1
|
Awad AA, Itumalla R, Gaidhane AM, Khatib MN, Ballal S, Bansal P, Srivastava M, Arora I, Kumar MR, Sinha A, Pant K, Serhan HA, Shabil M. Association of electronic cigarette use and suicidal behaviors: a systematic review and meta-analysis. BMC Psychiatry 2024; 24:608. [PMID: 39256668 PMCID: PMC11389297 DOI: 10.1186/s12888-024-06012-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 08/09/2024] [Indexed: 09/12/2024] Open
Abstract
BACKGROUND The proliferation of electronic cigarettes (e-cigarettes) has presented new challenges in public health, particularly among adolescents and young adults. While marketed as safer than tobacco and as cessation aids, e-cigarettes have raised concerns about their long-term health and psychosocial impacts, including potential links to increased suicidal behaviors. This study aims to evaluate the relationship between e-cigarette use and suicidal behaviors by conducting a systematic review of the current literature. METHODS We searched PubMed, Web of Science, and EMBASE for studies up to March 10, 2024, examining the relationship between e-cigarette use and suicidal behaviors. Eligible studies included cross-sectional, longitudinal, retrospective, prospective, and case-control designs. Meta-analysis was performed to calculate pooled odds ratios (ORs). Newcastle Ottawa scale was used to assess the quality of studies. R software (V 4.3) was used to perform the meta-analysis. RESULTS Our analysis included fourteen studies, predominantly from the US and Korea, with participants ranging from 1,151 to 255,887. The meta-analysis identified a significant association between e-cigarette use and an increased risk of suicidal ideation (OR = 1.489, 95% CI: 1.357 to 1.621), suicide attempts (OR = 2.497, 95% CI: 1.999 to 3.996), and suicidal planning (OR = 2.310, 95% CI: 1.810 to 2.810). Heterogeneity was noted among the studies. CONCLUSION E-cigarette use is significantly associated with the risk of suicidal behaviors, particularly among adolescents. The findings underscore the necessity for caution in endorsing e-cigarettes as a safer smoking alternative and call for more extensive research to understand the underlying mechanisms. Public health strategies should be developed to address and mitigate the risks of suicidal behaviors among e-cigarette users.
Collapse
Affiliation(s)
| | - Ramaiah Itumalla
- School of Management, The Apollo University, Chittoor, Andhra Pradesh, 517127, India
| | - Abhay M Gaidhane
- School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, and Global Health Academy, Datta Meghe Institute of Higher Education, Wardha, India.
| | - Mahalaqua Nazli Khatib
- Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India
| | - Suhas Ballal
- Department of Chemistry and Biochemistry, School of Sciences, JAIN (Deemed to Be University), Bangalore, Karnataka, India
| | - Pooja Bansal
- Department of Allied Healthcare and Sciences, Vivekananda Global University, Jaipur, Rajasthan, 303012, India
| | | | - Isha Arora
- Chandigarh Pharmacy College, Chandigarh Group of College, Jhanjeri, Mohali, Punjab, 140307, India
| | - MRavi Kumar
- Department of Chemistry, Raghu Engineering College, Visakhapatnam, Andhra Pradesh, 531162, India
| | - Aashna Sinha
- School of Applied and Life Sciences, Division of Research and Innovation, Uttaranchal University, Dehradun, India
| | - Kumud Pant
- Department of Biotechnology, Graphic Era (Deemed to Be University), Clement Town Dehradun, 248002, India
- Department of Allied Sciences, Graphic Era Hill University Clement Town Dehradun, Clement Town Dehradun, 248002, India
| | - Hashem Abu Serhan
- Department of Ophthalmology, Hamad Medical Corporation, Doha, Qatar.
| | - Muhammed Shabil
- Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
- Medical Laboratories Techniques Department, AL-Mustaqbal University, Hillah, Babil, 51001, Iraq
| |
Collapse
|
2
|
Besaratinia A, Tommasi S. The Untapped Biomarker Potential of MicroRNAs for Health Risk-Benefit Analysis of Vaping vs. Smoking. Cells 2024; 13:1330. [PMID: 39195220 DOI: 10.3390/cells13161330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 08/08/2024] [Accepted: 08/09/2024] [Indexed: 08/29/2024] Open
Abstract
Despite the popularity of electronic cigarettes (e-cigs) among adolescent never-smokers and adult smokers seeking a less pernicious substitute for tobacco cigarettes, the long-term health impact of vaping is largely unknown. Like cigarette smoke, e-cig vapor contains harmful and potentially harmful compounds, although in fewer numbers and at substantially lower concentrations. Many of the same constituents of e-cig vapor and cigarette smoke induce epigenetic changes that can lead to the dysregulation of disease-related genes. MicroRNAs (MiRNAs) are key regulators of gene expression in health and disease states. Extensive research has shown that miRNAs play a prominent role in the regulation of genes involved in the pathogenesis of smoking-related diseases. However, the use of miRNAs for investigating the disease-causing potential of vaping has not been fully explored. This review article provides an overview of e-cigs as a highly consequential electronic nicotine delivery system, describes trends in e-cig use among adolescents and adults, and discusses the ongoing debate on the public health impact of vaping. Highlighting the significance of miRNAs in cell biology and disease, it summarizes the published and ongoing research on miRNAs in relation to gene regulation and disease pathogenesis in e-cig users and in vitro experimental settings. It identifies gaps in knowledge and priorities for future research while underscoring the need for empirical evidence that can inform the regulation of tobacco products to protect youth and promote public health.
Collapse
Affiliation(s)
- Ahmad Besaratinia
- Department of Population & Public Health Sciences, USC Keck School of Medicine, University of Southern California, M/C 9603, Los Angeles, CA 90033, USA
| | - Stella Tommasi
- Department of Population & Public Health Sciences, USC Keck School of Medicine, University of Southern California, M/C 9603, Los Angeles, CA 90033, USA
| |
Collapse
|
3
|
Besaratinia A, Blumenfeld H, Tommasi S. Exploring the Utility of Long Non-Coding RNAs for Assessing the Health Consequences of Vaping. Int J Mol Sci 2024; 25:8554. [PMID: 39126120 PMCID: PMC11313266 DOI: 10.3390/ijms25158554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 07/31/2024] [Accepted: 08/02/2024] [Indexed: 08/12/2024] Open
Abstract
Electronic cigarette (e-cig) use, otherwise known as "vaping", is widespread among adolescent never-smokers and adult smokers seeking a less-harmful alternative to combustible tobacco products. To date, however, the long-term health consequences of vaping are largely unknown. Many toxicants and carcinogens present in e-cig vapor and tobacco smoke exert their biological effects through epigenetic changes that can cause dysregulation of disease-related genes. Long non-coding RNAs (lncRNAs) have emerged as prime regulators of gene expression in health and disease states. A large body of research has shown that lncRNAs regulate genes involved in the pathogenesis of smoking-associated diseases; however, the utility of lncRNAs for assessing the disease-causing potential of vaping remains to be fully determined. A limited but growing number of studies has shown that lncRNAs mediate dysregulation of disease-related genes in cells and tissues of vapers as well as cells treated in vitro with e-cig aerosol extract. This review article provides an overview of the evolution of e-cig technology, trends in use, and controversies on the safety, efficacy, and health risks or potential benefits of vaping relative to smoking. While highlighting the importance of lncRNAs in cell biology and disease, it summarizes the current and ongoing research on the modulatory effects of lncRNAs on gene regulation and disease pathogenesis in e-cig users and in vitro experimental settings. The gaps in knowledge are identified, priorities for future research are highlighted, and the importance of empirical data for tobacco products regulation and public health is underscored.
Collapse
Affiliation(s)
- Ahmad Besaratinia
- Department of Population & Public Health Sciences, USC Keck School of Medicine, University of Southern California, M/C 9603, Los Angeles, CA 90033, USA; (H.B.); (S.T.)
| | | | | |
Collapse
|
4
|
He Y, Yang Q, Alish Y, Ma S, Qiu Z, Chen J, Wagener T, Shang C. Relationship Between Product Features and the Prices of e-Cigarette Devices Sold in Web-Based Vape Shops: Comparison Study Using a Linear Regression Model. JMIR Form Res 2024; 8:e49276. [PMID: 38723251 PMCID: PMC11117130 DOI: 10.2196/49276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 02/07/2024] [Accepted: 03/01/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Open-system electronic cigarette (EC) product features, such as battery capacity, maximum output wattage, and so forth, are major components that drive product costs and may influence use patterns. Moreover, continued innovation and monitoring of product features and prices will provide critical information for designing appropriate taxation policies and product regulations. OBJECTIVE This study will examine how product features are associated with the prices of devices sold in web-based vape shops. METHODS We draw samples from 5 popular, US-based, web-based vape shops from April to August 2022 to examine starter kits, device-only products, and e-liquid container-only products. We implemented a linear regression model with a store-fixed effect to examine the association between device attributes and prices. RESULTS EC starter kits or devices vary significantly by type, with mod prices being much higher than pod and vape pen prices. The prices of mod starter kits were even lower than those of mod devices, suggesting that mod starter kits are discounted in web-based vape shops. The price of mod kits, mod device-only products, and pod kits increased as the battery capacity and output wattage increased. For vape pens, the price was positively associated with the volume size of the e-liquid container. On the other hand, the price of pod kits was positively associated with the number of containers. CONCLUSIONS A unit-based specific tax, therefore, will impose a higher tax burden on lower-priced devices such as vape pens or pod systems and a lower tax burden on mod devices. A volume- or capacity-based specific tax on devices will impose a higher tax burden on vape pens with a larger container size. Meanwhile, ad valorem taxes pegged to wholesale or retail prices would apply evenly across device types, meaning those with advanced features such as higher battery capacities and output wattage would face higher rates. Therefore, policy makers could manipulate tax rates by device type to discourage the use of certain device products.
Collapse
Affiliation(s)
- Yanyun He
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Qian Yang
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Yousef Alish
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States
| | - Shaoying Ma
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Zefeng Qiu
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH, United States
| | - Jian Chen
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH, United States
| | - Theodore Wagener
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- Medical Oncology Division, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Ce Shang
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- Medical Oncology Division, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| |
Collapse
|
5
|
Ju H, Lee H, Choi J, Kim S, Kang E. The online promotion strategies of e-cigarette and heated tobacco product retailers in South Korea following the COVID-19 pandemic: Implications for regulation. Tob Induc Dis 2024; 22:TID-22-37. [PMID: 38356660 PMCID: PMC10865470 DOI: 10.18332/tid/178380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/21/2023] [Accepted: 01/07/2024] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION The surge in popularity of e-cigarettes and heated tobacco products (HTPs) in South Korea, driven by perceived health benefits and COVID-19-related concerns, has led to increased advertising claims about their safety despite ongoing debates about their health effects. This study explores the marketing strategies of online e-cigarette and HTP retailers in South Korea pre- and post-COVID-19, examining potential misleading claims and providing a foundation for future regulatory measures. METHODS We conducted a comprehensive study of eight major e-commerce platforms and three dominant search engines in South Korea to analyze the marketing and advertising strategies of e-cigarettes and heated tobacco products (HTPs) (n=774). Using specific keywords, promotional strategies were identified and categorized, after which statistical analysis was conducted to understand the frequency and proportion of these strategies, highlighting differences between HTP and e-cigarette sellers. RESULTS Our analysis reveals a significant rise in the number of online retailers selling e-cigarettes and HTPs following the COVID-19 pandemic, with the promotional strategies 'Stay home and vape' and 'Trendy' being the most prevalent. Trends also indicate a shift in promotional strategies over the years, with a marked increase in health reassurance themes and appeals to trendiness, particularly targeting female consumers, which were used significantly more at HTPs stores. CONCLUSIONS The study highlights the need for stricter regulation due to the potential health risks posed by the aggressive marketing strategies of e-cigarette and HTP online retailers in South Korea, amplified by the COVID-19 pandemic.
Collapse
Affiliation(s)
- HyoRim Ju
- Department of Family Medicine, Dankook University Hospital, Cheonan, South Korea
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - HyeWon Lee
- National Cancer Control Institute, National Cancer Center, Goyang, South Korea
| | - Juyoung Choi
- National Cancer Control Institute, National Cancer Center, Goyang, South Korea
| | - Soojeong Kim
- Department of Biomedical Sciences, Seoul National University, Seoul, South Korea
| | - EunKyo Kang
- National Cancer Control Institute, National Cancer Center, Goyang, South Korea
- Department of Family Medicine, National Cancer Center, Goyang, South Korea
| |
Collapse
|
6
|
Li S, Zeng X, Di X, Liu S. Association between e-cigarette use and susceptibility to tobacco product use: findings from the 2019 China National Youth Tobacco Survey. Front Public Health 2024; 11:1272680. [PMID: 38288432 PMCID: PMC10823011 DOI: 10.3389/fpubh.2023.1272680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/11/2023] [Indexed: 01/31/2024] Open
Abstract
Background There is an ongoing debate about whether e-cigarettes act as a gateway to tobacco smoking or contribute to smoking cessation, and relevant studies are limited among Chinese adolescents. This cross-sectional study therefore aimed to explore the relationship between e-cigarette use and susceptibility to tobacco product use among Chinese high school students. Methods The study population comprised 107,633 never smokers and 19,377 former smokers, generated from the 2019 China National Youth Tobacco Survey. The primary independent variables of interest were ever e-cigarette use, current e-cigarette use, and the frequency of current e-cigarette use. The main outcome was the susceptibility to tobacco product use. Multilevel logistic regression was used to estimate the association between the primary independent variables of interest and the outcome variable. Moreover, two additional multilevel logistic regression models were fitted using two alternative definitions of the outcome as the sensitivity analyses. Results Among never smokers, students who ever used e-cigarettes were more likely to be susceptible to tobacco product use compared to students who never used e-cigarettes (AOR = 2.83, 95%CI = 2.59-3.08). Students who currently used e-cigarettes were more likely to be susceptible to tobacco product use than those who did not currently use e-cigarettes (AOR = 3.89, 95%CI = 3.21-4.72). Among former smokers, with the same settings of modeling, the AORs were 1.76 (95%CI = 1.62-1.91) and 3.16 (95%CI = 2.52-3.97), respectively. Similar results were obtained from the two sensitivity analyses. Conclusion Among Chinese high school students, both never smokers and former smokers, e-cigarette use, especially current e-cigarette use, was positively associated with susceptibility to tobacco product use. It is recommended to strengthen the monitoring of e-cigarettes and to provide targeted health education to adolescents.
Collapse
Affiliation(s)
- Sixuan Li
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xinying Zeng
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xinbo Di
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shiwei Liu
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China
| |
Collapse
|
7
|
Lindson N, Butler AR, McRobbie H, Bullen C, Hajek P, Begh R, Theodoulou A, Notley C, Rigotti NA, Turner T, Livingstone-Banks J, Morris T, Hartmann-Boyce J. Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev 2024; 1:CD010216. [PMID: 38189560 PMCID: PMC10772980 DOI: 10.1002/14651858.cd010216.pub8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
BACKGROUND Electronic cigarettes (ECs) are handheld electronic vaping devices which produce an aerosol by heating an e-liquid. People who smoke, healthcare providers and regulators want to know if ECs can help people quit smoking, and if they are safe to use for this purpose. This is a review update conducted as part of a living systematic review. OBJECTIVES To examine the safety, tolerability and effectiveness of using electronic cigarettes (ECs) to help people who smoke tobacco achieve long-term smoking abstinence, in comparison to non-nicotine EC, other smoking cessation treatments and no treatment. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's Specialized Register to 1 February 2023, and Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PsycINFO to 1 July 2023, and reference-checked and contacted study authors. SELECTION CRITERIA We included trials in which people who smoke were randomized to an EC or control condition. We also included uncontrolled intervention studies in which all participants received an EC intervention as these studies have the potential to provide further information on harms and longer-term use. Studies had to report an eligible outcome. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods for screening and data extraction. Critical outcomes were abstinence from smoking after at least six months, adverse events (AEs), and serious adverse events (SAEs). We used a fixed-effect Mantel-Haenszel model to calculate risk ratios (RRs) with a 95% confidence interval (CI) for dichotomous outcomes. For continuous outcomes, we calculated mean differences. Where appropriate, we pooled data in pairwise and network meta-analyses (NMA). MAIN RESULTS We included 88 completed studies (10 new to this update), representing 27,235 participants, of which 47 were randomized controlled trials (RCTs). Of the included studies, we rated ten (all but one contributing to our main comparisons) at low risk of bias overall, 58 at high risk overall (including all non-randomized studies), and the remainder at unclear risk. There is high certainty that nicotine EC increases quit rates compared to nicotine replacement therapy (NRT) (RR 1.59, 95% CI 1.29 to 1.93; I2 = 0%; 7 studies, 2544 participants). In absolute terms, this might translate to an additional four quitters per 100 (95% CI 2 to 6 more). There is moderate-certainty evidence (limited by imprecision) that the rate of occurrence of AEs is similar between groups (RR 1.03, 95% CI 0.91 to 1.17; I2 = 0%; 5 studies, 2052 participants). SAEs were rare, and there is insufficient evidence to determine whether rates differ between groups due to very serious imprecision (RR 1.20, 95% CI 0.90 to 1.60; I2 = 32%; 6 studies, 2761 participants; low-certainty evidence). There is moderate-certainty evidence, limited by imprecision, that nicotine EC increases quit rates compared to non-nicotine EC (RR 1.46, 95% CI 1.09 to 1.96; I2 = 4%; 6 studies, 1613 participants). In absolute terms, this might lead to an additional three quitters per 100 (95% CI 1 to 7 more). There is moderate-certainty evidence of no difference in the rate of AEs between these groups (RR 1.01, 95% CI 0.91 to 1.11; I2 = 0%; 5 studies, 1840 participants). There is insufficient evidence to determine whether rates of SAEs differ between groups, due to very serious imprecision (RR 1.00, 95% CI 0.56 to 1.79; I2 = 0%; 9 studies, 1412 participants; low-certainty evidence). Due to issues with risk of bias, there is low-certainty evidence that, compared to behavioural support only/no support, quit rates may be higher for participants randomized to nicotine EC (RR 1.88, 95% CI 1.56 to 2.25; I2 = 0%; 9 studies, 5024 participants). In absolute terms, this represents an additional four quitters per 100 (95% CI 2 to 5 more). There was some evidence that (non-serious) AEs may be more common in people randomized to nicotine EC (RR 1.22, 95% CI 1.12 to 1.32; I2 = 41%, low-certainty evidence; 4 studies, 765 participants) and, again, insufficient evidence to determine whether rates of SAEs differed between groups (RR 0.89, 95% CI 0.59 to 1.34; I2 = 23%; 10 studies, 3263 participants; very low-certainty evidence). Results from the NMA were consistent with those from pairwise meta-analyses for all critical outcomes, and there was no indication of inconsistency within the networks. Data from non-randomized studies were consistent with RCT data. The most commonly reported AEs were throat/mouth irritation, headache, cough, and nausea, which tended to dissipate with continued EC use. Very few studies reported data on other outcomes or comparisons, hence, evidence for these is limited, with CIs often encompassing both clinically significant harm and benefit. AUTHORS' CONCLUSIONS There is high-certainty evidence that ECs with nicotine increase quit rates compared to NRT and moderate-certainty evidence that they increase quit rates compared to ECs without nicotine. Evidence comparing nicotine EC with usual care/no treatment also suggests benefit, but is less certain due to risk of bias inherent in the study design. Confidence intervals were for the most part wide for data on AEs, SAEs and other safety markers, with no difference in AEs between nicotine and non-nicotine ECs nor between nicotine ECs and NRT. Overall incidence of SAEs was low across all study arms. We did not detect evidence of serious harm from nicotine EC, but the longest follow-up was two years and the number of studies was small. The main limitation of the evidence base remains imprecision due to the small number of RCTs, often with low event rates. Further RCTs are underway. To ensure the review continues to provide up-to-date information to decision-makers, this review is a living systematic review. We run searches monthly, with the review updated when relevant new evidence becomes available. Please refer to the Cochrane Database of Systematic Reviews for the review's current status.
Collapse
Affiliation(s)
- Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ailsa R Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Hayden McRobbie
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Chris Bullen
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Peter Hajek
- Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Rachna Begh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Tari Turner
- Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Tom Morris
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Jamie Hartmann-Boyce
- Department of Health Promotion and Policy, University of Massachusetts, Amherst, MA, USA
| |
Collapse
|
8
|
Chen TY, Lin YJ, Chiang TL, Tsai FJ. Trade agreements and tobacco control policy: analysis of the impact of FCTC on regulatory contents of trade agreements from 2001 to 2019. Global Health 2023; 19:77. [PMID: 37864219 PMCID: PMC10588176 DOI: 10.1186/s12992-023-00979-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 10/05/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND This study aims to analyze the impact of Framework of Convention of Tobacco Control (FCTC) on regulatory contents of trade agreements from 2001 to 2019. METHODS A search of trade agreements from'WTO Regional Free Trade Agreement Database' using keywords including "tobacco", "cigarette", "smoking" and "FCTC" from May to August 2020 resulted in a total sample of 268 trade agreements, from which 69 trade agreements were coded and analyzed. Provisions in trade agreements, identified via the aforementioned keywords, were categorized into 6 trade measures. The word counts of the provisions containing; FCTC; were calculated. Chi-square tests were applied to analyze the differences of regulatory patterns between different time frames. The import and export values (USD) of tobacco products under trade agreements containing the term "FCTC" were further collected from the "International Trade Statistics 2001-2020" for understanding the impact of the provision on the trade flow. RESULTS Among 69 agreements, the percentage of trade agreements containing keyword as "FCTC" increased significantly from 0% to 2011 to 12% after 2011. A significant decrease of using trade measures as "the exclusion list" was found after 2011 (from 10% to 0). The word counts of provisions containing; FCTC; increased from 24 words in 2011 to 164 words in 2018, and the content of the provisions became more concrete over time. There are six trade agreements containing "FCTC", and all these 6 agreements were ratified by European Union (EU). Despite EU ratified trade agreements with "FCTC", the import and export values of tobacco products between EU and the other party countries increased with time. But the gap of average trade values between trade agreements with and without "FCTC" being widened with time. CONCLUSIONS As a first study evaluated the impact of FCTC on regulatory contents of trade agreements, our study results showed that after countries signed trade agreements containing keyword FCTC, the regulatory contents changed significantly. Further studies are recommended to understand the reason and criteria for incorporating FCTC provisions into trade agreements, especially in the EU.
Collapse
Affiliation(s)
- Tzu-Ying Chen
- Institute of Health Policy and Management, National Taiwan University, Taipei City, Taiwan
| | - Ying-Jun Lin
- School of Law - Financial and Economic Law, Chung Yuan Christian University, Taoyuan City, Taiwan
| | - Tung-Liang Chiang
- Institute of Health Policy and Management, National Taiwan University, Taipei City, Taiwan
| | - Feng-Jen Tsai
- Ph. D. Program and Master Program in Global Health and Health Security, College of Public Health, Taipei Medical University, No.301, Yuantong Rd, New Taipei City, Taiwan.
| |
Collapse
|
9
|
Fearon IM, Seltzer RGN, Houser TL, Tope A, Cahours X, Verron T, Malt L, Nahde T, O'Connell G, Nides M. Examination of the impact of myblu electronic nicotine delivery system e-liquid nicotine strength on self-reported measures of dependence. Drug Test Anal 2023; 15:1270-1280. [PMID: 35712897 DOI: 10.1002/dta.3335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/31/2022] [Accepted: 06/15/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Greater nicotine delivery is associated with higher nicotine concentrations in electronic nicotine delivery system (ENDS) liquids. However, there is a current debate as to whether this leads to increased dependence and mitigates ENDS public health potential. METHODS Self-reported dependence among users of myblu ENDS containing different nicotine concentrations was examined with data from a multiwave cross-sectional survey of US young adults and adults. Questions examined responses related to dependence measures and participants' most often used myblu ENDS nicotine concentration (low: 0%, 1% and 1.2%; medium: 2%, 2.4% and 2.5%; or high: 3.6% and 4%). RESULTS A global general linear model using nicotine concentration, age and days myblu that was used in the past 30 revealed a significant difference in PROMIS scores among nicotine concentration groups (F = 4.07, p = 0.02). However, pairwise comparisons to examine which specific groups differed significantly from others showed no significant differences. Logistic regression demonstrated that strong past 30-day cravings to use myblu among participants using high or medium nicotine concentrations were not significantly different from those using a low concentration (ORs 0.66 [0.42, 1.03], p = 0.07 and 0.95 [0.49, 1.82], p = 0.98, respectively). Time to daily first use for high or medium nicotine concentration users was not significantly different from those using a low concentration (ORs 0.89 [0.70, 1.14], p = 0.35 and 0.84 [0.57, 1.25], p = 0.40, respectively). CONCLUSIONS Use of myblu ENDS with different nicotine concentrations is not associated with differing levels of dependence. Our findings contradict the notion that high ENDS e-liquid nicotine levels generate increased dependence.
Collapse
Affiliation(s)
| | | | - Trisha L Houser
- Houser Clinical Research Writing and Consulting, LLC, Durham, North Carolina, USA
| | | | | | | | | | - Thomas Nahde
- Reemtsma Cigarettenfabriken GmbH, Hamburg, Germany
| | | | | |
Collapse
|
10
|
Wamba A, Nekaa M, Leclerc L, Denis-Vatant C, Masson J, Pourchez J. Regional French evolution of tobacco and e-cigarette experimentation and use among adolescents aged 15-16 years: A cross-sectional observational study conducted in the Loire department from 2018 to 2020. Prev Med Rep 2023; 35:102278. [PMID: 37389205 PMCID: PMC10300395 DOI: 10.1016/j.pmedr.2023.102278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 07/01/2023] Open
Abstract
Background We assessed/compared the evolution of tobacco and e-cigarette experimentation and use among French adolescents of the Loire department aged 15-16 years. Methods A descriptive, cross-sectional/observational study conducted in 2018-2020 among 7,950 Year 11 pupils attending 27 public secondary schools of the Loire department, France. Results From 2018 to 2020, 66.18% of adolescents were "non-vapers and non-smokers", 19.76% were "vapers and smokers", 7.90% were "non-vapers and smokers" and 6.15% were "vapers and non-smokers". E-cigarette experimentation was more prevalent than tobacco experimentation (44.92% vs 41.67%), and daily vaping was less prevalent than daily smoking (5.40% vs 10.24%). More boys than girls were daily vapers or daily smokers. A decrease was observed in tobacco experimentation (from 41.22% in 2018 to 39.73% in 2020) and e-cigarette experimentation (from 50.28% in 2018 to 41.25% in 2020). Current vaping remained stable, with an increase in daily vaping. French adolescent vapers frequently use e-liquids with little or no nicotine or with fruit or sweet flavours. Conclusions Adolescents used e-cigarettes mainly for experimental and/or recreational purposes, with no intention of progression to daily smoking. Although the design of this study is not longitudinal and caution must be exercised, from our cross-sectional observational study data, it appears that the proportion of "non-vapers and non-smokers" tended to increase. "Smokers" tended to progress to the dual use of vaping and smoked tobacco, with the likely intention to reduce or quit smoking.
Collapse
Affiliation(s)
- André Wamba
- École normale supérieure de Yaoundé, Département des sciences de l’éducation, Université de Yaoundé I, Yaoundé, Cameroon
- Mines Saint-Etienne, Université Lyon, Université Jean Monnet, INSERM, U 1059 Sainbiose, Centre CIS, F-Saint-Etienne, France
- UCT Pôle DocP2 CHU Saint-Étienne, Saint-Étienne, France
| | - Mabrouk Nekaa
- Université Jean Monnet, Saint-Etienne, France
- Laboratoire ECP, Éducation, Cultures, Politiques (EA 4571), France
| | - Lara Leclerc
- Mines Saint-Etienne, Université Lyon, Université Jean Monnet, INSERM, U 1059 Sainbiose, Centre CIS, F-Saint-Etienne, France
| | | | - Julien Masson
- Institut national supérieur du professor at et de l’éducation (Académie de Lyon), Université Claude Bernard Lyon 1 – INSPé, Laboratoire P2S, France
| | - Jérémie Pourchez
- Mines Saint-Etienne, Université Lyon, Université Jean Monnet, INSERM, U 1059 Sainbiose, Centre CIS, F-Saint-Etienne, France
| |
Collapse
|
11
|
Shiffman S, Hannon MJ. Switching away from smoking at 12 months among adult JUUL users varying in recent history of quit attempts made with and without smoking cessation medication. Drug Test Anal 2023; 15:1281-1296. [PMID: 37489266 DOI: 10.1002/dta.3551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 07/26/2023]
Abstract
Some smokers switch away from smoking using e-cigarettes, but guidelines recommend trying approved medications first. We analyzed switching in adult smokers using JUUL by their recent history of quit attempts and use of smoking cessation medications. Participants were 8511 adult (21+) established smokers (at baseline), in which 50.3% are daily smokers, in a longitudinal observational study who completed a survey 12 months after first purchasing a JUUL Starter Kit. At baseline, participants reported attempts to quit smoking in the prior year and use of pharmacotherapy (nicotine replacement therapy [NRT] or prescription medication) in their most recent attempt. The outcomes were switching (self-reported no past-30-day smoking) and 50%+ reductions in cigarette consumption. Multivariable analyses were adjusted for baseline covariates. Two thirds of the participants had made a quit attempt in the year before purchasing JUUL. Overall, 59% [58%, 60%] had switched at 12 months. Switching was more likely in those who had used NRT and who attempted quitting without medication versus those who used prescription medications or made no quit attempt. In adjusted multivariable analyses, only making a past-year quit attempt (vs. not) was associated with higher odds of switching (OR = 1.15 [1.04, 1.28]). Over 60% of dual users reduced cigarette consumption by ≥50%. These associations were largely similar in daily smokers. Twelve months after purchasing JUUL, almost all smokers reported either switching or reducing their smoking by 50%+, including those who had recently failed to quit smoking with approved pharmacotherapies. E-cigarettes provide an alternative route to abstinence from smoking for smokers with a history of cessation and cessation treatment failure.
Collapse
Affiliation(s)
- Saul Shiffman
- Pinney Associates, Inc, Pittsburgh, Pennsylvania, USA
| | | |
Collapse
|
12
|
Nian T, Guo K, Liu W, Deng X, Hu X, Xu M, E F, Wang Z, Song G, Yang K, Li X, Shang W. Non-pharmacological interventions for smoking cessation: analysis of systematic reviews and meta-analyses. BMC Med 2023; 21:378. [PMID: 37775745 PMCID: PMC10542700 DOI: 10.1186/s12916-023-03087-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 09/20/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Although non-pharmacological smoking cessation measures have been widely used among smokers, current research evidence on the effects of smoking cessation is inconsistent and of mixed quality. Moreover, there is a lack of comprehensive evidence synthesis. This study seeks to systematically identify, describe, and evaluate the available evidence for non-pharmacological interventions in smoking populations through evidence mapping (EM), and to search for best-practice smoking cessation programs. METHODS A comprehensive search for relevant studies published from the establishment of the library to January 8, 2023, was conducted in PubMed, Web of Science, Embase, the Cochrane Library, CNKI, CBM, Wan Fang, and VIP. Two authors independently assessed eligibility and extracted data. The PRISMA statement and AMSTAR 2 tool were used to evaluate the report quality and methodology quality of systematic reviews/meta-analyses (SRs/MAs), respectively. Bubble plots were utilized to display information, such as the study population, intervention type, evidence quality, and original study sample size. RESULTS A total of 145 SRs/MAs regarding non-pharmacological interventions for smoking cessation were investigated, with 20 types of interventions identified. The most commonly used interventions were cognitive behaviour education (n = 32, 22.07%), professional counselling (n = 20, 13.79%), and non-nicotine electronic cigarettes (e-cigarettes) (n = 13, 8.97%). Among them, counselling and behavioural support can improve smoking cessation rates, but the effect varies depending on the characteristics of the support provided. These findings are consistent with previous SRs/MAs. The general population (n = 108, 74.48%) was the main cohort included in the SRs/MAs. The total score of PRISMA for the quality of the reports ranged from 8 to 27, and 13 studies (8.97%) were rated as high confidence, and nine studies (6.21%) as moderate confidence, in the AMSTAR 2 confidence rating. CONCLUSIONS The abstinence effect of cognitive behaviour education and money incentive intervention has advantages, and non-nicotine e-cigarettes appear to help some smokers transition to less harmful replacement tools. However, the methodological shortcomings of SRs/MAs should be considered. Therefore, to better guide future practice in the field of non-pharmacological smoking cessation, it is essential to improve the methodological quality of SRs and carry out high-quality randomized controlled trials (RCTs).
Collapse
Affiliation(s)
- Tao Nian
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
| | - Kangle Guo
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
| | - Wendi Liu
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
| | - Xinxin Deng
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
| | - Xiaoye Hu
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
| | - Meng Xu
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
| | - Fenfen E
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
| | - Ziyi Wang
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
| | - Guihang Song
- Gansu Provincial Medical Security Bureau, Lanzhou, 730000, People's Republic of China
| | - Kehu Yang
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
- Vidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, People's Republic of China
| | - Xiuxia Li
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
| | - Wenru Shang
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China.
- Vidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, People's Republic of China.
- Collaborative Innovation Center of First Hospital, Lanzhou University, Lanzhou, 730000, People's Republic of China.
| |
Collapse
|
13
|
Kim I, Begay C, Ma HJ, Orozco FR, Rogers CJ, Valente TW, Unger JB. E-Cigarette-Related Health Beliefs Expressed on Twitter Within the U.S. AJPM FOCUS 2023; 2:100067. [PMID: 37790637 PMCID: PMC10546567 DOI: 10.1016/j.focus.2023.100067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction This mixed-methods study analyzed English-language U.S.-based Twitter posts related to E-cigarette use from February 2021. Methods Posts were manually identified as health-related or not and, if health-related, whether they were posted by an E-cigarette user. A random selection of 1,000 health-related tweets from 986 unique E-cigarette users were qualitatively content analyzed for theory of planned behavior constructs as well as nature and tone of each tweet message. Using quantitative semantic network analysis, relationships among the identified topics and sentiment-specific conversation patterns were explored. Results The most salient health-related conversation topics of E-cigarette users, health beliefs corresponding to each theory of planned behavior construct, and major motivational contexts of E-cigarette use were identified. Seven topics emerged in positive tweets: smoking cessation, social impact generation, controls over addiction, therapeutic effects on physical and mental health, social support, device attachment, and peer influence. Nine topics emerged in negative tweets: side effects on physical health, vaping addiction, lack of E-cigarette regulations, peer pressure, increased risk of COVID-19, side effects on mental health, no help in smoking cessation, social conflict, and polysubstance use. Most assertions for E-cigarette benefits were not substantiated. Jokes in tweets appeared to contribute to the view of vaping as an attractive, enjoyable, safe, and fun activity. Discussions about positive aspects of E-cigarette use were concentrated on a few related topics, whereas tweets discouraging E-cigarette use presented a diverse, less related set of topics. Conclusions The results provide insights into the drivers of E-cigarette use behaviors. E-cigarette user perspectives gathered from social media may inform research to guide future prevention and cessation interventions.
Collapse
Affiliation(s)
- Ian Kim
- Keck School of Medicine of USC, University of Southern California, Los Angeles, California
- Dornsife Spatial Sciences Institute, University of Southern California, Los Angeles, California
| | - Cynthia Begay
- Keck School of Medicine of USC, University of Southern California, Los Angeles, California
| | - Harrison J. Ma
- Keck School of Medicine of USC, University of Southern California, Los Angeles, California
| | - Francis R. Orozco
- Keck School of Medicine of USC, University of Southern California, Los Angeles, California
| | - Christopher J. Rogers
- College of Health and Human Development, California State University Northridge, Los Angeles, California
| | - Thomas W. Valente
- Keck School of Medicine of USC, University of Southern California, Los Angeles, California
| | - Jennifer B. Unger
- Keck School of Medicine of USC, University of Southern California, Los Angeles, California
| |
Collapse
|
14
|
Larcombe AN, Chivers EK, Huxley RR, Musk A(BW, Franklin PJ, Mullins BJ. Electronic Cigarette Usage Patterns and Perceptions in Adult Australians. TOXICS 2023; 11:290. [PMID: 36977055 PMCID: PMC10056955 DOI: 10.3390/toxics11030290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/17/2023] [Accepted: 03/17/2023] [Indexed: 06/18/2023]
Abstract
Despite their increasing popularity, and Australia's unique regulatory environment, how and why Australian adults use e-cigarettes and their perceptions of their safety, efficacy and regulation have not been extensively reported before. In this study, we screened 2217 adult Australians with the aim of assessing these questions in a sample of current or former e-cigarette users. A total of 505 out of 2217 respondents were current or former e-cigarette users, with only these respondents completing the full survey. Key findings of this survey included the high proportion of respondents who indicated they were currently using e-cigarettes (307 out of 2217 = 13.8%), and the high proportion of current e-cigarette users that were also smokers (74.6%). The majority of respondents used e-liquids containing nicotine (70.3%), despite it being illegal in Australia without a prescription, and the majority bought their devices and liquids in Australia (65.7%). Respondents reported using e-cigarettes in a variety of places, including inside the home, inside public places (where it is illegal to smoke tobacco cigarettes), and around other people-which has implications for second and third hand exposures. A significant proportion of current e-cigarette users (30.6%) thought that e-cigarettes were completely safe to use long-term, although in general, there was a large amount of uncertainty/ambivalence with respect to perceptions of e-cigarette safety and efficacy as smoking cessation tools. This study shows that e-cigarette use is common in Australia, and that appropriate dissemination of unbiased research findings on their safety and efficacy in smoking cessation is urgently required.
Collapse
Affiliation(s)
- Alexander N. Larcombe
- Respiratory Environmental Health, Wal-yan Respiratory Research Centre, Telethon Kids Institute, Nedlands, WA 6009, Australia
- Occupation, Environment and Safety, School of Population Health, Curtin University, Perth, WA 6845, Australia
| | - Emily K. Chivers
- Respiratory Environmental Health, Wal-yan Respiratory Research Centre, Telethon Kids Institute, Nedlands, WA 6009, Australia
| | - Rachel R. Huxley
- The George Institute for Global Health, University of New South Wales, Newtown, NSW 2042, Australia
- Faculty of Health, Deakin University, Burwood, VIC 3125, Australia
| | - Arthur (Bill) W. Musk
- School of Population and Global Health, University of Western Australia, Crawley, WA 6009, Australia
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia
| | - Peter J. Franklin
- School of Population and Global Health, University of Western Australia, Crawley, WA 6009, Australia
| | - Benjamin J. Mullins
- Occupation, Environment and Safety, School of Population Health, Curtin University, Perth, WA 6845, Australia
| |
Collapse
|
15
|
Alcantara C, Chaparro L, Zagury GJ. Occurrence of metals in e-cigarette liquids: Influence of coils on metal leaching and exposure assessment. Heliyon 2023; 9:e14495. [PMID: 36950607 PMCID: PMC10025154 DOI: 10.1016/j.heliyon.2023.e14495] [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: 11/18/2022] [Revised: 03/08/2023] [Accepted: 03/08/2023] [Indexed: 03/12/2023] Open
Abstract
Electronic cigarettes are generally recognized as a safer alternative than conventional cigarettes. Nevertheless, previous research suggests metal (loid) leaching due to coil contact, potentially transferring to the e-liquid and its aerosolized form. In this study, Cr, Cd, Ni, and Pb levels were measured by inductively coupled plasma mass spectrometry (ICP-MS) on 17 samples of e-liquids with different chemical properties (e.g., pH, nicotine content, flavoring, free-base, and nicotine salts). Twelve e-liquids were then put in contact with 36-gauge Kanthal A-1, Nichrome 80, Stainless steel 317 L and disposable coils such as Juul, and Aspire BVC for three days at 200-250 °C for 1 h each day. Metal levels expressed as mean (standard deviation) metal concentration, were below detection (Cd) to very low in bottle samples (Ni ≤ 76 (18); Pb ≤ 16 (1.5); and Cr ≤ 386 (15.6) μg/kg). In the coil extracts, varying concentrations of the same metal (loid) were found, indicating that metal leaching capacity may differ per sample. All samples contained Ni and Cr, followed by Pb to a much lesser extent. Cd levels were mostly below detection limits. Coil + e-liquid combinations with the highest Ni, Cr, and Pb concentrations were: Aspire BVC + Melon 0 mg/mL: Ni = 1.22 E+04 (281); Aspire BVC + Hit Nicotine 40 mg/mL: Cr = 864 (116); and Nichrome 80 + Melon 0 mg/mL: Pb = 56 (5) μg/kg. Overall, results suggest that nicotine salts at 40 mg/mL enhance Cr and Ni transfer. Stainless steel 317 L released very low metal concentrations. A conservative screening level risk characterization showed that 10.5% and 3.5% of the coil extracts may exceed Ni and Cr (III) safe concentrations, respectively. In the aerosol phase, 8.8% of samples might be above Ni equivalent daily dose for chronic exposure and 1.8% for intermediate exposure. Further studies on coil metal leaching could aid in establishing coil manufacturing regulations.
Collapse
Affiliation(s)
- Claudia Alcantara
- Department of Civil, Geological and Mining Engineering, Polytechnique Montréal (QC), H3C 3A7, Canada
| | - Laura Chaparro
- Les Laboratoires Vaporus Inc., 9704 Trans Canada Route, Saint-Laurent (QC), H4S 1V9, Canada
| | - Gerald J. Zagury
- Department of Civil, Geological and Mining Engineering, Polytechnique Montréal (QC), H3C 3A7, Canada
| |
Collapse
|
16
|
Mendelsohn CP, Hall W, Borland R, Wodak A, Beaglehole R, Benowitz NL, Britton J, Bullen C, Etter JF, McNeill A, Rigotti NA. A critique of the Australian National Health and Medical Research Council CEO statement on electronic cigarettes. Addiction 2023; 118:1184-1192. [PMID: 36808672 DOI: 10.1111/add.16143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/13/2023] [Indexed: 02/23/2023]
Abstract
This paper critically analyses a statement by Australia's National Health and Medical Research Council (NHMRC) on e-cigarettes in May 2022 that will be used to guide national policy. We reviewed the evidence and the conclusions drawn in the NHMRC Statement. In our view, the Statement is not a balanced reflection of the benefits and risks of vaping because it exaggerates the risks of vaping and fails to compare them to the far greater risks of smoking; it uncritically accepts evidence of harms from e-cigarettes while adopting a highly sceptical attitude towards evidence of their benefits; it incorrectly claims that the association between adolescent vaping and subsequent smoking is causal; and it understates the evidence of the benefits of e-cigarettes in assisting smokers to quit. The Statement dismisses the evidence that vaping is probably already having a positive net public health effect and misapplies the precautionary principle. Several sources of evidence supporting our assessment were published after the NHMRC Statement's publication and are also referenced. The NHMRC Statement on e-cigarettes does not present a balanced assessment of the available scientific literature and fails to meet the standard expected of a leading national scientific body.
Collapse
Affiliation(s)
| | - Wayne Hall
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Queensland, Australia
| | - Ron Borland
- Melbourne Centre for Behaviour Change, School of Psychological Sciences, The University of Melbourne, Victoria, Australia
| | - Alex Wodak
- Emeritus Consultant, Alcohol and Drug Service, St Vincents' Hospital, Sydney, Australia
| | | | - Neal L Benowitz
- Department of Medicine, University of California San Francisco, California, USA
| | - John Britton
- University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Chris Bullen
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Jean-François Etter
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Ann McNeill
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Nancy A Rigotti
- Harvard Medical School, Director, Tobacco Research and Treatment Center, Massachusetts General Hospital, Massachusetts, Boston, USA
| |
Collapse
|
17
|
McKeon G, Scott JG. Smoke and mirrors: Support from psychiatrists for nicotine e-cigarette availability in Australia. Aust N Z J Psychiatry 2023; 57:169-180. [PMID: 36120959 DOI: 10.1177/00048674221126458] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The Royal Australian and New Zealand College of Psychiatrists' (RANZCP) 2018 position statement supports increased, regulated availability of e-cigarettes (ECs) as a harm-reduction measure and recommends further research into their use. Aligned with this recommendation, we aimed to critically evaluate the RANZCP's stance on this issue through a literature review focused on the areas identified in the position statement as requiring further investigation: (1) the adverse health effects attributable to ECs; (2) use of ECs for smoking cessation (particularly for people living with severe mental illness); and (3) EC-associated risks for nicotine naïve young people. We identified and summarised evidence of harm attributable to ECs that is particularly relevant to young people through direct adverse health sequelae, onset of nicotine dependence and increased risk of combustible cigarette (CC) use. A small number of studies suggest ECs can be used for harm-reduction purposes in people diagnosed with nicotine dependence and severe mental illness. However, these results must be considered alongside robust evidence supporting the effectiveness of existing pharmacological interventions for smoking cessation in people with severe mental illness. The position statement is in urgent need of review in line with the available evidence.
Collapse
Affiliation(s)
- Gemma McKeon
- Child and Youth Mental Health Group, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
- Metro North Mental Health Services, Herston, QLD, Australia
- Child and Youth Mental Health Group, UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
| | - James G Scott
- Child and Youth Mental Health Group, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
- Metro North Mental Health Services, Herston, QLD, Australia
- Child and Youth Mental Health Group, UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
- Child and Youth Mental Health Group, Queensland Centre for Mental Health Research, Wacol, QLD, Australia
| |
Collapse
|
18
|
Xu Y, Gu Z, Zhang Y, He M, Gerber BS, Sadasivam RS, Liu F, Wang Z. Global trends in smoking cessation research from 2002 to 2021: A bibliometric and visual analysis. Prev Med Rep 2022; 30:101991. [PMID: 36193091 PMCID: PMC9525896 DOI: 10.1016/j.pmedr.2022.101991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/17/2022] [Indexed: 11/17/2022] Open
Abstract
Our study is the first bibliometric and visual analysis on smoking cessation research of the past two decades. Our study identifies productive countries/regions, institutions, authors, journals, and reveals a global network of collaborations of smoking cessation research. The Co-occurrence Analysis of Keywords shed lights on the research frontier, trends and hot topics on smoking cessation research.
This study aimed to analyze the scientific outputs of smoking cessation research and explore its hotspots and frontiers from 2002 to 2021, using bibliometric methods. We use the core collection of Web of Science as a data source, and apply bibliometric methods to visually analyze articles published in smoking cessation research from 2002 to 2021, including publication year, countries/regions, journals, authors, institutions, and keywords. The VOSviewer (1.6.16) tool was used for the analysis. A total of 8797 articles related to smoking cessation research were identified. The USA was the leading contributor with 4671 publications. NICOTINE&TOBACCO RESEARCH contributed the most publications (528), with the most citations (13746) and the highest H-index (59). The most contributing institutions were the University College London and University of California San Francisco. Robert West was most productive author. We found active collaborations among both productive authors and productive institutions. There were five hot topics in smoking cessation research: (1) Public health harm from tobacco; (2) The role of e-health in smoking cessation; (3) Role of primary health care in eliminating tobacco dependence; (4) Nicotine replacement therapy and pharmacotherapy; (5) The biological and clinical understanding of addiction. Our current study showed a growing trend in smoking cessation based on the number of published articles over the last 20 years. There was active cooperation between institutions, and authors. Electronic cigarettes, mHealth, eHealth, public health and mental health are foci of new and emerging research.
Collapse
Affiliation(s)
- Yingxin Xu
- Department of Information Center, The First Hospital of China Medical University, Shenyang, China.,College of Health Management, China Medical University, Shenyang, China
| | - Zhengmin Gu
- Department of Information Center, The First Hospital of China Medical University, Shenyang, China
| | - Ye Zhang
- Department of Information Center, The First Hospital of China Medical University, Shenyang, China.,College of Health Management, China Medical University, Shenyang, China
| | - Miao He
- Department of Information Center, The First Hospital of China Medical University, Shenyang, China
| | - Ben S Gerber
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Rajani S Sadasivam
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Feifan Liu
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Zhongqing Wang
- Department of Information Center, The First Hospital of China Medical University, Shenyang, China
| |
Collapse
|
19
|
Hartmann-Boyce J, Lindson N, Butler AR, McRobbie H, Bullen C, Begh R, Theodoulou A, Notley C, Rigotti NA, Turner T, Fanshawe TR, Hajek P. Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev 2022; 11:CD010216. [PMID: 36384212 PMCID: PMC9668543 DOI: 10.1002/14651858.cd010216.pub7] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Electronic cigarettes (ECs) are handheld electronic vaping devices which produce an aerosol by heating an e-liquid. Some people who smoke use ECs to stop or reduce smoking, although some organizations, advocacy groups and policymakers have discouraged this, citing lack of evidence of efficacy and safety. People who smoke, healthcare providers and regulators want to know if ECs can help people quit smoking, and if they are safe to use for this purpose. This is a review update conducted as part of a living systematic review. OBJECTIVES To examine the effectiveness, tolerability, and safety of using electronic cigarettes (ECs) to help people who smoke tobacco achieve long-term smoking abstinence. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PsycINFO to 1 July 2022, and reference-checked and contacted study authors. SELECTION CRITERIA: We included randomized controlled trials (RCTs) and randomized cross-over trials, in which people who smoke were randomized to an EC or control condition. We also included uncontrolled intervention studies in which all participants received an EC intervention. Studies had to report abstinence from cigarettes at six months or longer or data on safety markers at one week or longer, or both. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods for screening and data extraction. Our primary outcome measures were abstinence from smoking after at least six months follow-up, adverse events (AEs), and serious adverse events (SAEs). Secondary outcomes included the proportion of people still using study product (EC or pharmacotherapy) at six or more months after randomization or starting EC use, changes in carbon monoxide (CO), blood pressure (BP), heart rate, arterial oxygen saturation, lung function, and levels of carcinogens or toxicants, or both. We used a fixed-effect Mantel-Haenszel model to calculate risk ratios (RRs) with a 95% confidence interval (CI) for dichotomous outcomes. For continuous outcomes, we calculated mean differences. Where appropriate, we pooled data in meta-analyses. MAIN RESULTS We included 78 completed studies, representing 22,052 participants, of which 40 were RCTs. Seventeen of the 78 included studies were new to this review update. Of the included studies, we rated ten (all but one contributing to our main comparisons) at low risk of bias overall, 50 at high risk overall (including all non-randomized studies), and the remainder at unclear risk. There was high certainty that quit rates were higher in people randomized to nicotine EC than in those randomized to nicotine replacement therapy (NRT) (RR 1.63, 95% CI 1.30 to 2.04; I2 = 10%; 6 studies, 2378 participants). In absolute terms, this might translate to an additional four quitters per 100 (95% CI 2 to 6). There was moderate-certainty evidence (limited by imprecision) that the rate of occurrence of AEs was similar between groups (RR 1.02, 95% CI 0.88 to 1.19; I2 = 0%; 4 studies, 1702 participants). SAEs were rare, but there was insufficient evidence to determine whether rates differed between groups due to very serious imprecision (RR 1.12, 95% CI 0.82 to 1.52; I2 = 34%; 5 studies, 2411 participants). There was moderate-certainty evidence, limited by imprecision, that quit rates were higher in people randomized to nicotine EC than to non-nicotine EC (RR 1.94, 95% CI 1.21 to 3.13; I2 = 0%; 5 studies, 1447 participants). In absolute terms, this might lead to an additional seven quitters per 100 (95% CI 2 to 16). There was moderate-certainty evidence of no difference in the rate of AEs between these groups (RR 1.01, 95% CI 0.91 to 1.11; I2 = 0%; 5 studies, 1840 participants). There was insufficient evidence to determine whether rates of SAEs differed between groups, due to very serious imprecision (RR 1.00, 95% CI 0.56 to 1.79; I2 = 0%; 8 studies, 1272 participants). Compared to behavioural support only/no support, quit rates were higher for participants randomized to nicotine EC (RR 2.66, 95% CI 1.52 to 4.65; I2 = 0%; 7 studies, 3126 participants). In absolute terms, this represents an additional two quitters per 100 (95% CI 1 to 3). However, this finding was of very low certainty, due to issues with imprecision and risk of bias. There was some evidence that (non-serious) AEs were more common in people randomized to nicotine EC (RR 1.22, 95% CI 1.12 to 1.32; I2 = 41%, low certainty; 4 studies, 765 participants) and, again, insufficient evidence to determine whether rates of SAEs differed between groups (RR 1.03, 95% CI 0.54 to 1.97; I2 = 38%; 9 studies, 1993 participants). Data from non-randomized studies were consistent with RCT data. The most commonly reported AEs were throat/mouth irritation, headache, cough, and nausea, which tended to dissipate with continued EC use. Very few studies reported data on other outcomes or comparisons, hence evidence for these is limited, with CIs often encompassing clinically significant harm and benefit. AUTHORS' CONCLUSIONS There is high-certainty evidence that ECs with nicotine increase quit rates compared to NRT and moderate-certainty evidence that they increase quit rates compared to ECs without nicotine. Evidence comparing nicotine EC with usual care/no treatment also suggests benefit, but is less certain. More studies are needed to confirm the effect size. Confidence intervals were for the most part wide for data on AEs, SAEs and other safety markers, with no difference in AEs between nicotine and non-nicotine ECs nor between nicotine ECs and NRT. Overall incidence of SAEs was low across all study arms. We did not detect evidence of serious harm from nicotine EC, but longest follow-up was two years and the number of studies was small. The main limitation of the evidence base remains imprecision due to the small number of RCTs, often with low event rates, but further RCTs are underway. To ensure the review continues to provide up-to-date information to decision-makers, this review is a living systematic review. We run searches monthly, with the review updated when relevant new evidence becomes available. Please refer to the Cochrane Database of Systematic Reviews for the review's current status.
Collapse
Affiliation(s)
- Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ailsa R Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Hayden McRobbie
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Chris Bullen
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Rachna Begh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Tari Turner
- Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Thomas R Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Peter Hajek
- Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| |
Collapse
|
20
|
Lucchiari C, Masiero M, Mazzocco K, Veronesi G, Maisonneuve P, Jemos C, Salè EO, Spina S, Bertolotti R, Busacchio D, Pravettoni G. Nicotine-Free E-Cigarettes Might Promote Tobacco Smoking Reduction Better Than Nicotine Delivery Devices: Results of a Double-Blind Randomized Controlled Trial at 1 Year. Curr Oncol 2022; 29:8579-8590. [PMID: 36421329 PMCID: PMC9717729 DOI: 10.3390/curroncol29110676] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/28/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
The purpose of the present study was to determine whether the use of e-cigarettes to aid in quitting contributed to the increase in the pulmonary health of chronic smokers. The efficacy of e-cigarettes to support a successful smoking cessation attempt was also investigated. A total of 210 smokers (78 women) were enrolled in a screening program for the early detection of lung cancer and distributed in three arms: nicotine e-cigarette plus support, nicotine-free e-cigarette plus support, and support. Results showed that participants in the nicotine e-cigarette arm had a significant and fast decrease in daily cigarettes, but that later they resume smoking more than the other two groups. Conversely, participants in the other two arms showed similar daily consumption at the two evaluation points. Among abstinent participants, only 12.5% reported cough, while 48% of current smokers had pulmonary symptoms. Our study suggests that, in the long run, the use of a nicotine-free liquid may favor reducing smoking and could be considered a good option in a clinical setting.
Collapse
Affiliation(s)
| | - Marianna Masiero
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (K.M.); (G.P.)
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy;
- Correspondence: ; Tel.: +39-02-9437-2099
| | - Ketti Mazzocco
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (K.M.); (G.P.)
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy;
| | - Giulia Veronesi
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132 Milan, Italy;
- Division of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy;
| | - Costantino Jemos
- Division of Pharmacy, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (C.J.); (E.O.S.)
| | - Emanuela Omodeo Salè
- Division of Pharmacy, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (C.J.); (E.O.S.)
| | - Stefania Spina
- Division of Thoracic and General Surgery, Humanitas Research Hospital, 20089 Milan, Italy;
| | - Raffaella Bertolotti
- Division of Thoracic Surgery, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy;
| | - Derna Busacchio
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy;
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (K.M.); (G.P.)
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy;
| |
Collapse
|
21
|
Su Z, McDonnell D, Cheshmehzangi A, Ahmad J, Šegalo S, da Veiga CP. A call to ban the sale of tobacco products. Front Public Health 2022; 10:904971. [PMID: 36438262 PMCID: PMC9684640 DOI: 10.3389/fpubh.2022.904971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/26/2022] [Indexed: 11/12/2022] Open
Abstract
Tobacco is both toxic and addictive. Mounting evidence shows that tobacco use has a detrimental impact on almost every aspect of human health, causing or worsening deadly public health crises from the cancer epidemic to the COVID-19 pandemic. However, while tobacco use is a threat to both personal and public health, it continues to surge across the world, especially in China and other low- and middle-income countries. To this end, this article argues in favor of using a ban on the sale of all tobacco products as a practical solution to the global tobacco use epidemic. It is our hope that insights provided by our work will inspire swift policy actions in countries such as China and beyond to curb the tide of rising tobacco consumption, so that populations around the world could be better shielded from the pervasive and long-lasting damage that tobacco products cause or compound.
Collapse
Affiliation(s)
- Zhaohui Su
- School of Public Health, Southeast University, Nanjing, China,*Correspondence: Zhaohui Su
| | - Dean McDonnell
- Department of Humanities, Institute of Technology Carlow, Carlow, Ireland
| | - Ali Cheshmehzangi
- Faculty of Science and Engineering, University of Nottingham Ningbo China, Ningbo, China,Network for Education and Research on Peace and Sustainability, Hiroshima University, Hiroshima, Japan
| | | | - Sabina Šegalo
- Faculty of Health Studies, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | |
Collapse
|
22
|
Li J, Hui X, Fu J, Ahmed MM, Yao L, Yang K. Electronic cigarettes versus nicotine-replacement therapy for smoking cessation: A systematic review and meta-analysis of randomized controlled trials. Tob Induc Dis 2022; 20:90. [PMID: 36339933 PMCID: PMC9582581 DOI: 10.18332/tid/154075] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/09/2022] [Accepted: 09/14/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Nicotine-replacement therapy (NRT) and electronic cigarettes (e-cigarettes) have been frequently used for smoking cessation. The aim of this review is to investigate the effectiveness and safety of e-cigarettes versus NRT for smoking cessation. METHODS We searched PubMed, EMBASE, the Cochrane Library from inception to 10 October 2021. We included randomized controlled trials (RCTs) comparing e-cigarettes versus NRT for smoking cessation. Two authors independently screened titles, abstracts and full texts for eligibility. Paired authors extracted data, assessed risk of bias, and used GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) to rate the certainty of evidence. RESULTS The study included five RCTs with 1748 participants. The meta-analysis suggested the e-cigarettes versus NRT increased the ≥6 months continuous abstinence rate (RR=1.67; 95% CI: 1.21-2.28; 55 more per 1000 participants, low certainty), and 7-day point abstinence rate at ≥6 months follow-up (RR=1.43; 95% CI: 1.19-1.72; 84 more per 1000, low certainty). However, we found no evidence that e-cigarettes versus NRT increased 3-6 months continuous abstinence rate (RR=1.07; 95% CI: 0.73-1.57; 10 more per 1000, very low certainty) and <3 months continuous abstinence rate (RR=1.20; 95% CI: 0.90-1.60; 54 more per 1000, low certainty); similar results were found at <3 months follow-up (RR=1.19; 95% CI: 0.92-1.54; 55 more per 1000, very low certainty) and 3-6 months follow-up in 7-day point abstinence rate (RR=1.01; 95% CI: 0.70-1.44; 2 more per 1000, very low certainty). The adverse events were not significant between e-cigarettes and NRT other than throat irritation (RR=1.27; 95% CI: 1.13-1.42; 118 more per 1000, low certainty). CONCLUSIONS E-cigarettes appeared to be superior to NRT in ≥6 months continuous abstinence rate and 7-day point abstinence rate. At short-term duration, we found no evidence that e-cigarettes compared to NRT increased the <6 months continuous abstinence rate and 7-day point abstinence rate.
Collapse
Affiliation(s)
- Jing Li
- Health Technology Assessment Centre, School of Public Health, Lanzhou University, Lanzhou, People’s Republic of China,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, People’s Republic of China
| | - Xu Hui
- Health Technology Assessment Centre, School of Public Health, Lanzhou University, Lanzhou, People’s Republic of China,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, People’s Republic of China
| | - Jiani Fu
- Second Clinical Medical College, Lanzhou University, Lanzhou, People’s Republic of China
| | | | - Liang Yao
- Department of Health Research Methodology, McMaster University, Hamilton, Canada
| | - Kehu Yang
- Health Technology Assessment Centre, School of Public Health, Lanzhou University, Lanzhou, People’s Republic of China,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, People’s Republic of China,Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, People’s Republic of China
| |
Collapse
|
23
|
Pipe AL, Mir H. E-Cigarettes Reexamined: Product Toxicity. Can J Cardiol 2022; 38:1395-1405. [PMID: 36089290 DOI: 10.1016/j.cjca.2022.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 08/03/2022] [Accepted: 08/03/2022] [Indexed: 12/24/2022] Open
Abstract
The introduction of e-cigarettes, or electronic nicotine delivery systems (ENDS), has been accompanied by controversy regarding their safety and effectiveness as a cessation aid and by an explosion in their use by youth. Their use does not involve the combustion of tobacco and the creation of harmful combustion products; they have been seen as a "harm reduction" tool that may be of assistance in promoting smoking cessation. Recognition that ENDS can deliver an array of chemicals and materials with known adverse consequences has spurred more careful examination of these products. Nicotine, nitrosamines, carbonyl compounds, heavy metals, free radicals, reactive oxygen species, particulate matter, and "emerging chemicals of concern" are among the constituents of the heated chemical aerosol that is inhaled when ENDS are used. They raise concerns for cardiovascular and respiratory health that merit the attention of clinicians and regulatory agencies. Frequently cited concerns include evidence of disordered respiratory function, altered hemodynamics, endothelial dysfunction, vascular reactivity, and enhanced thrombogenesis. The absence of evidence of the consequences of their long-term use is of additional concern. Their effectiveness as cessation aids and beneficial impact on health outcomes continue to be examined. It is important to ensure that their production and availability are thoughtfully regulated to optimise their safety and permit their use as harm reduction devices and potentially as smoking-cessation aids. It is equally vital to effectively prevent them from becoming ubiquitous consumer products with the potential to rapidly induce nicotine addiction among large numbers of youth. Clinicians should understand the nature of these products and the implications of their use.
Collapse
Affiliation(s)
- Andrew L Pipe
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
| | - Hassan Mir
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| |
Collapse
|
24
|
Muacevic A, Adler JR, Wasserman P, Agarwal S, Baird GL, Sokolovsky A, Maxwell A, Healey T. Electronic Cigarettes for Smoking Cessation: The Gap Between Behavior in Smokers and Medical Education. Cureus 2022; 14:e29603. [PMID: 36320942 PMCID: PMC9600939 DOI: 10.7759/cureus.29603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2022] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION E-cigarettes have engendered a great deal of controversy within the public health and medical communities. Methods: Two cross-sectional surveys were administered. First, patients at an annual lung cancer screening appointment who self-identified as former smokers were asked about strategies for achieving and maintaining smoking cessation with open-ended questions. Second, medical students at a single university reported their opinion and knowledge of combustible cigarettes and e-cigarettes. RESULTS Among the n=102 in the patient survey indicating that they used e-cigarettes or over-the-counter (OTC) nicotine replacement products for smoking cessation, 34.3% (35/102) vaped e-cigarettes, making it the second most common next to patches (47.1% {48/102}). By comparison, n=48 reported using medication. Medical student participants (n=168) were mixed regarding whether a patient should switch from traditional to electronic cigarettes (56.0% yes; 44.0% no) and reported receiving education about traditional cigarettes (92.3%) at a much higher rate than for e-cigarettes (46.4%), p<.001. CONCLUSION Many former heavy smokers undergoing a lung cancer screen used e-cigarettes to achieve smoking cessation. However, nearly half of medical students surveyed do not think patients should switch from traditional to e-cigarettes.
Collapse
|
25
|
Propylene glycol, a component of electronic cigarette liquid, damages epithelial cells in human small airways. Respir Res 2022; 23:216. [PMID: 35999544 PMCID: PMC9400210 DOI: 10.1186/s12931-022-02142-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 08/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background Electronic cigarettes (e-cigarettes) are used worldwide as a substitute for conventional cigarettes. Although they are primarily intended to support smoking cessation, e-cigarettes have been identified as a gateway to smoking habits for young people. Multiple recent reports have described the health effects of inhaling e-cigarettes. E-cigarette liquid (e-liquid) is mainly composed of propylene glycol (PG) and glycerol (Gly), and the aerosol generated by these devices primarily contains these two components. Thus, this study aimed to evaluate the effects of PG and Gly on human small airway epithelial cells (SAECs). Methods SAECs were exposed to PG or Gly, and cell proliferation, cell viability, lactate dehydrogenase (LDH) release, DNA damage, cell cycle, and apoptosis were evaluated. Additionally, SAECs derived from chronic obstructive pulmonary disease (COPD) patients (COPD-SAECs) were investigated. Results Exposure of SAECs to PG significantly inhibited proliferation (1%, PG, p = 0.021; 2–4% PG, p < 0.0001) and decreased cell viability (1–4% PG, p < 0.0001) in a concentration-dependent manner. Gly elicited similar effects but to a reduced degree as compared to the same concentration of PG. PG also increased LDH release in a concentration-dependent manner (3% PG, p = 0.0055; 4% PG, p < 0.0001), whereas Gly did not show a significant effect on LDH release. SAECs exposed to 4% PG contained more cells that were positive for phosphorylated histone H2AX (p < 0.0001), a marker of DNA damage, and an increased proportion of cells in the G1 phase (p < 0.0001) and increased p21 expression (p = 0.0005). Moreover, caspase 3/7-activated cells and cleaved poly (ADP-ribose) polymerase 1 expression were increased in SAECs exposed to 4% PG (p = 0.0054). Furthermore, comparing COPD-SAECs to SAECs without COPD in PG exposure, cell proliferation, cell viability, DNA damage and apoptosis were significantly greater in COPD-SAECs. Conclusion PG damaged SAECs more than Gly. In addition, COPD-SAECs were more susceptible to PG than SAECs without COPD. Usage of e-cigarettes may be harmful to the respiratory system, especially in patients with COPD.
Collapse
|
26
|
Mendelsohn CP, Wodak A, Hall W, Borland R. A critical analysis of 'Electronic cigarettes and health outcomes: Systematic review of global evidence'. Drug Alcohol Rev 2022; 41:1493-1498. [PMID: 35862283 DOI: 10.1111/dar.13515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/19/2022] [Accepted: 06/25/2022] [Indexed: 11/26/2022]
Affiliation(s)
| | - Alex Wodak
- St Vincent's Hospital Sydney, Alcohol and Drug Service, Sydney, Australia
| | - Wayne Hall
- University of Queensland, Centre for Youth Substance Abuse Research, Brisbane, Australia
| | - Ron Borland
- School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
27
|
The Reshaping of the E-Cigarette Retail Environment: Its Evolution and Public Health Concerns. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148518. [PMID: 35886373 PMCID: PMC9319677 DOI: 10.3390/ijerph19148518] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/27/2022] [Accepted: 07/02/2022] [Indexed: 02/04/2023]
Abstract
E-cigarette use represents a public health controversy in the US and globally. Despite the potential of e-cigarettes to support cigarette cessation, their use increases health risks and risk for addiction, particularly in young people. Various federal, state, and local laws have impacted tobacco retail in general and e-cigarettes in particular. In the US, 2019–2020 federal laws increased in the minimum legal sales age for tobacco to 21 and banned flavored cartridge-based e-cigarettes. Many states and localities were early adopters of Tobacco 21 and implemented more comprehensive flavor restrictions than the federal ban. Meanwhile, cannabis retail is increasingly being legalized in the US—while cannabis-based product regulation has notable gaps at the federal, state, and local levels. These regulatory complexities have impacted specialized retailers selling e-cigarettes, including “vape shops” that exclusively sell e-cigarettes, “smoke shops” that sell e-cigarettes and other tobacco (and potentially CBD/THC and other un- or under-regulated products), and online retail. This commentary outlines public health concerns related to: (1) youth access; (2) consumer exposure to a broader range of tobacco products and marketing in retail settings where they may seek products to aid in cigarette cessation (i.e., such broad product exposure could hinder cessation attempts); (3) consumer exposure to un-/under-regulated products (e.g., delta-8-THC, kratom); and (4) federal, state, and local regulations being undermined by consumer access to prohibited products online and via the mail. These concerns underscore the need for ongoing surveillance of how retailers and consumers respond to regulations.
Collapse
|
28
|
Ruokolainen O, Ollila H, Karjalainen K. Correlates of e-cigarette use before and after comprehensive regulatory changes and e-liquid flavour ban among general population. Drug Alcohol Rev 2022; 41:1174-1183. [PMID: 35106874 DOI: 10.1111/dar.13435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/05/2022] [Accepted: 01/05/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In 2016, the Finnish Tobacco Act was revised to harmonise e-cigarette regulations with the EU Tobacco Products Directive. Unlike before, the sale of nicotine-containing e-liquids was allowed while additional national regulations included, for example, a ban for other than unflavoured and tobacco-flavoured e-liquids. This study examines the correlates of e-cigarette use before and after the comprehensive regulatory change, and characteristics and correlates of flavoured e-cigarette use after the flavour ban in the general Finnish population. METHODS Repeated cross-sectional population-based drug surveys for 15-69-year-olds in 2014 (n = 3485; 50% response rate) and in 2018 (n = 3229; 46%). Correlates of e-cigarette use were studied with logistic regression models. RESULTS Current e-cigarette use remained infrequent (approximately 2%) and the correlates of e-cigarette use varied only slightly between the study years. In 2018, of past-year e-cigarette users (n = 316), 43% used unflavoured e-liquids, 24% used tobacco and 43% used other flavours, fruits being the most common. In univariate models, demographic variables, smoking and e-cigarette use-related factors were associated with flavoured e-cigarette use. In multivariable models, those who used e-cigarettes to experiment used unflavoured e-cigarettes more likely than other than tobacco flavours (odds ratio 3.00, 95% confidence interval 1.15-7.82). DISCUSSION AND CONCLUSIONS In Finland, the regulated entry of nicotine-containing e-liquids to retail sales has not led to increased e-cigarette use in the general population. After the flavour ban, other than tobacco-flavoured e-cigarette use still occurs. The use of flavoured e-cigarettes is associated with reasons for e-cigarette use. Flavoured e-cigarette use and its correlates warrant further monitoring.
Collapse
Affiliation(s)
- Otto Ruokolainen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hanna Ollila
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Karoliina Karjalainen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| |
Collapse
|
29
|
Lee PN, Fry JS. Investigating the effect of e-cigarette use on quitting smoking in adults aged 25 years or more using the PATH study. F1000Res 2022; 9:1099. [PMID: 35813077 PMCID: PMC9214270 DOI: 10.12688/f1000research.26167.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 12/03/2022] Open
Abstract
Background: The evidence on harms and benefits of e-cigarettes partly concerns whether their use encourages smokers to quit. We addressed this using data from the nationally representative PATH study, with detailed accounting for potential confounding variables. Methods: We considered adults aged 25+. Our original analyses, reported in version 1 of this paper, used data for Waves 1 to 3, separate analyses considering Waves 1 to 2, 2 to 3 and 1 to 3. These related baseline ever e-cigarette use (or e-product use at Wave 2) to quitting at follow-up, adjusting for confounders derived from 55 candidates. Sensitivity analyses omitted ever other product users, linked quitting to current e-cigarette use, and used values of some predictors modified using follow-up data. Additional analyses used data for Waves 1 to 4, separately considering sustained, delayed and temporary quitting during Waves 1 to 3, 2 to 4 and 1 to 4. Sensitivity analyses considered 30-day quitting, restricted attention to smokers attempting to quit, and considered ever smokeless tobacco or snus use. Results: In the original analyses, unadjusted odds ratios (ORs) of quitting smoking for ever e-cigarette use were 1.29 (95% CI 1.01-1.66), 1.52 (1.26-1.83) and 1.47 (1.19-1.82) for the Wave 1 to 2, 2 to 3, and 1 to 3 analyses. These reduced after adjustment, to 1.23 (0.94-1.61), 1.51 (1.24-1.85) and 1.39 (1.11-1.74). Quitting rates remained elevated in users in all sensitivity analyses. The additional analyses found associations of e-cigarette use with sustained, delayed and temporary quitting, associations little affected by considering 30-day quitting, and only slightly reduced restricting attention to quit attempters. Ever use of smokeless tobacco or snus also predicted increased quitting. Conclusions: As does most evidence from clinical trials, other analyses of PATH, and other epidemiological studies, our results suggest using e-cigarettes helps adult smokers to quit.
Collapse
Affiliation(s)
- Peter N. Lee
- P.N.Lee Statistics and Computing, Sutton, Surrey, SM2 5DA, UK
| | - John S. Fry
- RoeLee Statistics Ltd, Sutton, Surrey, SM2 5DA, UK
| |
Collapse
|
30
|
Farrell KR, Weitzman M, Karey E, Lai TKY, Gordon T, Xu S. Passive exposure to e-cigarette emissions is associated with worsened mental health. BMC Public Health 2022; 22:1138. [PMID: 35672813 PMCID: PMC9172130 DOI: 10.1186/s12889-022-13470-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 05/12/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Cigarette smoking, secondhand cigarette smoke (SHS) exposure, and e-cigarette use ("vaping") are each associated with increased rates of depressive symptoms and other internalizing mental health disorders. The prevalence of vaping has increased greatly, yet the mental health correlates of secondhand exposure to e-cigarette emissions are as yet to be investigated. This study examined the potential adverse mental health outcomes associated with different tobacco exposures (direct and passive), with a particular focus on the mental health correlates of secondhand exposure to e-cigarette emissions. METHODS The Population Assessment of Tobacco and Health Study data collected from a sample of 16,173 Wave 4 adults were used to test the hypothesis that secondhand e-cigarette emissions exposure is associated with increased odds of internalizing mental health disorders. Individuals were categorized as exclusive cigarette smokers, exclusive e-cigarette users, cigarette and e-cigarette dual users, exclusive noncombustible tobacco users, secondhand smoke exposed non-users, secondhand e-cigarette emissions exposed non-users, and non-users with no current SHS/secondhand e-cigarette aerosol exposure. Adjusted weighted logistic regression analysis was used to investigate the association between exposure type and internalizing problems as assessed by scores on the Global Appraisal of Individual Needs-Short Screener (GAIN-SS), a widely used instrument for assessing mental health problems. RESULTS Cigarette smokers (AOR = 2.53, 95% CI: 2.19-2.92), e-cigarette users (AOR = 3.14, 2.41-4.09), dual users (AOR = 3.37, 2.85-4.00), noncombustible tobacco users (AOR = 1.48, 1.01-2.17), SHS exposed non-users (AOR = 1.63, 1.37-1.94), and secondhand e-cigarette emissions exposed non-users (AOR = 1.43, 1.03-1.99) were each associated with increased odds of moderate to severe internalizing mental health problems as compared to unexposed non-users. Odds of internalizing problems among SHS and secondhand e-cigarette emissions exposed non-users did not differ (p = 0.46). CONCLUSIONS This is the first study, to our knowledge, to identify an association between recent secondhand exposure to e-cigarette emissions and mental health problems, and the risk is comparable to that of SHS. Corroboration of this relationship needs further research to explicate directionality and mechanisms underlying this association.
Collapse
Affiliation(s)
- Kayla Rae Farrell
- Department of Environmental Medicine, New York University Grossman School of Medicine, New York, NY 10010 USA
| | - Michael Weitzman
- Department of Environmental Medicine, New York University Grossman School of Medicine, New York, NY 10010 USA
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY 10003 USA
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY 10016 USA
| | - Emma Karey
- Department of Environmental Medicine, New York University Grossman School of Medicine, New York, NY 10010 USA
| | - Teresa K. Y. Lai
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY 10003 USA
| | - Terry Gordon
- Department of Environmental Medicine, New York University Grossman School of Medicine, New York, NY 10010 USA
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY 10003 USA
| | - Shu Xu
- Department of Biostatistics, New York University School of Global Public Health, 708 Broadway, 7th floor - Rm 761, New York, NY 10003 USA
| |
Collapse
|
31
|
Wu J, Gao Y, Li D, Gao N. Emission and Gas/Particle Partitioning Characteristics of Nicotine in Aerosols for Electronic Cigarettes. Chem Res Toxicol 2022; 35:890-897. [PMID: 35512282 DOI: 10.1021/acs.chemrestox.2c00076] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Nicotine is a dependence-producing component in electronic cigarettes. The nicotine release characteristics of electronic cigarettes are closely connected with human exposure and respiratory health. In this paper, a theoretical model was established to study the effects of the compositions of e-liquids and the heating powers of device on the emission and gas/particle partitioning characteristics of nicotine in aerosols at equilibrium. The simulation results of nicotine emissions were compared with the experimental data. The errors between them were within a reasonable range. At a larger heating power level, a higher nicotine yield and a larger vaporization amount of e-liquids could be observed. Under the same heating power condition, a higher vegetable glycerin content in e-liquids could result in a lower nicotine emission. When the heating powers supplied by the device increased, a larger mass fraction of particle-phase nicotine in aerosols at equilibrium would appear. As more propylene glycol was added into e-liquids, a lower mass fraction of gas-phase nicotine would exist in aerosols at equilibrium. The results may provide more information for the industry to set technical standards for electronic cigarettes and for the government department to make regulatory policies.
Collapse
Affiliation(s)
- Jinlu Wu
- School of Mechanical Engineering, Tongji University, Shanghai 201804, China
| | - Yihan Gao
- Shanghai New Tobacco Product Research Institute, Shanghai 201315, China
| | - Dian Li
- China Tobacco Guangxi Industrial Co., Ltd., Nanning 530001, China
| | - Naiping Gao
- School of Mechanical Engineering, Tongji University, Shanghai 201804, China
| |
Collapse
|
32
|
Lund M, Lund I. Smoking cessation aids and strategies: a population-based survey of former and current smokers in Norway. BMC Public Health 2022; 22:631. [PMID: 35361172 PMCID: PMC8973793 DOI: 10.1186/s12889-022-13032-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Norway, tobacco consumption is equally divided between combustible (cigarettes) and non-combustible (snus) tobacco. In the process of quitting, people who smoke can choose between several smoking cessation aids and strategies based on what is available on the market or what are recommended as cessation aids. A quit attempt may be planned or unplanned and consist of a gradual decline in consumption or an abrupt quitting. This study explores smoking cessation aids and strategies used at the latest quit attempt among people who have ever smoked. How prevalent is the use of various cessation aids and strategies, and do they correlate with each other? Are there any differences in successful quits depending on the use of a specific cessation aid or strategy? METHOD We used repeated cross-sectional representative surveys in Norway for 2017, 2018, 2019 and 2020. The analytic sample consists of people aged 20 years or older who have ever smoked daily, more precisely current daily smokers with at least one quit attempt (n = 476), and former daily smokers who quit in 2012 or later (n = 397). Participants answered questions on cessation aids and strategies used at their last quit attempt. Logistic regression analysis was used to estimate the associations between cessation aids and strategies and sociodemographic and smoking-related variables and successful quit attempts. RESULTS Fifty-six percent of people who ever smoked daily reported any use of cessation aids, and nicotine replacement therapy (NRT), snus and e-cigarettes were the most commonly used cessation aids. Snus and web/mobile use was associated with successful quits, while NRT was associated with unsuccessful quit attempts. When exclusive use was separated from the combined use of several aids, only snus was associated with successful quits. CONCLUSION Snus use was found to be a "stand-alone" cessation aid, and only weakly associated with the use of other cessation aids. Further investigation of cessation aid preferences is needed, especially among smokers with little or no contact with health services and/or for whom traditional cessation aids have no appeal.
Collapse
Affiliation(s)
- Marianne Lund
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway.
| | - Ingeborg Lund
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
| |
Collapse
|
33
|
Goldenson NI, Augustson EM, Shiffman S. Differences in switching away from cigarettes and JUUL use characteristics among adult menthol and nonmenthol smokers who purchased the JUUL System. Drug Alcohol Depend 2022; 231:109238. [PMID: 34974269 DOI: 10.1016/j.drugalcdep.2021.109238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 11/18/2021] [Accepted: 11/30/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Studies have assessed switching away from cigarettes among adult smokers who use electronic nicotine delivery systems (ENDS), but there is little data assessing differences in likelihood of switching or ENDS use characteristics by menthol smoking. METHODS Adult (age ≥ 21) established smokers who purchased a JUUL Starter Kit (N = 15,036) completed baseline and 1-, 2-, 3-, 6-, 9- and 12-month assessments. Switching (no past-30-day cigarette smoking) and flavor use were assessed at each follow-up. Repeated-measure logistic regression models evaluated association of menthol smoking and switching across 1 year. RESULTS Across the 6 follow-ups, more menthol smokers primarily used Menthol/Mint-flavored JUULpods (53.8%) than nonmenthol smokers (22.9%). Only 6.4% of menthol smokers primarily used Tobacco flavors (vs. 25.9% of nonmenthol smokers). Across all follow-ups menthol smokers (41.2% of sample) were more likely to switch than nonmenthol smokers (42.6% vs. 38.8%: OR [95% CI] = 1.17 [1.11, 1.23]); this association remained significant after adjustment for sociodemographic, smoking and JUUL use covariates (aOR [95% CI] = 1.13 [1.05, 1.21]). Nonmenthol smokers, but not menthol smokers, were significantly more likely to switch when primarily using Menthol/Mint-flavored (vs. Tobacco-flavored) JUULpods (aOR [95% CI] = 1.14 [1.04, 1.25]). Differences in baseline smoking characteristics between menthol and nonmenthol smokers were small in magnitude. CONCLUSIONS Adult menthol (vs. nonmenthol) smokers using JUUL were more likely to switch. More than twice as many menthol (vs. nonmenthol) smokers primarily used Menthol/Mint-flavor JUULpods; few menthol smokers used tobacco flavors. Given these pronounced differences in flavor preferences, availability of ENDS in menthol flavors may be particularly important for menthol smokers, but may also benefit some nonmenthol smokers.
Collapse
|
34
|
Electronic Cigarettes or Vaping: Are There Any Differences in the Profiles, Use and Perceptions between a Developed and a Developing Country? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031673. [PMID: 35162695 PMCID: PMC8834803 DOI: 10.3390/ijerph19031673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/28/2022] [Accepted: 01/29/2022] [Indexed: 11/30/2022]
Abstract
The use of electronic cigarettes or vaping is currently increasing in popularity globally. Debate continues regarding their potential role for smoking cessation. We aimed to compare the profiles, use and perceptions of using e-cigarettes amongst online forum users in a developed and a developing country. A cross-sectional survey was conducted among members of different popular online forums in Australia and Bangladesh who were current or ex-users of e-cigarettes. There were 422 study participants, 261 (62%) from Australia and 161 (38%) from Bangladesh. The mean age was 36.3 (±12) years and 83% were men. Australians were more likely to be exclusive users of e-cigarettes (70% vs. 30%, AOR 3.05 [95% CI 1.63–5.71]), but less likely to be dual users of smoking and e-cigarettes (43% vs. 57%, 0.36 [0.19–0.69]); they were also more likely to mention that the perceived reasons for using were their low cost, good taste/flavour, safety and assistance in reducing or quitting smoking (66% vs. 34%, 5.10 [2.04–12.8]), but less likely to mention a social/cool image as a reason for use (23% vs. 77%, 0.11 [0.01–0.87]) compared with Bangladeshi participants. About two-thirds of the participants in both countries perceived the use of e-cigarettes as less addictive than cigarettes and more than three-quarters perceived them as less harmful. E-cigarette users in Australia were more likely to use them to reduce or quit cigarettes compared with those in Bangladesh, and dual use was common in Bangladesh. These findings warrant the consideration of precautions for promoting e-cigarettes as a harm reduction strategy for smoking cessation in developing countries, such as Bangladesh.
Collapse
|
35
|
Grilo G, Crespi E, Cohen JE. A scoping review on disparities in exposure to advertising for e-cigarettes and heated tobacco products and implications for advancing a health equity research agenda. Int J Equity Health 2021; 20:238. [PMID: 34717629 PMCID: PMC8557615 DOI: 10.1186/s12939-021-01576-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/19/2021] [Indexed: 01/13/2023] Open
Abstract
Background Disparities in exposure to and density of tobacco advertising are well established; however, it is still unclear how e-cigarette and heated tobacco product (HTP) advertising vary by age, education, sex, gender identity, race/ethnicity, sexual orientation, socioeconomic status (SES), and/or urban/rural area. Through a scoping review, we sought to identify potential disparities in exposure to e-cigarette and HTP advertising and promotion across populations. Methods In January 2020, a systematic literature search was conducted in five databases: PubMed, Scopus, Embase, Web of Science, and the Cochrane Library. The search was updated in October 2020. Articles reporting on exposure to e-cigarette and/or HTP advertising and promotion across age, education, sex, gender identity, race/ethnicity, sexual orientation, SES, and/or urban/rural areas were included for full-text review (n = 25). Of those, 15 were deemed relevant for data extraction. Results The majority of the studies were from the U.S. (n = 12) and cross-sectional (n = 14). Studies were published between 2014 and 2020 and focused on determining causal relationships that underlie disparities; only one study assessed HTP advertising and promotion. Exposure to e-cigarette and HTP advertising was assessed at the individual-level (e.g., recall seeing ads on television) and at the neighborhood-level (e.g., ad density at the point-of-sale). Studies addressed differences across age (n = 6), education (n = 2), sex (n = 6), gender identity and sexual orientation (n = 3), race/ethnicity (n = 11), SES (n = 5), and urban/rural (n = 2). The following populations were more likely to be exposed to e-cigarette advertising: youth, those with more than a high school diploma, males, sexual and gender minorities, Whites, and urban residents. At the neighborhood-level, e-cigarette advertisements were more prevalent in non-White neighborhoods. Conclusions Exposure to e-cigarette/HTP advertising varies based on sociodemographic characteristics, although the literature is limited especially regarding HTPs. Higher exposure among youth might increase tobacco-related disparities since it can lead to nicotine/tobacco use. Research should incorporate and apply a health equity lens from its inception to obtain data to inform the elimination of those disparities.
Collapse
Affiliation(s)
- Graziele Grilo
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street, Fourth Floor, Baltimore, MD, 21205, USA.
| | - Elizabeth Crespi
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street, Fourth Floor, Baltimore, MD, 21205, USA
| | - Joanna E Cohen
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street, Fourth Floor, Baltimore, MD, 21205, USA
| |
Collapse
|
36
|
Hartmann-Boyce J, McRobbie H, Butler AR, Lindson N, Bullen C, Begh R, Theodoulou A, Notley C, Rigotti NA, Turner T, Fanshawe TR, Hajek P. Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev 2021; 9:CD010216. [PMID: 34519354 PMCID: PMC8438601 DOI: 10.1002/14651858.cd010216.pub6] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Electronic cigarettes (ECs) are handheld electronic vaping devices which produce an aerosol formed by heating an e-liquid. Some people who smoke use ECs to stop or reduce smoking, but some organizations, advocacy groups and policymakers have discouraged this, citing lack of evidence of efficacy and safety. People who smoke, healthcare providers and regulators want to know if ECs can help people quit and if they are safe to use for this purpose. This is an update conducted as part of a living systematic review. OBJECTIVES To examine the effectiveness, tolerability, and safety of using electronic cigarettes (ECs) to help people who smoke tobacco achieve long-term smoking abstinence. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PsycINFO to 1 May 2021, and reference-checked and contacted study authors. We screened abstracts from the Society for Research on Nicotine and Tobacco (SRNT) 2021 Annual Meeting. SELECTION CRITERIA: We included randomized controlled trials (RCTs) and randomized cross-over trials, in which people who smoke were randomized to an EC or control condition. We also included uncontrolled intervention studies in which all participants received an EC intervention. Studies had to report abstinence from cigarettes at six months or longer or data on safety markers at one week or longer, or both. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods for screening and data extraction. Our primary outcome measures were abstinence from smoking after at least six months follow-up, adverse events (AEs), and serious adverse events (SAEs). Secondary outcomes included the proportion of people still using study product (EC or pharmacotherapy) at six or more months after randomization or starting EC use, changes in carbon monoxide (CO), blood pressure (BP), heart rate, arterial oxygen saturation, lung function, and levels of carcinogens or toxicants or both. We used a fixed-effect Mantel-Haenszel model to calculate risk ratios (RRs) with a 95% confidence interval (CI) for dichotomous outcomes. For continuous outcomes, we calculated mean differences. Where appropriate, we pooled data in meta-analyses. MAIN RESULTS We included 61 completed studies, representing 16,759 participants, of which 34 were RCTs. Five of the 61 included studies were new to this review update. Of the included studies, we rated seven (all contributing to our main comparisons) at low risk of bias overall, 42 at high risk overall (including all non-randomized studies), and the remainder at unclear risk. There was moderate-certainty evidence, limited by imprecision, that quit rates were higher in people randomized to nicotine EC than in those randomized to nicotine replacement therapy (NRT) (risk ratio (RR) 1.53, 95% confidence interval (CI) 1.21 to 1.93; I2 = 0%; 4 studies, 1924 participants). In absolute terms, this might translate to an additional three quitters per 100 (95% CI 1 to 6). There was low-certainty evidence (limited by very serious imprecision) that the rate of occurrence of AEs was similar (RR 0.98, 95% CI 0.80 to 1.19; I2 = 0%; 2 studies, 485 participants). SAEs were rare, but there was insufficient evidence to determine whether rates differed between groups due to very serious imprecision (RR 1.30, 95% CI 0.89 to 1.90: I2 = 0; 4 studies, 1424 participants). There was moderate-certainty evidence, again limited by imprecision, that quit rates were higher in people randomized to nicotine EC than to non-nicotine EC (RR 1.94, 95% CI 1.21 to 3.13; I2 = 0%; 5 studies, 1447 participants). In absolute terms, this might lead to an additional seven quitters per 100 (95% CI 2 to 16). There was moderate-certainty evidence of no difference in the rate of AEs between these groups (RR 1.01, 95% CI 0.91 to 1.11; I2 = 0%; 3 studies, 601 participants). There was insufficient evidence to determine whether rates of SAEs differed between groups, due to very serious imprecision (RR 1.06, 95% CI 0.47 to 2.38; I2 = 0; 5 studies, 792 participants). Compared to behavioural support only/no support, quit rates were higher for participants randomized to nicotine EC (RR 2.61, 95% CI 1.44 to 4.74; I2 = 0%; 6 studies, 2886 participants). In absolute terms this represents an additional six quitters per 100 (95% CI 2 to 15). However, this finding was of very low certainty, due to issues with imprecision and risk of bias. There was some evidence that non-serious AEs were more common in people randomized to nicotine EC (RR 1.22, 95% CI 1.12 to 1.32; I2 = 41%, low certainty; 4 studies, 765 participants), and again, insufficient evidence to determine whether rates of SAEs differed between groups (RR 1.51, 95% CI 0.70 to 3.24; I2 = 0%; 7 studies, 1303 participants). Data from non-randomized studies were consistent with RCT data. The most commonly reported AEs were throat/mouth irritation, headache, cough, and nausea, which tended to dissipate with continued use. Very few studies reported data on other outcomes or comparisons, hence evidence for these is limited, with CIs often encompassing clinically significant harm and benefit. AUTHORS' CONCLUSIONS There is moderate-certainty evidence that ECs with nicotine increase quit rates compared to NRT and compared to ECs without nicotine. Evidence comparing nicotine EC with usual care/no treatment also suggests benefit, but is less certain. More studies are needed to confirm the effect size. Confidence intervals were for the most part wide for data on AEs, SAEs and other safety markers, with no difference in AEs between nicotine and non-nicotine ECs. Overall incidence of SAEs was low across all study arms. We did not detect evidence of harm from nicotine EC, but longest follow-up was two years and the number of studies was small. The main limitation of the evidence base remains imprecision due to the small number of RCTs, often with low event rates, but further RCTs are underway. To ensure the review continues to provide up-to-date information to decision-makers, this review is now a living systematic review. We run searches monthly, with the review updated when relevant new evidence becomes available. Please refer to the Cochrane Database of Systematic Reviews for the review's current status.
Collapse
Affiliation(s)
- Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Hayden McRobbie
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Ailsa R Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Chris Bullen
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Rachna Begh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Tari Turner
- Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Thomas R Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Peter Hajek
- Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| |
Collapse
|
37
|
DeVito EE, Fagle T, Allen AM, Pang RD, Petersen N, Smith PH, Weinberger AH. Electronic Nicotine Delivery Systems (ENDS) Use and Pregnancy I: ENDS Use Behavior During Pregnancy. CURRENT ADDICTION REPORTS 2021; 8:347-365. [PMID: 34513567 PMCID: PMC8425312 DOI: 10.1007/s40429-021-00380-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW This review examines Electronic Nicotine Delivery Systems (ENDS) use behavior during pregnancy, including the prevalence of and transitions in use during pregnancy. RECENT FINDINGS Twenty-two papers addressed the prevalence of and/or transitions in ENDS use during pregnancy. Findings show a complex landscape of ENDS use. A minority (0.4%-7.0%) of pregnant persons use ENDS; most commonly this occurs in the form of dual use (ENDS and combustible cigarettes (CC); 75%). Many pregnant persons report using ENDS because they perceive them to be a lower-risk alternative and/or potential cessation aide for CC smoking. However, while a subset of those who use ENDS do quit all tobacco product use during pregnancy, only a small proportion switch from exclusive CC smoking to exclusive ENDS use. SUMMARY ENDS are a somewhat new addition to the tobacco product landscape. The perception of ENDS as a lower-risk alternative may contribute to ENDS use in pregnancy. There is insufficient evidence to support the notion that ENDS facilities the cessation of tobacco product use during pregnancy.
Collapse
Affiliation(s)
- Elise E. DeVito
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Tessa Fagle
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Alicia M. Allen
- Department of Family and Community Medicine, College of Medicine – Tucson, University of Arizona, Tucson, AZ, USA
| | - Raina D. Pang
- Department of Preventative Medicine, Keck School of Medicine of USC, and Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Nicole Petersen
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Philip H. Smith
- Department of Kinesiology, Nutrition and Health, College of Education, Health and Society, Miami University, Oxford, OH, USA
| | - Andrea H. Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University and Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| |
Collapse
|
38
|
Balfour DJK, Benowitz NL, Colby SM, Hatsukami DK, Lando HA, Leischow SJ, Lerman C, Mermelstein RJ, Niaura R, Perkins KA, Pomerleau OF, Rigotti NA, Swan GE, Warner KE, West R. Balancing Consideration of the Risks and Benefits of E-Cigarettes. Am J Public Health 2021; 111:1661-1672. [PMID: 34410826 PMCID: PMC8589069 DOI: 10.2105/ajph.2021.306416] [Citation(s) in RCA: 149] [Impact Index Per Article: 49.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2021] [Indexed: 11/04/2022]
Abstract
The topic of e-cigarettes is controversial. Opponents focus on e-cigarettes' risks for young people, while supporters emphasize the potential for e-cigarettes to assist smokers in quitting smoking. Most US health organizations, media coverage, and policymakers have focused primarily on risks to youths. Because of their messaging, much of the public-including most smokers-now consider e-cigarette use as dangerous as or more dangerous than smoking. By contrast, the National Academies of Science, Engineering, and Medicine concluded that e-cigarette use is likely far less hazardous than smoking. Policies intended to reduce adolescent vaping may also reduce adult smokers' use of e-cigarettes in quit attempts. Because evidence indicates that e-cigarette use can increase the odds of quitting smoking, many scientists, including this essay's authors, encourage the health community, media, and policymakers to more carefully weigh vaping's potential to reduce adult smoking-attributable mortality. We review the health risks of e-cigarette use, the likelihood that vaping increases smoking cessation, concerns about youth vaping, and the need to balance valid concerns about risks to youths with the potential benefits of increasing adult smoking cessation.
Collapse
Affiliation(s)
- David J K Balfour
- David J. K. Balfour is professor emeritus with the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois‒Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is professor emeritus with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Neal L Benowitz
- David J. K. Balfour is professor emeritus with the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois‒Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is professor emeritus with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Suzanne M Colby
- David J. K. Balfour is professor emeritus with the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois‒Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is professor emeritus with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Dorothy K Hatsukami
- David J. K. Balfour is professor emeritus with the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois‒Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is professor emeritus with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Harry A Lando
- David J. K. Balfour is professor emeritus with the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois‒Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is professor emeritus with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Scott J Leischow
- David J. K. Balfour is professor emeritus with the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois‒Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is professor emeritus with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Caryn Lerman
- David J. K. Balfour is professor emeritus with the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois‒Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is professor emeritus with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Robin J Mermelstein
- David J. K. Balfour is professor emeritus with the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois‒Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is professor emeritus with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Raymond Niaura
- David J. K. Balfour is professor emeritus with the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois‒Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is professor emeritus with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Kenneth A Perkins
- David J. K. Balfour is professor emeritus with the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois‒Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is professor emeritus with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Ovide F Pomerleau
- David J. K. Balfour is professor emeritus with the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois‒Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is professor emeritus with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Nancy A Rigotti
- David J. K. Balfour is professor emeritus with the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois‒Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is professor emeritus with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Gary E Swan
- David J. K. Balfour is professor emeritus with the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois‒Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is professor emeritus with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Kenneth E Warner
- David J. K. Balfour is professor emeritus with the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois‒Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is professor emeritus with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Robert West
- David J. K. Balfour is professor emeritus with the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois‒Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is professor emeritus with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| |
Collapse
|
39
|
El-Khoury F, El Aarbaoui T, Héron M, Hejblum G, Métadieu B, Le Faou AL, Ibanez G, Melchior M. Smoking cessation using preference-based tools among socially disadvantaged smokers: study protocol for a pragmatic, multicentre randomised controlled trial. BMJ Open 2021; 11:e048859. [PMID: 34193499 PMCID: PMC8246378 DOI: 10.1136/bmjopen-2021-048859] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 06/11/2021] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Many smoking cessation aids such as nicotine replacement treatments and e-cigarettes have been proven effective in aiding smoking cessation attempts. Encouraging smokers with low socioeconomic position (SEP) to choose their smoking aid tool based on their preferences, and giving that tool free of charge, might increase the odds of smoking cessation. This trial examines the effectiveness of the 'STOP' (Sevrage Tabagique à l'aide d'Outils dédiés selon la Préférence: Smoking cessation using preference-based tools), a preference-based smoking cessation intervention for smokers with low SEP. METHODS AND ANALYSIS The STOP study is a randomised, multicentre, controlled trial (RCT). Smokers with low SEP and wishing to quit will be randomised to either the intervention or the control group (standard care). Participants in the intervention group will be asked to choose between different types of nicotine substitutes (patches, inhalers, gum, tablets, etc) and/or an electronic cigarette which will be delivered free of charge to aid their smoking cessation attempt.The primary outcome will be smoking abstinence at 6 months after inclusion, defined as self-reported 7-day point prevalence of tobacco abstinence. Secondary outcomes include the total number of days of abstinence at 6 months after inclusion, 7-day point prevalence tobacco abstinence at 1 and 3 months after inclusion and number of relapses.The study will also include an economic evaluation, and a process evaluation using a mixed methods approach. ETHICS AND DISSEMINATION The study was approved by the 'Île de France II' Institutional Review Board on 8 September 2020 (CPP Île de France II; Ref No: 20.01.31.65528 RIPH2 HPS), and results will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT04654585.
Collapse
Affiliation(s)
- Fabienne El-Khoury
- Sorbonne Université, INSERM UMR_S 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), department of Social epidemiology, Paris, France
- Eepidemiology department, University Hospital Group of Psychiatry and Neurosciences (GHU Paris), Paris, France
| | - Tarik El Aarbaoui
- Sorbonne Université, INSERM UMR_S 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), department of Social epidemiology, Paris, France
| | - Mégane Héron
- Sorbonne Université, INSERM UMR_S 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), department of Social epidemiology, Paris, France
| | - Gilles Hejblum
- Sorbonne Université, INSERM UMR_S 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), CLEPIVIR research team, Paris, France
| | | | - Anne-Laurence Le Faou
- Addiction Centre, Hôpital Européen Georges Pompidou, Pôle Psychiatrie-Addictologie, Hôpitaux Universitaires Paris-Ouest, Paris, France
- Network of research in substance use disorder, Fédération hospitalo-universitaire, Paris, France
| | - Gladys Ibanez
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Sorbonne University Faculty of Medicine, Paris, France
- SFTG Recherche (Société de Formation Thérapeutique du Généraliste Recherche), Paris, France
| | - Maria Melchior
- Sorbonne Université, INSERM UMR_S 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), department of Social epidemiology, Paris, France
| |
Collapse
|
40
|
Héron M, Le Faou AL, Ibanez G, Métadieu B, Melchior M, El-Khoury Lesueur F. Smoking cessation using preference-based tools: a mixed method pilot study of a novel intervention among smokers with low socioeconomic position. Addict Sci Clin Pract 2021; 16:43. [PMID: 34193288 PMCID: PMC8243481 DOI: 10.1186/s13722-021-00254-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 06/22/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Compared to smokers with favorable socio-economic position (SEP), those with low SEP are less likely to have a successful smoking cessation attempt. Tailored approaches are therefore needed, and general practitioners could help reaching and assisting usually hard-to-reach population. METHOD STOP (Sevrage Tabagique à l'aide d'Outils dédiés selon la Préférence) is a pilot study, examining the feasibility, acceptability and potentiality of a smoking cessation intervention centered on smoker's preference. Smokers with low SEP, wishing to quit, were recruited in six healthcare centers in the Greater Paris area. They were asked to choose between different types of nicotine replacement therapy (NRT) products and/or e-cigarette with liquids delivered free of charge to aid their smoking cessation attempt. We describe the characteristics of recruited participants, their perception of smoking cessation aids, and the evolution of their smoking status 4 to 6 weeks after recruitment. RESULTS We recruited 49 participants, of which 29% chose an e-cigarette, 29% chose NRT and 42% chose both an e-cigarette and NRT. The intervention was shown to be acceptable by participants and health professionals. Among the 24 participants followed for at least one month, 14 (28% of all participants) stopped smoking, and 9 (18%) considerably reduced their consumption. CONCLUSION The STOP intervention is feasible and acceptable, even if more efforts should be made to limit lost-to-follow-up. This preference-based intervention also shows interesting prospect in helping smokers with low SEP quit smoking. We will test the efficacy of this preference-based intervention in a randomized controlled trial.
Collapse
Affiliation(s)
- Mégane Héron
- Social Epidemiology Departement, Sorbonne Université, INSERM UMR_S 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique IPLESP, 27 rue Chaligny, Paris, 75012, France
| | - Anne-Laurence Le Faou
- Centre Ambulatoire d'Addictologie, DMU Psychiatrie et Addictologie, Hôpital Européen Georges Pompidou, APHP.Centre, Paris, France
- Fédération Hospitalo-Universitaire Network of Research in Substance Use Disorder, Université de Paris, Paris, France
| | - Gladys Ibanez
- Social Epidemiology Departement, Sorbonne Université, INSERM UMR_S 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique IPLESP, 27 rue Chaligny, Paris, 75012, France
- Department of General Practice, Sorbonne Université, Paris, France
| | | | - Maria Melchior
- Social Epidemiology Departement, Sorbonne Université, INSERM UMR_S 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique IPLESP, 27 rue Chaligny, Paris, 75012, France
| | - Fabienne El-Khoury Lesueur
- Social Epidemiology Departement, Sorbonne Université, INSERM UMR_S 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique IPLESP, 27 rue Chaligny, Paris, 75012, France.
- Epidemiology Department, University Hospital Group of Psychiatry and Neurosciences (GHU-Paris), Paris, France.
| |
Collapse
|
41
|
Fu R, O'Connor S, Diemert L, Pelletier H, Eissenberg T, Cohen J, Schwartz R. Real-world vaping experiences and smoking cessation among cigarette smoking adults. Addict Behav 2021; 116:106814. [PMID: 33429257 DOI: 10.1016/j.addbeh.2020.106814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/18/2020] [Accepted: 12/28/2020] [Indexed: 12/26/2022]
Abstract
INTRODUCTION E-cigarettes may have the potential to be an effective cessation aid for some cigarette smokers. However, the extent to which smokers' experiences using e-cigarettes (vaping) to quit smoking impact their cessation outcomes is unclear. In this cross-sectional survey study, we develop a multidimensional measure of vaping experiences in adults who quit smoking by vaping and test its association with perceived success in smoking cessation. METHODS In 2019, recruitment invitations were emailed to adult past-year smokers who had accessed cessation services across Ontario, Canada. Respondents who tried vaping to quit smoking in the past year completed a detailed online survey. Factor analysis was performed on ratings of 45 vaping experiences items to identify dimensions of vaping experiences. Factor scores were entered into logistic regressions to test if vaping experiences dimensions had differential impact on perceived success in smoking cessation. RESULTS Of the 889 participants, 56.0% were female, 81.1% were Caucasian, and the mean age was 37.7 ± 11.9 years. Twenty percent (19.6%) reported having successfully quit smoking by vaping in the past year. Among the six vaping experiences factors, better experiences in five factors-Relationships, Flexibility of Vaping, Side Effects, Vaping Devices, and Sensory Functions-were each independently and positively associated with improved odds of successful quitting. Notably, Relationships [OR = 2.01, 95% CI: 1.61-2.64] and Side Effects [OR = 1.95; 95% CI 1.54-2.29] were the strongest correlates of perceived success in smoking cessation. CONCLUSIONS These findings indicate an opportunity to increase cessation rates by improving the experiences of smokers who vape to quit smoking.
Collapse
|
42
|
Langley T. What Works in Tobacco Control? Making the Case for Something Old and Something New. Nicotine Tob Res 2021; 23:623-624. [PMID: 33527132 DOI: 10.1093/ntr/ntab019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 11/12/2022]
Affiliation(s)
- Tessa Langley
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham City Hospital, Nottingham, UK
- SPECTRUM Consortium, UK
| |
Collapse
|
43
|
Mantey DS, Omega-Njemnobi O, Ruiz FA, Vaughn TL, Kelder SH, Springer AE. Association between observing peers vaping on campus and E-cigarette use and susceptibility in middle and high school students. Drug Alcohol Depend 2021; 219:108476. [PMID: 33360854 PMCID: PMC7975070 DOI: 10.1016/j.drugalcdep.2020.108476] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/23/2020] [Accepted: 11/23/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND This study examines the association between exposure to e-cigarette use on school campus and e-cigarette use behaviors among adolescents in the United States. METHODS Data were obtained from the 2019 National Youth Tobacco Survey. First, two multivariate logistic regression models examined the association between in-school exposure to e-cigarette use and ever and past 30-day (i.e., current) e-cigarette use. Next, a multivariate logistic regression model to examine the relationship between in-school exposure to e-cigarette use and susceptibility to use was conducted among a subsample (n = 11,958) of never e-cigarette users. Covariates included grade, race/ethnicity, marketing exposure, and ever use of other tobacco products. RESULTS Approximately 64.3 % of adolescents reported seeing someone use an e-cigarette on school campus; the most common locations being in the bathroom/locker room (34.4 %) and parking lot (34.0 %). In-school exposure to e-cigarette use was associated with greater odds of ever (Adj OR: 2.06; 95 % CI: 1.82-2.33) and current (Adj OR: 1.70; 95 % CI: 1.46-1.98) e-cigarette use among adolescents as well as greater odds of susceptibility to use (Adj OR: 2.00; 95 % CI: 1.82-2.20) among never e-cigarette users. CONCLUSIONS Observing e-cigarette use on school campus was associated with greater odds of e-cigarette use and susceptibility. It is plausible that observing e-cigarette use on campus reinforces the social acceptability of adolescent e-cigarette use. Findings inform on the prevalence of e-cigarettes use on-campus as well as how this phenomenon may influence e-cigarette use/susceptibility among youth. The observed relationship highlights the role of schools in the efforts to reduce adolescent e-cigarette use.
Collapse
Affiliation(s)
- Dale S Mantey
- UT Health Science Center at Houston, UT Health, School of Public Health in Austin, 1616 Guadalupe, Suite 6.300, Austin, TX 78701, USA.
| | - Onyinye Omega-Njemnobi
- UT Health Science Center at Houston, UT Health, School of Public Health in Austin, 1616 Guadalupe, Suite 6.300, Austin, TX 78701, USA
| | - Felisa A Ruiz
- UT Health Science Center at Houston, UT Health, School of Public Health in Austin, 1616 Guadalupe, Suite 6.300, Austin, TX 78701, USA
| | - Tara L Vaughn
- UT Health Science Center at Houston, UT Health, School of Public Health in Austin, 1616 Guadalupe, Suite 6.300, Austin, TX 78701, USA
| | - Steven H Kelder
- UT Health Science Center at Houston, UT Health, School of Public Health in Austin, 1616 Guadalupe, Suite 6.300, Austin, TX 78701, USA
| | - Andrew E Springer
- UT Health Science Center at Houston, UT Health, School of Public Health in Austin, 1616 Guadalupe, Suite 6.300, Austin, TX 78701, USA
| |
Collapse
|
44
|
Algiers O, Wang Y, Laestadius L. Content Analysis of U.S. Newspaper Coverage of Causes and Solutions to Vaping-Associated Lung Injury. Subst Use Misuse 2021; 56:522-528. [PMID: 33627031 DOI: 10.1080/10826084.2021.1883663] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In 2019, an outbreak of vaping-associated lung injury (also known as "EVALI") spread throughout the U.S., linked to use of illicit THC cartridges. This paper examines U.S. newspaper coverage on the causes and solutions to EVALI. Methods: A content analysis of 417 articles from April to December 2019 from two national newspapers, one regional newspaper, and the Associated Press was conducted. Articles were coded for information about EVALI causes, mentions of the brand Dank Vapes, calls for individuals take a specific action to prevent harm, and mentions of policy actions to address vaping. Mentions of increasing youth vaping and JUUL were also coded. Results: Most articles (77%) provided an update on the number of EVALI cases and/or deaths. Fewer described EVALI symptoms (20%) or mentioned vaping cessation resources available to the public (2%). Almost half of articles also mentioned youth vaping as a concern (49%). Dank Vapes was mentioned rarely (4%) compared to JUUL (39%). After CDC recommendations changed to no longer recommend avoiding all vaping products, news articles became significantly less likely to mention nicotine products as a cause of EVALI or suggest that individuals cease all vaping. While policy was generally not articulated as a solution to EVALI, banning or limiting flavored nicotine vaping products were the most common policy actions mentioned. Conclusions/Importance: The discussions of causes of and solutions to EVALI were often intertwined with coverage of youth vaping, potentially failing to convey a clear sense of how the public should respond to the EVALI outbreak.
Collapse
Affiliation(s)
- Olivia Algiers
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Yang Wang
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Linnea Laestadius
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| |
Collapse
|
45
|
Affiliation(s)
- Nancy A Rigotti
- Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| |
Collapse
|
46
|
Kapan A, Stefanac S, Sandner I, Haider S, Grabovac I, Dorner T. Use of Electronic Cigarettes in European Populations: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1971. [PMID: 32192139 PMCID: PMC7142603 DOI: 10.3390/ijerph17061971] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 12/28/2022]
Abstract
The increasing popularity of electronic cigarettes in past decades has aroused public health concern. This study aims to review the literature on the prevalence of e-cigarette use among the general adult and young populations in Europe. We searched Medline and Google Scholar from September 2019, and included "prevalence of e-cigarettes", "electronic cigarettes" or "e-cigarettes", and "electronic nicotine delivery system" or "vaping". The prevalence of current e-cigarette use ranged from 0.2% to 27%, ever-use ranged from 5.5% to 56.6% and daily use ranged from 1% to 2.9%. Current smokers of conventional cigarettes showed the highest prevalence for the use of e-cigarettes, ranging from 20.4% to 83.1%, followed by ex-smokers, with ranges from 7% to 15%. The following socio-demographic factors were associated with a higher chance of using e-cigarettes: male sex and younger age groups; results for economic status were inconclusive. In European countries, there is a higher prevalence of e-cigarette use among males, adolescents and young adults, smokers of conventional cigarettes, and former smokers.
Collapse
Affiliation(s)
- A. Kapan
- Department of Social and Preventive Medicine, Centre of Public Health, Medical University of Vienna, Vienna 1090, Austria; (S.S.); (I.S.); (S.H.); (I.G.); (T.E.D.)
| | - S. Stefanac
- Department of Social and Preventive Medicine, Centre of Public Health, Medical University of Vienna, Vienna 1090, Austria; (S.S.); (I.S.); (S.H.); (I.G.); (T.E.D.)
- Institute of Outcomes Research, Centre for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna 1090, Austria
| | - I. Sandner
- Department of Social and Preventive Medicine, Centre of Public Health, Medical University of Vienna, Vienna 1090, Austria; (S.S.); (I.S.); (S.H.); (I.G.); (T.E.D.)
| | - S. Haider
- Department of Social and Preventive Medicine, Centre of Public Health, Medical University of Vienna, Vienna 1090, Austria; (S.S.); (I.S.); (S.H.); (I.G.); (T.E.D.)
| | - I. Grabovac
- Department of Social and Preventive Medicine, Centre of Public Health, Medical University of Vienna, Vienna 1090, Austria; (S.S.); (I.S.); (S.H.); (I.G.); (T.E.D.)
| | - T.E. Dorner
- Department of Social and Preventive Medicine, Centre of Public Health, Medical University of Vienna, Vienna 1090, Austria; (S.S.); (I.S.); (S.H.); (I.G.); (T.E.D.)
| |
Collapse
|