on long-term cessation lacks sufficient evidence. CONCLUSION This position paper describes the evidence regarding the prevalence of e-cigarette smoking, uptake of e-cigarettes in the young, related legislations, cardiovascular effects of e-cigarettes and the impact of e-cigarettes on smoking cessation. Knowledge gaps in the field are also highlighted. The recommendations from the population science and public health section of the European Association of Preventive Cardiology are presented.
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Affiliation(s)
- Maryam Kavousi
- Department of Epidemiology, University Medical Center Rotterdam, The Netherlands
| | - Charlotta Pisinger
- Centre for Clinical Research and Prevention, University of Copenhagen, Denmark
| | | | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, Belgium
| | | | | | | | | | | | | | - Maja-Lisa Løchen
- Department of Community Medicine, The Arctic University of Norway, Norway
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Rodríguez-Bolaños R, Arillo-Santillán E, Guzmán-Rodríguez C, Barrientos-Gutiérrez I, Gallegos-Carrillo K, Titus A, Cruz-Jiménez L, Thrasher JF. Similarities and Differences in Substance Use Patterns Among Lesbian, Gay, Bisexual, and Heterosexual Mexican Adult Smokers. LGBT Health 2021; 8:545-553. [DOI: 10.1089/lgbt.2020.0457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rosibel Rodríguez-Bolaños
- Tobacco Research Department, Population Health Research Center, Mexican National Institute of Public Health, Cuernavaca, Mexico
| | - Edna Arillo-Santillán
- Tobacco Research Department, Population Health Research Center, Mexican National Institute of Public Health, Cuernavaca, Mexico
| | | | - Inti Barrientos-Gutiérrez
- Center for Evaluation and Survey Research, Mexican National Institute of Public Health, Cuernavaca, Mexico
| | - Katia Gallegos-Carrillo
- Epidemiology and Health Services Research Unit, Mexican Institute of Social Security, Cuernavaca, Mexico
| | - Andrea Titus
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Lizeth Cruz-Jiménez
- Center for Evaluation and Survey Research, Mexican National Institute of Public Health, Cuernavaca, Mexico
| | - James F. Thrasher
- Tobacco Research Department, Population Health Research Center, Mexican National Institute of Public Health, Cuernavaca, Mexico
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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11
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Patanavanich R, Glantz S. Successful countering of tobacco industry efforts to overturn Thailand's ENDS ban. Tob Control 2021; 30:e10-e19. [PMID: 33229463 PMCID: PMC8141069 DOI: 10.1136/tobaccocontrol-2020-056058] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/08/2020] [Accepted: 08/26/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND After Thailand enacted laws to ban the import and sale of all types of electronic nicotine delivery systems (ENDS, including e-cigarettes and heated tobacco products (HTPs)) in 2015, pro-ENDS advocacy groups pressured the government to lift the ban, particularly after Philip Morris International (PMI) started promoting its HTP IQOS in 2017. METHODS We reviewed information related to ENDS in Thailand between 2014 and 2019 from Thai newspaper articles, meeting minutes and letters submitted to government agencies, websites and social media platforms of pro-ENDS networks and Thai tobacco control organisations. RESULTS The tobacco industry and the pro-ENDS groups used five tactics to try to reverse the Thai ban on ENDS: creating front groups, lobbying decision-makers, running public relations campaigns, seeking to discredit tobacco control advocates and funding pro-tobacco harm reduction research. ENDS Cigarette Smoking Thailand (ECST), a pro-ENDS group in Thailand, worked in parallel to Philip Morris Thailand Limited (PMTL) to oppose the ban. The group connected with international coalitions that promote harm reduction through the PMI-funded Foundation for a Smoke-Free World. CONCLUSION Although ECST and PMTL continuously worked to revoke the ban since 2017, the government still kept ENDS illegal as of October 2020. This decision resulted from the strong commitment and collaboration among Thai tobacco control organisations and their shared vision to protect the public's health from harmful tobacco products. The similar strategies used by the pro-ENDS movement in Thailand and the tobacco companies could inform health advocates and policy-makers in other low and middle income countries facing pressure to market ENDS.
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Affiliation(s)
- Roengrudee Patanavanich
- Center for Tobacco Control Research and Education, University of California, San Francisco, California, USA
- Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital Mahidol University, Bangkok, Thailand
| | - Stanton Glantz
- Center for Tobacco Control Research and Education, University of California, San Francisco, California, USA
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12
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Yoong SL, Hall A, Leonard A, McCrabb S, Wiggers J, Tursan d'Espaignet E, Stockings E, Gouda H, Fayokun R, Commar A, Prasad VM, Paul C, Oldmeadow C, Chai LK, Thompson B, Wolfenden L. Prevalence of electronic nicotine delivery systems and electronic non-nicotine delivery systems in children and adolescents: a systematic review and meta-analysis. Lancet Public Health 2021; 6:e661-e673. [PMID: 34274048 PMCID: PMC8390387 DOI: 10.1016/s2468-2667(21)00106-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/26/2021] [Accepted: 04/26/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND There are concerns that the use of electronic nicotine delivery systems (ENDS) and electronic non-nicotine delivery systems (ENNDS) in children and adolescents could potentially be harmful to health. Understanding the extent of use of these devices is crucial to informing public health policy. We aimed to synthesise the prevalence of ENDS or ENNDS use in children and adolescents younger than 20 years. METHODS In this systematic review and meta-analysis, we undertook an electronic search in five databases (MEDLINE, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Embase, and Wiley Cochrane Library) from Jan 1, 2016, to Aug 31, 2020, and a grey literature search. Included studies reported on the prevalence of ENDS or ENNDS use in nationally representative samples in populations younger than 20 years and collected data between the years 2016 and 2020. Studies were excluded if they were done in those aged 20 years or older, used data from specialist panels that did not apply appropriate weighting, or did not use methods that ensured recruitment of a nationally representative sample. We included the most recent data for each country. We combined multiple national estimates for a country if they were done in the same year. We undertook risk of bias assessment for all surveys included in the review using the Joanna Briggs Institute Critical Appraisal Checklist (by two reviewers in the author list). A random effects meta-analysis was used to pool overall prevalence estimates for ever, current, occasional, and daily use. This study was prospectively registered with PROSPERO, CRD42020199485. FINDINGS The most recent prevalence data from 26 national surveys representing 69 countries and territories, with a median sample size of 3925 (IQR 1=2266, IQR 3=10 593) children and adolescents was included. In children and adolescents aged between 8 years and younger than 20 years, the pooled prevalence for ever (defined as any lifetime use) ENDS or ENNDS use was 17·2% (95% CI 15-20, I2=99·9%), whereas for current use (defined as use in past 30 days) the pooled prevalence estimate was 7·8% (6-9, I2=99·8%). The pooled estimate for occasional use was 0·8% (0·5-1·2, I2=99·4%) for daily use and 7·5% (6·1-9·1, I2=99·4%) for occasional use. Prevalence of ENDS or ENNDS use was highest in high-income geographical regions. In terms of study quality, all surveys scored had a low risk of bias for the sampling frame used, due to the nationally representative nature of the studies. The most poorly conducted methodological feature of the included studies was subjects and setting described in detail. Few surveys reported on the use of flavours or types of ENDS or ENNDS. INTERPRETATION There is significant variability in the prevalence of ENDS and ENNDS use in children and adolescents globally by country income status. These findings are possibly due to differences in regulatory context, market availability, and differences in surveillance systems. FUNDING World Health Organization and the Bill & Melinda Gates Foundation.
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Affiliation(s)
- Sze Lin Yoong
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
| | - Alix Hall
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia; Hunter New England Population Health, Wallsend, NSW, Australia
| | - Alecia Leonard
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Sam McCrabb
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - John Wiggers
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia; Hunter New England Population Health, Wallsend, NSW, Australia
| | - Edouard Tursan d'Espaignet
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia; Hunter New England Population Health, Wallsend, NSW, Australia; School of Rural Medicine, University of New England, Armidale, NSW, Australia
| | - Emily Stockings
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia
| | - Hebe Gouda
- Department of Health Promotion, No Tobacco Unit, World Health Organization, Geneva, Switzerland
| | - Ranti Fayokun
- Department of Health Promotion, No Tobacco Unit, World Health Organization, Geneva, Switzerland
| | - Alison Commar
- Department of Health Promotion, No Tobacco Unit, World Health Organization, Geneva, Switzerland
| | - Vinayak M Prasad
- Department of Health Promotion, No Tobacco Unit, World Health Organization, Geneva, Switzerland
| | - Christine Paul
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | | | - Li Kheng Chai
- Health and Wellbeing Queensland, Queensland Government, Milton, QLD, Australia; Centre for Children's Health Research, Institute of Health and Biomedical Innovation Exercise and Nutrition, Queensland University of Technology, South Brisbane, QLD, Australia
| | - Bruce Thompson
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia; Hunter New England Population Health, Wallsend, NSW, Australia
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13
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Patanavanich R, Aekplakorn W, Glantz SA, Kalayasiri R. Use of E-Cigarettes and Associated Factors among Youth in Thailand. Asian Pac J Cancer Prev 2021; 22:2199-2207. [PMID: 34319044 PMCID: PMC8607077 DOI: 10.31557/apjcp.2021.22.7.2199] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/09/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The study explored e-cigarette use among youth and associated factors in Thailand. METHODS This was a cross sectional study of 6,045 seventh grade students selected using a multistage design. Self-administered questionnaires relating to the socio-demographic characteristics, history of cigarette and e-cigarette uses, friends' and family's use of e-cigarettes, knowledge and perception of e-cigarette use, history of alcohol uses, and life assets were gathered. Multivariate logistic regression models were used to examine the variables and their association with e-cigarette use. RESULTS Prevalence of ever e-cigarette use was 7.2% and current e-cigarette use was 3.7%. We found that current cigarette smoking (AOR 4.28, 95% CI: 2.05-8.94), parental e-cigarette use (AOR 6.08, 95% CI: 2.81-13.17), peer e-cigarette use (AOR 3.82, 95% CI: 2.19-6.65), peer approval of smoking (AOR 1.95, 95% CI: 1.11-3.41), and unaware of e-cigarettes' risk (AOR 5.25, 95% CI: 2.67-10.34). were significantly associated with current use of e-cigarettes. Male sex, poor academic achievement, and poor life assets (power of wisdom) were only significantly associated with ever e-cigarette use. CONCLUSION Prevalence of current e-cigarette use among Thai middle school students did not change significantly since the government banned importation and sales of e-cigarettes in 2015, suggesting that the Thai ban has been a success. Factors associated with e-cigarette use among Thai youth were consistent with other countries. Ever e-cigarette use, increased, but less than in countries without a ban. To strengthen efforts to prevent youth from e-cigarette use and addiction, the government should improve law enforcement, especially against online marketing and strengthen school-based anti-smoking programs to include e-cigarette lessons, educating parents and the public about the harm of e-cigarettes, including secondhand effects on non-users. .
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Affiliation(s)
- Roengrudee Patanavanich
- Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Wichai Aekplakorn
- Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Stanton A Glantz
- Center for Tobacco Control Research and Education (retired), University of California San Francisco, San Francisco, US.
| | - Rasmon Kalayasiri
- Department of Psychiatry, Faculty of Medicine Chulalongkorn University, Bangkok, Thailand.
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Sánchez-Romero LM, Zavala-Arciniega L, Reynales-Shigematsu LM, de Miera-Juárez BS, Yuan Z, Li Y, Lau YK, Fleischer NL, Meza R, Thrasher JF, Levy DT. The Mexico SimSmoke tobacco control policy model: Development of a simulation model of daily and nondaily cigarette smoking. PLoS One 2021; 16:e0248215. [PMID: 34153063 PMCID: PMC8216521 DOI: 10.1371/journal.pone.0248215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 02/22/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Nondaily smoking has been on the rise, especially in Mexico. While Mexico has strengthened its tobacco control policies, their effects on nondaily smokers have gone largely unexamined. We developed a simulation model to estimate the impact of tobacco control policies on daily and nondaily smoking in Mexico. METHODS A previously validated Mexico SimSmoke model that estimated overall trends in smoking prevalence from 2002 through 2013 was extended to 2018 and adapted to distinguish daily and nondaily smoking prevalence. The model was then validated using data from Mexican surveys through 2016. To gauge the potential effects of policies, we compared the trends in smoking under current policies with trends from policies kept at their 2002 levels. RESULTS Between 2002 and 2016, Mexico SimSmoke underestimated the reduction in male and female daily smoking rates. For nondaily smoking, SimSmoke predicted a decline among both males and females, while survey rates showed increasing rates in both genders, primarily among ages 15-44. Of the total reduction in smoking rates predicted by the model by 2018, tax policies account for more than 55%, followed by health warnings, cessation treatment, smoke-free air laws, and tobacco control spending. CONCLUSIONS Although Mexico SimSmoke did not successfully explain trends in daily and nondaily smoking, it helps to identify gaps in surveillance and policy evaluation for nondaily smokers. Future research should consider appropriate measures of nondaily smoking prevalence, trajectories between daily and nondaily smoking, and the separate impact of tobacco control policies on each group.
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Affiliation(s)
- Luz María Sánchez-Romero
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States of America
| | - Luis Zavala-Arciniega
- Tobacco Research Department, National Institute of Public Health, Cuernavaca, México
- Department of Epidemiology, University of Michigan School Public Health, Ann Arbor, Michigan, United States of America
| | | | | | - Zhe Yuan
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States of America
| | - Yameng Li
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States of America
| | - Yan Kwan Lau
- Department of Epidemiology, University of Michigan School Public Health, Ann Arbor, Michigan, United States of America
| | - Nancy L. Fleischer
- Department of Epidemiology, University of Michigan School Public Health, Ann Arbor, Michigan, United States of America
| | - Rafael Meza
- Department of Epidemiology, University of Michigan School Public Health, Ann Arbor, Michigan, United States of America
| | - James F. Thrasher
- Tobacco Research Department, National Institute of Public Health, Cuernavaca, México
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
| | - David T. Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States of America
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15
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Gottschlich A, Mus S, Monzon JC, Thrasher JF, Barnoya J. Cross-sectional study on the awareness, susceptibility and use of heated tobacco products among adolescents in Guatemala City, Guatemala. BMJ Open 2020; 10:e039792. [PMID: 33318112 PMCID: PMC7737060 DOI: 10.1136/bmjopen-2020-039792] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES Heated tobacco products (HTPs) are increasingly marketed worldwide, yet limited research on HTPs has been conducted in low and middle-income countries (LMICs) or among adolescents. Guatemala is one of the few LMICs where HTPs are available. This study examined prevalence and correlates of HTP awareness, susceptibility and use among adolescents in Guatemala. DESIGN, SETTING AND PARTICIPANTS A cross-sectional survey on HTP awareness, susceptibility and use was conducted among 2870 students between the ages of 13 and 17 in private schools in Guatemala City, Guatemala. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was susceptibility to future use of HTP among school-aged current and never smokers in Guatemala. We also explored awareness and use of HTPs. Multivariate binomial regression models were used to explore associations between these outcomes and both sociodemographic factors and established smoking correlates. RESULTS Of all students (n=2870), about half were aware of HTPs (52.4%) and susceptible to future or continued use (52.4%). Whereas 8.4% of students had tried HTPs in the lifetime (but not in the last month), only 2.9% used HTPs in the past month. Independent correlates of HTP susceptibility and ever-use included: use of other tobacco products (current smoking: adjusted OR (AOR)=10.53 and 6.63, respectively; current e-cigarette use: AOR=21.87 and 10.40, respectively), moderate alcohol consumption (AOR=1.49 and 1.19, respectively), marijuana use in the past 30 days (AOR=3.49 and 2.29, respectively) and having friends who use HTPs (AOR=1.83 and 7.28, respectively). CONCLUSIONS Among this sample of adolescents in Guatemala City, where tobacco control is weak, the prevalence of HTP use was low but susceptibility to future use was high. Tobacco prevention and intervention strategies for cigarettes and e-cigarettes should now also include HTPs, which tend to be used by similar adolescent populations (ie, those who use other substances or are exposed to tobacco through family and friends).
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Affiliation(s)
- Anna Gottschlich
- Instituto de Investigación y Estudios Superiores en Ciencias de la Salud, Universidad Rafael Landivar, Guatemala, Guatemala
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Sophia Mus
- Instituto de Investigación y Estudios Superiores en Ciencias de la Salud, Universidad Rafael Landivar, Guatemala, Guatemala
| | - Jose Carlos Monzon
- Instituto de Investigación y Estudios Superiores en Ciencias de la Salud, Universidad Rafael Landivar, Guatemala, Guatemala
| | - James F Thrasher
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, South Carolina, USA
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Joaquin Barnoya
- Instituto de Investigación y Estudios Superiores en Ciencias de la Salud, Universidad Rafael Landivar, Guatemala, Guatemala
- Departamento de Investigacion, Unidad de Cirugia Cardiovascular, Guatemala, Guatemala
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16
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Zavala-Arciniega L, Reynales-Shigematsu LM, Levy DT, Lau YK, Meza R, Gutiérrez-Torres DS, Arillo-Santillán E, Fleischer NL, Thrasher J. Smoking trends in Mexico, 2002-2016: before and after the ratification of the WHO's Framework Convention on Tobacco Control. Tob Control 2020; 29:687-691. [PMID: 32019893 PMCID: PMC7398822 DOI: 10.1136/tobaccocontrol-2019-055153] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/16/2019] [Accepted: 09/02/2019] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Mexico was the first Latin American country to ratify the Framework Convention on Tobacco Control (FCTC) in 2004, after which it implemented some key FCTC policies (e.g., taxes, smoke-free, pictorial warnings and ad bans). This study assessed trends in the prevalence of current, daily and non-daily smoking in Mexico before and after the implementation of key FCTC policies. METHODS Data were analysed from two comparable, nationally representative surveys (i.e., the National Survey on Addictions 2002, 2011 and 2016, and the Global Adult Tobacco Survey 2009 and 2015). The pooled sample comprised 100 302 persons aged 15-65 years. Changes in the prevalence of current, daily and non-daily smoking were assessed. RESULTS From 2002 to 2016, the prevalence of current smoking fell 11% in relative terms (from 21.5% to 19.0%). The decrease was registered between 2002 and 2009, and after that, a slight increase was observed (from 16.5% in 2009 to 19% in 2016). The prevalence of daily smoking decreased by about 50% between 2002 and 2016 (from 13.5% to 7.0%) with most of the decrease occurring by 2009. Conversely, the prevalence of non-daily smoking increased by 35% between 2009 and 2016 (from 8.8% to 11.9%). CONCLUSIONS Full implementation of the FCTC is necessary to further reduce smoking. Specific interventions may be needed to target non-daily smokers, who now comprise more than half of current smokers in Mexico.
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Affiliation(s)
- Luis Zavala-Arciniega
- Departamento de Investigación sobre Tabaco, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Luz Myriam Reynales-Shigematsu
- Departamento de Investigación sobre Tabaco, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
- Tobacco Research Department, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - David T Levy
- Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA
| | - Yan Kwan Lau
- Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Rafael Meza
- Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniela Sarahí Gutiérrez-Torres
- Departamento de Investigación sobre Tabaco, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Edna Arillo-Santillán
- Departamento de Investigación sobre Tabaco, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | | | - James Thrasher
- Health Promotion, Education, & Behavior, School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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Wang L, Chen J, Ho SY, Leung LT, Wang MP, Lam TH. Exposure to e-cigarette advertising, attitudes, and use susceptibility in adolescents who had never used e-cigarettes or cigarettes. BMC Public Health 2020; 20:1349. [PMID: 32887586 PMCID: PMC7650221 DOI: 10.1186/s12889-020-09422-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 08/23/2020] [Indexed: 12/02/2022] Open
Abstract
Background Tobacco advertisements have been banned in Hong Kong, but low intensity e-cigarette (EC) advertising can still be found in various media outlets. We investigated the associations between exposure to EC advertising and susceptibility to EC use in adolescents who had never used cigarettes or ECs, with potential mediation by attitudes towards ECs and the tobacco industry. Methods The School-based Smoking Survey 2016/17 assessed exposure to EC advertising in the past 30 days, attitudes towards ECs and the tobacco industry, susceptibility to EC use, and other covariates. Generalised linear mixed models and multiple mediation analysis methods were used in data analyses. Results Among 7082 students (mean age 14.9 years), 28.8% reported exposure to EC advertising. Exposure was associated with being uncertain about the harm of EC use, being tolerant towards ECs, believing the tobacco industry is respectable, and being susceptible to EC use; the magnitudes of these associations increased with the number of types of advertising exposed (0, 1, and ≥ 2) (all p-values < 0.01). These attitudinal factors were in turn associated with EC use susceptibility (all p-values < 0.001). The perception that tobacco companies make youth smoke was not associated with the advertising exposure or EC use susceptibility. Of the total effects of EC advertising on use susceptibility, only 16.6% were mediated by attitudinal factors: perceived harm (3.1%), attitudes towards ECs (8.2%), and attitudes towards the tobacco industry (4.9%). Conclusions Even exposure to low intensity EC advertising was associated with susceptibility to EC use in adolescents who had never used cigarettes or ECs. The association was weakly mediated by tolerant attitudes towards ECs and the tobacco industry. The government should reinforce the regulations on EC advertising to protect adolescent health.
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Affiliation(s)
- Lijun Wang
- School of Public Health, University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong, P. R. China
| | - Jianjiu Chen
- School of Public Health, University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong, P. R. China
| | - Sai Yin Ho
- School of Public Health, University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong, P. R. China.
| | - Lok Tung Leung
- School of Public Health, University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong, P. R. China
| | - Man Ping Wang
- School of Nursing, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong, P. R. China
| | - Tai Hing Lam
- School of Public Health, University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong, P. R. China
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18
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Cruz-Jiménez L, Barrientos-Gutiérrez I, Coutiño-Escamilla L, Gallegos-Carrillo K, Arillo-Santillán E, Thrasher JF. Adult Smokers' Awareness and Interest in Trying Heated Tobacco Products: Perspectives from Mexico, where HTPs and E-Cigarettes Are Banned. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2173. [PMID: 32218161 PMCID: PMC7177513 DOI: 10.3390/ijerph17072173] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/17/2020] [Accepted: 03/19/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND We evaluated smokers' perceptions of heated tobacco products (HTPs) in Mexico, where industry publically lobbied to introduce HTPs into this country that banned both HTPs and e-cigarettes. METHODS Online surveys (November 2018 to July 2019) were analyzed from adults who only smoked cigarettes (n = 2091) or who smoked and used e-cigarettes ("dual users"n = 1128). Logistic models regressed HTP awareness, interest to trying HTPs, and having seen HTPs for sale (only among aware participants) on sociodemographics and tobacco-related variables. RESULTS Of the 17.1% who were aware of HTPs, 52.7% reported having seen HTPs for sale. Of all respondents, 75% were somewhat or very interested in trying HTPs. Compared to their counterparts, more frequent smokers, dual users, those exposed to online e-cigarette ads, and those with friends who used e-cigarettes were both more aware of and interested in trying HTPs. Greater awareness was also associated with higher education, recent attempts to quit, receipt of email e-cigarette ads, and smoking among friends and family. Seeing HTPs for sale was higher for those who recently attempted to quit, were exposed to e-cigarette ads online or by email, or had friends who used e-cigarettes. CONCLUSION Interest in HTPs is high among smokers in Mexico, which already has a large black market for illegal e-cigarettes. HTPs use should be monitored in this context, especially given the public health impacts of HTPs are unclear.
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Affiliation(s)
- Lizeth Cruz-Jiménez
- Evaluation and Surveys Research Center, National Institute of Public Health, Cuernavaca, Mor 62100, Mexico;
| | - Inti Barrientos-Gutiérrez
- Evaluation and Surveys Research Center, National Institute of Public Health, Cuernavaca, Mor 62100, Mexico;
| | - Liliana Coutiño-Escamilla
- Tobacco Research Department, National Institute of Public Health, Cuernavaca, Mor 62100, Mexico; (L.C.-E.); (K.G.-C.); (E.A.-S.)
| | - Katia Gallegos-Carrillo
- Tobacco Research Department, National Institute of Public Health, Cuernavaca, Mor 62100, Mexico; (L.C.-E.); (K.G.-C.); (E.A.-S.)
- Epidemiology and Health Services Research Unit, Mexican Institute of Social Security, Cuernavaca, Mor 62000, Mexico
| | - Edna Arillo-Santillán
- Tobacco Research Department, National Institute of Public Health, Cuernavaca, Mor 62100, Mexico; (L.C.-E.); (K.G.-C.); (E.A.-S.)
- School of Demography, Australian National University, Canberra 0200, Australia
| | - James F. Thrasher
- Tobacco Research Department, National Institute of Public Health, Cuernavaca, Mor 62100, Mexico; (L.C.-E.); (K.G.-C.); (E.A.-S.)
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
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Bozier J, Chivers EK, Chapman DG, Larcombe AN, Bastian NA, Masso-Silva JA, Byun MK, McDonald CF, Crotty Alexander LE, Ween MP. The Evolving Landscape of e-Cigarettes: A Systematic Review of Recent Evidence. Chest 2020; 157:1362-1390. [PMID: 32006591 DOI: 10.1016/j.chest.2019.12.042] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/15/2019] [Accepted: 12/16/2019] [Indexed: 01/12/2023] Open
Abstract
Smoking continues to be a burden to economies and health-care systems across the world. One proposed solution to the problem has been e-cigarettes; however, because they are a relatively new product in the market, little is known about their potential health impacts. Furthermore, e-cigarettes continue to evolve at a rapid rate, making it necessary to regularly review and summarize available studies. Although e-cigarettes are marketed as a smoking cessation tool by some manufacturers, the reality is that many nonsmokers, including youth, are using them. This review focuses on two major demographic groups (smokers and nonsmokers) and evaluates the most recent data (early 2017 to mid 2019) regarding the potential health effects of e-cigarettes. We assessed peer-reviewed studies on the health impacts of e-cigarettes, with a particular focus on common questions asked by policy makers, clinicians, and scientists: (1) What are the effects of e-cigarettes compared with air/not smoking?; (2) Is there any direct evidence of harm or benefit to humans?; (3) Is there a risk from secondhand exposure?; (4) What are the risks and/or benefits of e-cigarettes compared with tobacco cigarette use?; (5) Are there risks or benefits to specific populations (eg, people with COPD or asthma, pregnant women [and their offspring])?; (6) What are the effects of flavoring chemicals?; (7) What are the effects of including nicotine in e-liquids?; (8) How often is nicotine concentration labeling incorrect?; and (9) What are the risks when e-cigarettes explode?
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Affiliation(s)
- Jack Bozier
- School of Life Sciences, University of Technology Sydney, Sydney, NSW, Australia; Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | | | - David G Chapman
- School of Life Sciences, University of Technology Sydney, Sydney, NSW, Australia; Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Alexander N Larcombe
- Telethon Kids Institute, Perth, WA, Australia; School of Public Health, Curtin University, Perth, WA, Australia
| | - Nicole A Bastian
- Discipline of Obstetrics and Gynaecology, School of Medicine, Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - Jorge A Masso-Silva
- Department of Medicine, Division of Pulmonary Critical Care & Sleep, University of California San Diego, San Diego, CA
| | - Min Kwang Byun
- Department of Medicine, Division of Pulmonary Critical Care & Sleep, University of California San Diego, San Diego, CA; Division of Pulmonology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Christine F McDonald
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia; Institute for Breathing and Sleep, Heidelberg, VIC, Australia; School of Medicine, University of Melbourne, VIC, Australia
| | - Laura E Crotty Alexander
- Department of Medicine, Division of Pulmonary Critical Care & Sleep, University of California San Diego, San Diego, CA; Pulmonary Critical Care Section, Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Miranda P Ween
- School of Medicine, University of Adelaide, Adelaide, SA, Australia; Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia.
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20
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Lozano P, Arillo-Santillán E, Barrientos-Gutiérrez I, Zavala-Arciniega L, Reynales-Shigematsu LM, Thrasher JF. E-cigarette use and its association with smoking reduction and cessation intentions among Mexican smokers. SALUD PUBLICA DE MEXICO 2020; 61:276-285. [PMID: 31276343 DOI: 10.21149/9797] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 09/04/2018] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Evaluate the patterns of e-cigarette use andtheir association with smoking behavior. MATERIALS AND METHODS We analyzed data from a population-based representative cohort of adult smokers who participated in the International Tobacco Control Policy Evaluation Surveys in Mexico. The analytic sample (n=760) was restricted to participants who were followed up from wave 6 (2012) to wave 7 (2014-2015). GEE models regressed e-cigarette use at follow-up and changes in cigarettes per day (CPD) between waves, on baseline sociodemographic variables, smoking status (daily, non-daily, quit), e-cigarette trial, and quit intentions. RESULTS Smokers who were younger, had a higher income, and had tried e-cigarettes at baseline were more likely to be current e-cigarette users at follow-up. Ecigarette use at follow-up was not associated with a change in CPD over time. CONCLUSIONS E-cigarette use does not appear to have promoted smoking cessation or reduction in this sample of Mexican smokers.
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Affiliation(s)
- Paula Lozano
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina. Columbia, SC, USA
| | - Edna Arillo-Santillán
- Departamento de Investigación sobre Tabaco, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, México
| | - Inti Barrientos-Gutiérrez
- Departamento de Investigación sobre Tabaco, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, México
| | - Luis Zavala-Arciniega
- Departamento de Investigación sobre Tabaco, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, México
| | | | - James F Thrasher
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina. Columbia, SC, USA.,Departamento de Investigación sobre Tabaco, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, México
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21
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Gallegos-Carrillo K, Barrientos-Gutiérrez I, Arillo-Santillán E, Zavala-Arciniega L, Cho YJ, Thrasher JF. Health Professionals' Counseling about Electronic Cigarettes for Smokers and Vapers in a Country That Bans the Sales and Marketing of Electronic Cigarettes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020442. [PMID: 31936477 PMCID: PMC7013470 DOI: 10.3390/ijerph17020442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 12/20/2019] [Accepted: 01/08/2020] [Indexed: 12/18/2022]
Abstract
This study describes the prevalence and correlates of adult smokers’ discussions about electronic cigarettes (e-cigarettes) with health professionals (HPs), including whether these discussions may lead smokers and vapers to use e-cigarettes for smoking cessation. Methods: We analyzed data from an online survey of Mexican smokers recruited from a consumer panel for marketing research. Participants who had visited an HP in the prior four months (n = 1073) were asked about discussions of e-cigarettes during that visit and whether this led them to try to quit. Logistic models regressed these variables on socio-demographics and tobacco use-related variables. Results: Smokers who also used e-cigarettes (i.e., dual users) were more likely than exclusive smokers to have discussed e-cigarettes with their HP (adjusted odds ratio (AOR) = 3.96; 95% C.I. 2.73, 5.74), as were those who had recently attempted to quit smoking (AOR = 1.89; 95% C.I. 1.33, 2.7). Of smokers who had discussed e-cigarettes, 53.3% reported that the discussion led them to use e-cigarettes in their quit attempt. Also, dual users (AOR = 2.6; 95% C.I. 1.5, 4.5) and daily smokers (>5 cigarettes per day) (AOR = 3.62; 95% C.I. 1.9, 6.8) were more likely to report being led by their HP to use e-cigarettes in the quit attempt compared to exclusive smokers and non-daily smokers, respectively. Conclusions: Discussions between HP and smokers about e-cigarettes were relatively common in Mexico, where e-cigarettes are banned. These discussions appear driven by the use of e-cigarettes, as well as by greater smoking frequency and intentions to quit smoking.
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Affiliation(s)
- Katia Gallegos-Carrillo
- Epidemiology and Health Services Research Unit, Mexican Institute of Social Security, Cuernavaca, Morelos 62000, Mexico
- Tobacco Research Department, National Institute of Public Health, Cuernavaca, Morelos 62100, Mexico;
- Correspondence: (K.G.-C.); (J.F.T.); Tel.: +52-777-100-1364 (K.G.-C.); +1-803-777-4862 (J.F.T.)
| | - Inti Barrientos-Gutiérrez
- Evaluation and Surveys Research Center, National Institute of Public Health, Cuernavaca, Morelos 62100, Mexico;
| | - Edna Arillo-Santillán
- Tobacco Research Department, National Institute of Public Health, Cuernavaca, Morelos 62100, Mexico;
- School of Demography, The Australian National University, Canberra, Australia/Tobacco Research Department, National Institute of Public Health, Cuernavaca, Morelos 62100, Mexico
| | | | - Yoo Jin Cho
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA;
| | - James F. Thrasher
- Tobacco Research Department, National Institute of Public Health, Cuernavaca, Morelos 62100, Mexico;
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA;
- Correspondence: (K.G.-C.); (J.F.T.); Tel.: +52-777-100-1364 (K.G.-C.); +1-803-777-4862 (J.F.T.)
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22
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Rodríguez-Bolaños R, Arillo-Santillán E, Barrientos-Gutiérrez I, Zavala-Arciniega L, Ntansah CA, Thrasher JF. Sex Differences in Becoming a Current Electronic Cigarette User, Current Smoker and Current Dual User of Both Products: A Longitudinal Study among Mexican Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:E196. [PMID: 31892159 PMCID: PMC6981723 DOI: 10.3390/ijerph17010196] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 12/22/2019] [Accepted: 12/23/2019] [Indexed: 02/05/2023]
Abstract
This study aimed to assess sex differences in predictors for becoming a current exclusive electronic cigarette (e-cigarette) user, current exclusive smoker, or current dual user (concurrent smoking and e-cigarette use). This longitudinal study included 2399 females and 2177 males who had tried neither cigarettes nor e-cigarettes at baseline and attended 57 middle schools in the three largest cities in Mexico. We estimated multinomial logistic models stratified by sex. At follow-up, the prevalence of current exclusive e-cigarette use was 6.4% for males and 5.5% for females; current exclusive smoking was similar among males (3.6%) and females (3.5%); dual use was 2.4% females and 1.8% males. In the adjusted model, current e-cigarette use among females was associated with baseline current drinking (ARR = 1.85; p < 0.05), having a job (ARR = 1.99; p < 0.05), higher technophilia (ARR = 1.27; p < 0.05), and higher positive smoking expectancies (ARR = 1.39; p < 0.05). Among males, only having friends who smoke cigarettes at baseline was a significant predictor of current exclusive e-cigarette use at follow-up (ARR = 1.44; p < 0.05). For both sexes, current exclusive smoking at follow-up was associated with baseline current drinking (male ARR = 2.56; p < 0.05; female ARR = 2.31; p < 0.05) and, among males, only with having a parent who smoked (ARR = 1.64; p < 0.05). For both sexes, dual use at follow-up was associated with baseline current drinking (male ARR = 3.52; p < 0.005; female ARR = 2.77; p < 0.05); among females, with having paid work (ARR = 2.50; p < 0.001); and among males, with parental smoking (ARR = 3.20; p < 0.05). Results suggested both common and different risk factors by sex, suggesting that interventions may need to consider targeting sex differences.
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Affiliation(s)
- Rosibel Rodríguez-Bolaños
- Population Health Research Center, Mexican National Institute of Public Health, Av. Universidad 655 Col. Santa María Ahuacatitlán, Cuernavaca, Morelos 62100, Mexico; (E.A.-S.); (J.F.T.)
| | - Edna Arillo-Santillán
- Population Health Research Center, Mexican National Institute of Public Health, Av. Universidad 655 Col. Santa María Ahuacatitlán, Cuernavaca, Morelos 62100, Mexico; (E.A.-S.); (J.F.T.)
- School of Demography, Australian National University, Canberra 2601, Australia
| | - Inti Barrientos-Gutiérrez
- Center for Evaluation and Survey Research, Mexican National Institute of Public Health, Av. Universidad 655 Col. Santa María Ahuacatitlán, Cuernavaca, Morelos 62100, Mexico;
| | | | - Charity A. Ntansah
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA;
| | - James F. Thrasher
- Population Health Research Center, Mexican National Institute of Public Health, Av. Universidad 655 Col. Santa María Ahuacatitlán, Cuernavaca, Morelos 62100, Mexico; (E.A.-S.); (J.F.T.)
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA;
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23
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Zavala-Arciniega L, Lozano P, Kollath-Cattano C, Gutierrez-Torres DS, Arillo-Santillán E, Barrientos-Gutiérrez I, Hardin JW, Thrasher JF. E-cigarette use frequency and motivations among current users in middle school. Drug Alcohol Depend 2019; 204:107585. [PMID: 31590130 PMCID: PMC6944441 DOI: 10.1016/j.drugalcdep.2019.107585] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 08/05/2019] [Accepted: 08/08/2019] [Indexed: 01/05/2023]
Abstract
INTRODUCTION The popularity of electronic cigarettes (e-cigarettes) has increased worldwide among youth, even in countries like Mexico that ban them. This study aimed to assess the correlates of e-cigarette use frequency among Mexican students who currently use ecigarettes, as well as to describe their reasons for use. METHODS Data were analyzed from a school-based survey of 57 public middle schools from the three largest cities in Mexico. Primary analyses were confined to those who used e-cigarettes in the prior 30 days. Censored binomial models for truncated distributions were estimated, regressing lifetime and past month frequency of use on participant sociodemographics, other substance use (smoking, alcohol, drugs), technophilia (appeal of new technologies), characteristics of e-cigarettes used, and family's and friends' use of nicotine products. RESULTS Being male (APR = 1.93 95% CI 1.53-2.44), using drugs, (APR = 1.51 95% CI 1.03-2.20), higher technophilia (APR = 1.66 CI 1.21-2.29) and having a family member who uses e-cigarettes and cigarettes were associated with more frequent use in the last month. Students who preferred fruit and combined flavors had used e-cigarettes more often in their lifetime compared to students who preferred mint/menthol flavors. CONCLUSIONS Some risk factors for more frequent e-cigarette use among Mexican youth are similar to those foudn in other countries (having relatives who use ecigarettes, using drugs, and use of fruit flavors). Additionally, the novel measure of technophilia was positively associated with frequency of e-cigarette use. The appeal of flavors, in particular, suggests the importance of reducing youth access to flavored products to impede product initiation and progression.
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Affiliation(s)
- Luis Zavala-Arciniega
- Tobacco Research Department, National Institute of Public Health, Cuernavaca, Mexico
| | - Paula Lozano
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | | | | | - Edna Arillo-Santillán
- Tobacco Research Department, National Institute of Public Health, Cuernavaca, Mexico
| | | | - James W Hardin
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - James F. Thrasher
- Tobacco Research Department, National Institute of Public Health, Cuernavaca, Mexico,Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, USA
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24
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Gravely S, Driezen P, Ouimet J, Quah ACK, Cummings KM, Thompson ME, Boudreau C, Hammond D, McNeill A, Borland R, Thrasher JF, Edwards R, Omar M, Hitchman SC, Yong H, Barrientos‐Gutierrez T, Willemsen MC, Bianco E, Boado M, Goma FM, Seo HG, Nargis N, Jiang Y, Perez CDA, Fong GT. Prevalence of awareness, ever-use and current use of nicotine vaping products (NVPs) among adult current smokers and ex-smokers in 14 countries with differing regulations on sales and marketing of NVPs: cross-sectional findings from the ITC Project. Addiction 2019; 114:1060-1073. [PMID: 30681215 PMCID: PMC6510648 DOI: 10.1111/add.14558] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/21/2018] [Accepted: 01/14/2019] [Indexed: 11/30/2022]
Abstract
AIMS This paper presents updated prevalence estimates of awareness, ever-use, and current use of nicotine vaping products (NVPs) from 14 International Tobacco Control Policy Evaluation Project (ITC Project) countries that have varying regulations governing NVP sales and marketing. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS A cross-sectional analysis of adult (≥ 18 years) current smokers and ex-smokers from 14 countries participating in the ITC Project. Data from the most recent survey questionnaire for each country were included, which spanned the period 2013-17. Countries were categorized into four groups based on regulations governing NVP sales and marketing (allowable or not), and level of enforcement (strict or weak where NVPs are not permitted to be sold): (1) most restrictive policies (MRPs), not legal to be sold or marketed with strict enforcement: Australia, Brazil, Uruguay; (2) restrictive policies (RPs), not approved for sale or marketing with weak enforcement: Canada, Malaysia, Mexico, New Zealand; (3) less restrictive policies (LRPs), legal to be sold and marketed with regulations: England, the Netherlands, Republic of Korea, United States; and (4) no regulatory policies (NRPs), Bangladesh, China, Zambia. Countries were also grouped by World Bank Income Classifications. Country-specific weighted logistic regression models estimated adjusted NVP prevalence estimates for: awareness, ever/current use, and frequency of use (daily versus non-daily). FINDINGS NVP awareness and use were lowest in NRP countries. Generally, ever- and current use of NVPs were lower in MRP countries (ever-use = 7.1-48.9%; current use = 0.3-3.5%) relative to LRP countries (ever-use = 38.9-66.6%; current use = 5.5-17.2%) and RP countries (ever-use = 10.0-62.4%; current use = 1.4-15.5%). NVP use was highest among high-income countries, followed by upper-middle-income countries, and then by lower-middle-income countries. CONCLUSIONS With a few exceptions, awareness and use of nicotine vaping products varied by the strength of national regulations governing nicotine vaping product sales/marketing, and by country income. In countries with no regulatory policies, use rates were very low, suggesting that there was little availability, marketing and/or interest in nicotine vaping products in these countries where smoking populations are predominantly poorer. The higher awareness and use of nicotine vaping products in high income countries with moderately (e.g. Canada, New Zealand) and less (e.g. England, United States) restrictive policies, is likely due to the greater availability and affordability of nicotine vaping products.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ann McNeill
- Addictions Department, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK,UK Centre for Tobacco and Alcohol StudiesUniversity of NottinghamNottinghamUK
| | | | - James F. Thrasher
- National Institute of Public HealthCuernavacaMorelosMexico,Arnold School of Public HealthColumbiaSCUSA
| | | | | | | | - Hua‐Hie Yong
- Cancer Council VictoriaMelbourneAustralia,Deakin UniversityGeelongVictoriaAustralia
| | | | | | - Eduardo Bianco
- Centro de Investigación para la Epidemia del TabaquismoMontevideoUruguay
| | | | | | - Hong Gwan Seo
- National Cancer CenterGoyang‐siGyeonggi‐doRepublic of Korea
| | | | - Yuan Jiang
- Chinese Center for Disease Control and Prevention (China CDC)BeijingChina
| | | | - Geoffrey T. Fong
- University of WaterlooWaterlooOntarioCanada,Ontario Institute for Cancer ResearchTorontoCanada
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25
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Lozano P, Arillo-Santillán E, Barrientos-Gutíerrez I, Shigematsu LMR, Thrasher JF. E-Cigarette Social Norms and Risk Perceptions Among Susceptible Adolescents in a Country That Bans E-Cigarettes. HEALTH EDUCATION & BEHAVIOR 2019; 46:275-285. [PMID: 30606077 PMCID: PMC6438717 DOI: 10.1177/1090198118818239] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND This study examined how risk perceptions and social norms around e-cigarettes are associated with susceptibility (i.e., openness to using the product in the next 12 months) of e-cigarettes and smoking among adolescents. METHODS We analyzed data from a 2016 representative survey of 8,718 middle school students in Mexico. The study sample was restricted to students who had tried neither e-cigarettes nor cigarettes, ( N = 4471). Students reported on the risks of e-cigarettes compared with those of cigarettes, and product-specific norms were measured by assessing current use by family members, at least one close friend, and, for e-cigarettes, by perceived societal acceptability of use (i.e., acceptability among people in general). Adjusted prevalence ratios (APR) were estimated using generalized estimating equation models that regressed e-cigarette societal acceptability on study variables. Adjusted generalized estimating equation models also regressed susceptibility for each product on study variables. RESULTS Susceptibility to both e-cigarettes and smoking was higher among students who reported that their family and friends used only cigarettes or both products when compared with students whose family and friends did not use either of these products. Friend use of e-cigarettes was associated with e-cigarette susceptibility (APR = 1.33) but not smoking susceptibility. Students who perceived that e-cigarettes were less risky than smoking were more susceptible to e-cigarette use (APR = 1.45). The association between e-cigarette susceptibility and friend or family use was not mediated by societal acceptability. CONCLUSIONS E-cigarette use among family and peers appears associated with susceptibility to use e-cigarettes in a way that is similar to the patterns found for cigarettes. However, the influences appear somewhat specific to the type of product that network members use.
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Affiliation(s)
- Paula Lozano
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Edna Arillo-Santillán
- Department of Tobacco Research, Center for Population Health Research, National Institute of Public Health, Cuernavaca, México
| | - Inti Barrientos-Gutíerrez
- Department of Tobacco Research, Center for Population Health Research, National Institute of Public Health, Cuernavaca, México
| | - Luz Myriam Reynales Shigematsu
- Department of Tobacco Research, Center for Population Health Research, National Institute of Public Health, Cuernavaca, México
| | - James F. Thrasher
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, USA
- Department of Tobacco Research, Center for Population Health Research, National Institute of Public Health, Cuernavaca, México
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