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Cottin M, Catellin M, De Guiran E, Miliani K, Josseran L, Gautier S. Understanding adolescent consumption patterns and attitudes towards the "puff" on the path to a smoke-free generation: a 2022 French perspective. Front Public Health 2024; 12:1411099. [PMID: 39371210 PMCID: PMC11449732 DOI: 10.3389/fpubh.2024.1411099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 09/05/2024] [Indexed: 10/08/2024] Open
Abstract
Purpose Tobacco use remains the leading preventable cause of death in France, with 75,000 deaths each year. France aims to reduce smoking and achieve a smoke-free generation by 2032. However, recent tobacco industry innovations which mainly target young people, could undermine this goal. The main objective of this study is to assess the knowledge and consumption patterns of the "puff" among French adolescents in 2022. Methods A cross-sectional study using a structured online survey on a representative sample of 400 adolescents aged 13 to 16 years was conducted from July 4th to 20th, 2022. Results Around 66% of adolescents reported having heard of the puff", and one in ten having tried it. Slightly fewer of them have tried cigarettes; 89.6% of experimenters reported that it allowed them to explore unique flavors, 81.9% found it fun to play with the puff-cloud, and 94.5% of regular consumers considered it a stylish or cool product. 76% of adolescents believe that the puff is dangerous to their health, 71.6% describe it as a polluting device, and 62.8% think it's a gadget. Conclusion The "puff" is widely known by French adolescents and more commonly used than cigarettes, due, in part, to marketing specifically designed to target youth. That is why it could represent a threat to the smoke-free generation objectives. Public health policy could be informed by the ecological awareness of adolescents as a new lever of counter-influence to prevent this kind of consumption, as did ACT with the #stopcigarettespollution prevention campaign.
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Affiliation(s)
- Marin Cottin
- Department of Epidemiology and Public Health, Raymond Poincaré Hospital, Garches, France
- INSERM UMR1018, Primary Care and Prevention Team, Paris-Saclay University and Versailles Saint-Quentin-en-Yvelines University, Villejuif, France
- Academic Department of Public Health, Prevention, Observation, Territories, UFR Simone Veil, Health, Versailles Saint-Quentin-en-Yvelines University, Montigny-le-Bretonneux, France
| | | | | | - Katiuska Miliani
- Department of Epidemiology and Public Health, Raymond Poincaré Hospital, Garches, France
| | - Loïc Josseran
- Department of Epidemiology and Public Health, Raymond Poincaré Hospital, Garches, France
- INSERM UMR1018, Primary Care and Prevention Team, Paris-Saclay University and Versailles Saint-Quentin-en-Yvelines University, Villejuif, France
- Academic Department of Public Health, Prevention, Observation, Territories, UFR Simone Veil, Health, Versailles Saint-Quentin-en-Yvelines University, Montigny-le-Bretonneux, France
- ACT-French Alliance Against Tobacco, Paris, France
| | - Sylvain Gautier
- Department of Epidemiology and Public Health, Raymond Poincaré Hospital, Garches, France
- INSERM UMR1018, Primary Care and Prevention Team, Paris-Saclay University and Versailles Saint-Quentin-en-Yvelines University, Villejuif, France
- Academic Department of Public Health, Prevention, Observation, Territories, UFR Simone Veil, Health, Versailles Saint-Quentin-en-Yvelines University, Montigny-le-Bretonneux, France
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Quisenberry AJ, Osborn CC, Pike Moore S, Schneller L, John L, Klein EG, Trapl E. ENDS function as a complement for cigarillos in sexual and gender minority young adult women. Nicotine Tob Res 2024:ntae197. [PMID: 39159047 DOI: 10.1093/ntr/ntae197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Indexed: 08/21/2024]
Abstract
INTRODUCTION Cigarillos are the second most used tobacco product among younger populations. The highest prevalence of use of cigars is among sexual and gender minority (SGM) women. Policy interventions like flavor bans and the availability of alternative tobacco products may have a disparate effect. METHODS The current study utilized an online store analog, The Experimental Tobacco Marketplace (ETM), to investigate the effects of cigarillo and ENDS flavor bans on tobacco product purchasing. SGM (n=72) and cisgender heterosexual (Cis-Het; n =46) women viewed conditions in which cigarillo flavors were available or unavailable and ENDS flavors available or unavailable and the interaction between the two. Mixed models were conducted on each dependent variable with condition, price, and SGM identity as predictors and nicotine dependence, annual income, and race/ethnicity as covariates. Simple linear regressions were performed to determine the substitution profile for each tobacco product. Condition showed no effect. RESULTS We found a main effect of price on cigarillo purchasing and a main effect of SGM identity in which SGM women purchased more ENDS than CisHet women. A complementary association between cigarillos and ENDS in which ENDS purchasing decreased as cigarillo purchasing decreased was found. This association was irrespective of flavor ban conditions and among SGM women only. CONCLUSIONS These results suggest that flavor availability of cigarillos and ENDS may not influence women who use cigarillos to move to another tobacco product and that women SGM cigarillo users are not likely to substitute their cigarillo smoking behavior with ENDS. IMPLICATIONS The results of this study suggest that SGM women are not likely to quit using cigarillos if flavors are removed from the market and instead will use unflavored products. Substituting their cigarillo use with ENDS does not appear likely given the complementary relation found between cigarillos and ENDS. The substitution patterns found for cigarettes and ENDS are not found for cigarillos and ENDS among young adult women who use cigarillos, further demonstrating the need for research on the conditions in which people who use cigarillos will decrease consumption or switch to a potentially less harmful product.
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Affiliation(s)
- Amanda J Quisenberry
- Assistant Professor of Oncology, Assistant Member, Department of Health Behavior, Carlton House A-408, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Catherine C Osborn
- Project Manager, CFLASH, Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, 11000 Cedar Avenue, Room 447, Cleveland, OH
| | - Stephanie Pike Moore
- Research Scientist, Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, 11000 Cedar Avenue, Room 452, Cleveland, OH
| | - Liane Schneller
- HRI Scientist, Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Lovina John
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Elizabeth G Klein
- Professor, Heath Behavior and Health Promotion, The Ohio State University, 1841 Neil Avenue, 358 Cunz Hall, Columbus, OH
| | - Erika Trapl
- Professor, Dept. of Population and Quantitative Health Sciences, Director, Prevention Research Center for Healthy Neighborhoods, Associate Director of Community Outreach and Engagement, Case Comprehensive Cancer Center, Case Western Reserve University, 11000 Cedar Ave., BioEnterprise, Room 445, Cleveland, Ohio
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Bertrand A, Diaz MC, Goyette R, Schillo B, Kreslake JM. Tracking technology changes of e-cigarettes: characteristics and capabilities of new smart vape devices. Tob Control 2024:tc-2024-058862. [PMID: 39153863 DOI: 10.1136/tc-2024-058862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2024]
Affiliation(s)
- Adrian Bertrand
- Truth Initiative Schroeder Institute, Washington, District of Columbia, USA
| | - Megan C Diaz
- Truth Initiative Schroeder Institute, Washington, District of Columbia, USA
| | - Rebecca Goyette
- Truth Initiative Schroeder Institute, Washington, District of Columbia, USA
| | - Barbara Schillo
- Truth Initiative Schroeder Institute, Washington, District of Columbia, USA
| | - Jennifer M Kreslake
- Truth Initiative Schroeder Institute, Washington, District of Columbia, USA
- Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Mattingly DT, Agbonlahor O, Richardson M, Rayens MK, Rose SW, Hart JL. Factors associated with disposable electronic cigarette use among US youth: A national repeated cross-sectional study, 2021-22. Addiction 2024. [PMID: 39044259 DOI: 10.1111/add.16628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 06/28/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND AND AIMS Disposable electronic cigarette (e-cigarette) use is becoming more popular among US youth, given the shifting landscape in product marketing, availability and regulation. This study aimed to estimate the prevalence of and test factors associated with the most used e-cigarette product (disposable versus other) among US youth aged 9-18 years who currently use e-cigarettes. DESIGN, SETTING AND PARTICIPANTS This was an observational study using cross-sectional data from the US-based 2021 and 2022 National Youth Tobacco Surveys (n = 48 704). We restricted our analytical sample to youth who currently use e-cigarettes (n = 4137). The sample ranged from 9 to 18 years old and was 53.0% female. MEASUREMENTS We dichotomized e-cigarette device type to disposable versus all other types (e.g. refillable pods/cartridges). We conducted logistic regression to estimate whether age, sex, race/ethnicity, sexual orientation, frequency of e-cigarette use, nicotine vaping, flavored e-cigarette use and current combustible/non-combustible tobacco use were associated with disposable e-cigarette use, compared with other e-cigarette use. FINDINGS Among youth who currently use e-cigarettes, 54.5% used disposable e-cigarettes. Older age (17-18 years), relative to younger age (9-14 years) [odds ratio (OR) = 1.43, 95% confidence interval (CI) = 1.07-1.91], non-Hispanic Black (versus non-Hispanic White) race/ethnicity (OR = 1.47, 95% CI = 1.01-2.15), any nicotine (versus non-nicotine) vaping (OR = 2.51, 95% CI = 1.96-3.23) and flavored (versus non-flavored) e-cigarette use (OR = 1.93, 95% CI = 1.46-2.56) were associated with increased odds of mainly using disposable e-cigarettes, compared with using other e-cigarette products, whereas current combustible tobacco use (versus non-current) (OR = 0.65, 95% CI = 0.53-0.80) and current non-combustible tobacco use (versus non-current) (OR = 0.58, 95% CI = 0.43-0.78) were associated with lower odds. CONCLUSION Disposable e-cigarettes appear to be the most used type of e-cigarette product among US youth. Older age, non-Hispanic Black race/ethnicity, nicotine vaping and flavored e-cigarette use are associated with mainly using disposable e-cigarettes, relative to other e-cigarette products.
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Affiliation(s)
- Delvon T Mattingly
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, USA
- Center for Health Equity Transformation, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Osayande Agbonlahor
- Department of Communication, College of Arts and Sciences, University of Louisville, Louisville, KY, USA
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY, USA
| | - Maggie Richardson
- Department of Educational, School, and Counseling Psychology, College of Education, University of Kentucky, Lexington, KY, USA
| | - Mary Kay Rayens
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Shyanika W Rose
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, USA
- Center for Health Equity Transformation, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Joy L Hart
- Department of Communication, College of Arts and Sciences, University of Louisville, Louisville, KY, USA
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY, USA
- American Heart Association Tobacco Center for Regulatory Science, Dallas, TX, USA
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5
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Graham-DeMello A, Sloan O, Frost K, Hoek J. Young people's experiences of addiction to nicotine vaping products: A qualitative analysis from Aotearoa New Zealand. Drug Alcohol Rev 2024. [PMID: 39008419 DOI: 10.1111/dar.13902] [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: 12/12/2023] [Revised: 06/17/2024] [Accepted: 06/21/2024] [Indexed: 07/17/2024]
Abstract
INTRODUCTION Young people who use nicotine-containing electronic cigarettes, or 'vapes', risk becoming addicted to these products. While several studies document dependency symptoms, few report in-depth qualitative analyses of addiction. METHODS We explored experiences of self-reported vaping addiction using in-depth interviews with 22 young people aged 16-20 years who vaped and lived in Aotearoa New Zealand. Our semi-structured interview guide probed participants' early experiences and how they progressed from experimentation to addiction and explored how addiction affected their perceptions and daily routines. We used an inductive reflexive thematic analysis approach to interpret the data. RESULTS Vaping's pervasiveness piqued participants' curiosity and encouraged trial. Most transitioned from experimentation to addiction within a couple of months; while a minority described a slower progression, nearly all felt irritable, angry or uncomfortable if they had to delay vaping. Intense cravings disrupted school and work routines and dictated how they spent their time. Many deeply regretted vaping and some suffered shame and embarrassment. These participants saw vaping as a threat to the well-being of younger youth, which they tried to shield from addiction. DISCUSSION AND CONCLUSIONS We go beyond earlier studies by probing the burden vaping comes to represent, offering new insights into young people's everyday experiences of vaping addiction. In addition to informing health promotion campaigns, our findings could inform policy directions. Understanding the speed with which addiction can occur, its impact on daily life, and the considerable regret many felt could help inform a more strategic and sorely needed approach to reducing youth vaping.
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Affiliation(s)
| | - Olivia Sloan
- Otago School of Medicine, University of Otago, Dunedin, New Zealand
| | - Katie Frost
- Otago School of Medicine, University of Otago, Dunedin, New Zealand
| | - Janet Hoek
- Department of Public Health, University of Otago, Wellington, New Zealand
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Nottage MK, Taylor EV, East KA, McNeill A, Thrasher JF, Reid JL, Hammond D, Simonavičius E. Packaging of disposable vaping products and e-liquids in England, Canada and the United States: A content analysis. Addiction 2024. [PMID: 38970447 DOI: 10.1111/add.16611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 06/09/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND AND AIMS Vaping product packaging is varied and often features bright colours and novel designs, particularly among recently marketed disposable vapes. This study provides an overview of attributes found on the packaging of popular disposable vapes and e-liquid bottles in England, Canada and the United States (US) and assesses compliance with local packaging regulations. DESIGN Content analysis. SETTING Brick-and-mortar and online shops in England (London), Canada (Ontario) and the US (New Hampshire and South Carolina). CASES 108 vaping products (including packaging) from 76 brands in a range of flavours and nicotine levels. Specifically, 48 disposable vapes (15 from England, 16 from Canada, 17 from the US) and 60 e-liquid bottles (20 per country). MEASUREMENTS Textual and graphic branding and marketing elements, independently coded by two researchers and checked by a third. FINDINGS Compliance with local packaging regulations varied across countries. Health warnings were present on the packaging of all but one nicotine-containing product, although 33% of disposables and 17% of e-liquids featuring the warning did not adhere to formatting requirements. Leaflets were seldom included with e-liquid bottles, even in England (45%) where mandatory, and omitted elsewhere. Labelling of nicotine type and batch numbers was inconsistent. Vaping product packaging featured claims relating to sensory perceptions (41%), most often flavours, and some (32%) featured youth-appealing content. Common graphic elements included stylised brand fonts (80%), brand logos (54%), product representations on the external packaging (47%) and abstract graphic elements (64%). Colours on packaging, disposable vapes and e-liquid bottles were associated with product flavour. CONCLUSIONS In England, Canada and the United States, popular disposable vapes and e-liquid bottles appear to have varying compliance with local packaging regulations and inconsistent labelling of nicotine and product characteristics. The use of colourful designs, evocative descriptors and appealing graphics to promote flavours underscores the need for comprehensive packaging regulations and enforcement.
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Affiliation(s)
- Matilda K Nottage
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Eve V Taylor
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Katherine A East
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Ann McNeill
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - James F Thrasher
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Jessica L Reid
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Erikas Simonavičius
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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Li W, Krishnan-Sarin S, Morean ME, Bold KW, Davis DR, Camenga DR, Kong G. Non-tobacco nicotine E-cigarette use and flavored E-cigarette use among young adults in the United States. Prev Med 2024; 184:108001. [PMID: 38735588 DOI: 10.1016/j.ypmed.2024.108001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/18/2024] [Accepted: 05/09/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND E-cigarette flavors can create sensations of sweetness and coolness while masking the aversiveness of nicotine. Recently, non-tobacco nicotine (NTN) products were introduced to the market, but little is known about flavors in NTN e-cigarette use. We examined associations between flavors (i.e., sweet, mint/menthol) and susceptibility to and use of NTN e-cigarettes. METHODS 1239 US young adults (18-25 years) completed an anonymous, online survey in Fall 2021. The analytic sample included 520 participants who had used e-cigarettes and heard of NTN. Multinomial logistic regression models analyzed associations of flavored e-cigarette use (sweet and mint/menthol) with NTN e-cigarette use status (i.e., current [past-month] use, past [ever but not current] use, susceptible to use, and non-susceptible to use [reference]). RESULTS Overall, 46.2% of participants reported current NTN use, 14.8% reported past use, 16.7% were susceptible to use, and 22.3% reported no susceptibility. Participants reported dual-use of sweet and mint/menthol NTN e-cigarette flavors (56.5%), sweet flavors use (24.8%), and mint/menthol flavor use (1.7%). Ever dual use of sweet and mint/menthol flavors was associated with current (OR = 9.64, 95%CI: 3.21-28.98) and past NTN e-cigarette use (8.30, [2.10-32.80]). Ever sweet flavor use was associated with current NTN use (3.80, 95%CI: 1.44-10.03) and susceptibility to future use (4.25, [1.53-11.81]). Similar findings were observed for mint/menthol flavors (current: 5.03, [1.41-17.99]; susceptible: 5.65, [1.64-19.51]). CONCLUSION The use of sweet and mint/menthol flavors was significantly associated with NTN e-cigarette use among US young adults, highlighting the need for ongoing surveillance of flavored NTN e-cigarettes and appropriate regulations to discourage use.
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Affiliation(s)
- Wei Li
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
| | | | - Meghan E Morean
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Krysten W Bold
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Danielle R Davis
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Deepa R Camenga
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Grace Kong
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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Lee J, Yao Z, Boakye E, Blaha MJ. The impact of chronic electronic cigarette use on endothelial dysfunction measured by flow-mediated vasodilation: A systematic review and meta-analysis. Tob Induc Dis 2024; 22:TID-22-84. [PMID: 38779295 PMCID: PMC11110651 DOI: 10.18332/tid/186932] [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: 11/10/2023] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Despite electronic cigarettes (e-cigarettes) being marketed as a safer alternative to combustible cigarettes, the effects of chronic e-cigarette use on vascular health remain uncertain. Our meta-analysis aimed to assess the health implications of chronic exclusive e-cigarette use on endothelial dysfunction, as measured by flow-mediated vasodilation (FMD). METHODS PubMed, Embase and Scopus were searched for studies from 1 January 2004 to 31 March 2024. Four cross-sectional studies (n=769) were pooled using a random-effects model. The mean differences (MD) of FMD were reported by comparing exclusive e-cigarette use versus non-use; exclusive e-cigarette use versus combustible cigarette use; and combustible cigarette use versus non-use. RESULTS A non-significant reduction in FMD in exclusive e-cigarette use compared to non-use was reported (MD of FMD: -1.47%; 95% CI: -3.96 - 1.02; I2= 84%). Similar MD of FMD in exclusive e-cigarette use and exclusive combustible cigarette use (vs non-use) suggested that both of these products might have comparable adverse influences on endothelial health. CONCLUSIONS The limited availability of studies assessing the chronic impact of e-cigarette use restricted our ability to provide definitive findings. We emphasize the importance of additional research that explores the long-term impact of e-cigarette use on endothelial dysfunction, and identify key areas and give suggestions for further study.
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Affiliation(s)
- Jieun Lee
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Zhiqi Yao
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, United States
| | - Ellen Boakye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, United States
| | - Michael J. Blaha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, United States
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Han DH, Harlow AF, Feldstein Ewing SW, Audrain-McGovern JE, Unger JB, Sussman SY, McConnell R, Barrington-Trimis JL, Leventhal AM. Disposable E-Cigarette Use and Subsequent Use Patterns in Adolescents and Young Adults. Pediatrics 2024; 153:e2023063430. [PMID: 38463010 PMCID: PMC10979299 DOI: 10.1542/peds.2023-063430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Disposable electronic cigarettes (e-cigarettes) are widely used by adolescents and young adults (AYAs). Whether using disposable devices is associated with future e-cigarette use patterns is unknown but important for informing e-cigarette regulation. METHODS Prospective longitudinal study combining data from adolescent (14-17 years) and young adult (21-24 years) cohorts from Southern California surveyed at baseline and approximately 8-month follow-up during 2021 to 2022. The analyses included AYAs who used e-cigarettes in the past 30 days at baseline and had exposure and outcome data (N = 403; adolescent n = 124, young adult n = 279). RESULTS In the pooled sample of AYAs who used e-cigarettes at baseline (57.2% cis-gender female, 56.2% Hispanic), 278 (69.0%) reported past 30-day disposable e-cigarette use, and 125 (31.0%) used only nondisposable e-cigarettes. Baseline use of disposable (versus only nondisposable) devices was associated with higher odds of continued e-cigarette use (adjusted odds ratio = 1.92; 95% confidence interval = 1.09-3.42) and a greater number of times used e-cigarettes per day at follow-up (adjusted incidence rate ratio = 1.29; 95% confidence interval = 1.02-1.63). In supplemental analyses, disposable e-cigarette use was associated with greater odds of no changes (versus reductions) in e-cigarette use frequency and puffs per episode from baseline to follow-up but was not associated with increases in use frequency and intensity. No differences in e-cigarette use outcomes were found between those with poly-device (disposable and nondisposable) versus only disposable device use. CONCLUSIONS Use of disposable e-cigarette devices among AYAs may be associated with higher risks for persistent e-cigarette use patterns, which should be considered in tobacco product regulation designed to protect AYAs.
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Affiliation(s)
- Dae-Hee Han
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California
- Institute for Addiction Science, University of Southern California, Los Angeles, California
| | - Alyssa F Harlow
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California
- Institute for Addiction Science, University of Southern California, Los Angeles, California
| | | | | | - Jennifer B Unger
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California
- Institute for Addiction Science, University of Southern California, Los Angeles, California
| | - Steve Y Sussman
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California
- Institute for Addiction Science, University of Southern California, Los Angeles, California
- Department of Psychology
- School of Social Work, University of Southern California, Los Angeles, California
| | - Rob McConnell
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California
- Institute for Addiction Science, University of Southern California, Los Angeles, California
| | - Jessica L Barrington-Trimis
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California
- Institute for Addiction Science, University of Southern California, Los Angeles, California
| | - Adam M Leventhal
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California
- Institute for Addiction Science, University of Southern California, Los Angeles, California
- Department of Psychology
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10
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Bello MS, Schulte AR, Ring CR, Cho J, Barrington-Trimis JL, Pang RD, Jao NC, Colby SM, Cassidy RN, Leventhal AM. Effects of mint, menthol, and tobacco-flavored e-cigarettes on tobacco withdrawal symptoms in adults who smoke menthol cigarettes: A laboratory pilot study. Drug Alcohol Depend 2024; 256:111110. [PMID: 38359606 PMCID: PMC10906679 DOI: 10.1016/j.drugalcdep.2024.111110] [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: 05/08/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Menthol cigarette smoking has remained stable or increased in certain groups, despite an overall decline in cigarette smoking rates in the U.S. Understanding whether e-cigarettes alter patterns of menthol cigarette use is critical to informing efforts for reducing the public health burden of menthol cigarette smoking. This 2019-2020 laboratory pilot study evaluated whether self-administration of mint-, menthol-, or tobacco-flavored e-cigarettes would differentially impact tobacco withdrawal symptoms in e-cigarette-naïve adults who smoke menthol cigarettes daily. METHODS Participants (N=17; 35.3% Female; mean age=51.8) attended three laboratory sessions after 16-hours of tobacco abstinence. Participants self-administered a study-provided JUUL e-cigarette (0.7mL with 5% nicotine by weight) at each session in which flavor was manipulated (mint vs. menthol vs. tobacco; order randomized). Participants completed pre- and post-e-cigarette administration self-report assessments on smoking urges, nicotine withdrawal, and positive and negative affect states. Multilevel linear regression models tested differences between the three flavor conditions for individual study outcomes. RESULTS Following overnight tobacco abstinence, vaping either a mint or menthol (vs. tobacco) flavored e-cigarette led to significantly greater reductions in smoking urges over time; menthol (vs. tobacco) flavored e-cigarettes also suppressed urges to smoke for pleasure. Notably, no differences in nicotine withdrawal, positive affect, or negative affect were observed. CONCLUSIONS In this laboratory pilot study, mint and menthol (vs. tobacco) flavored e-cigarettes provided some negative reinforcement effects via acute reductions in smoking urges during tobacco abstinence, yet only menthol flavored e-cigarettes demonstrated suppressive effects on smoking urges for pleasure in adults who smoke menthol cigarettes daily.
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Affiliation(s)
- Mariel S Bello
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA.
| | - Alison R Schulte
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Colin R Ring
- Department of Psychology, Loma Linda University School of Behavioral Health, Loma Linda, CA, USA
| | - Junhan Cho
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Institute for Addiction Science, University of Southern California, Los Angeles, CA, USA
| | - Jessica L Barrington-Trimis
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Institute for Addiction Science, University of Southern California, Los Angeles, CA, USA
| | - Raina D Pang
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Institute for Addiction Science, University of Southern California, Los Angeles, CA, USA
| | - Nancy C Jao
- Department of Psychology, Rosalind Franklin University of Medicine and Science, Chicago, IL, USA
| | - Suzanne M Colby
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA; Department of Psychiatry & Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Rachel N Cassidy
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - Adam M Leventhal
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Institute for Addiction Science, University of Southern California, Los Angeles, CA, USA
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11
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Ali FRM, Seaman EL, Diaz MC, Ajose J, King BA. Trends in unit sales of cooling flavoured e-cigarettes, USA, 2017-2021. Tob Control 2024; 33:147-153. [PMID: 35840317 DOI: 10.1136/tc-2022-057395] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/24/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Flavours that produce a cooling sensation, such as menthol, enhance the appeal of e-cigarettes among youth; but not all e-cigarettes that produce cooling sensations are labelled as menthol. This study assessed trends in unit sales of cooling flavoured e-cigarettes in the USA. DESIGN E-cigarette retail sales during 26 January 2017 to 28 November 2021 were licensed from Information Resources, Inc, which records brick-and-mortar retail scanner sales but not online or vape shop sales. Cooling flavours were identified using six descriptors: menthol, ice, cool, chill, freeze or frost; ambiguous flavours were verified using online searches. Cooling flavours were categorised by characterising flavour (menthol, mint, other) and product type (prefilled cartridges, disposables, e-liquids). Joinpoint regression was used to assess sales and price trends. RESULTS During January 2017 to November 2021, unit sales of cooling flavoured e-cigarettes increased by 693.0% (1.5 to 12.0 million units); the percentage of these sales from total sales increased from 26.4% to 54.9%. Among cooling flavours, percentage of menthol sales decreased from 94.5% to 73.0% (p<0.001). Among menthol cooling flavours, percentage of prefilled cartridges increased from 67.2% to 96.6% (p<0.001); among non-menthol cooling flavours, percentage of disposable e-cigarettes increased from 5.2% to 99.2% (p<0.001). There were no significant price differences between cooling and non-cooling flavoured disposable e-cigarettes. CONCLUSION The percentage of cooling flavoured e-cigarette sales from total sales doubled during 2017-2021, and sales of non-menthol cooling disposable e-cigarettes experienced the highest percentage increase. Cooling flavoured e-cigarettes are important to consider when developing strategies to address flavoured e-cigarette use among youth.
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Affiliation(s)
- Fatma Romeh M Ali
- Non-Infectious Disease Programs, CDC Foundation, Atlanta, Georgia, USA
| | | | - Megan C Diaz
- Schroeder Institute, Truth Initiative, Washington, DC, USA
| | - Julianah Ajose
- Non-Infectious Disease Programs, CDC Foundation, Atlanta, Georgia, USA
| | - Brian A King
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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12
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Garey L, Smit T, Bizier A, Redmond BY, Ditre JW, Rogers AH, Bakhshaie J, Nizio P, Zvolensky MJ. Pain interference among adult dual combustible and electronic tobacco users in terms of perceived barriers for quitting. Exp Clin Psychopharmacol 2024; 32:45-53. [PMID: 37166909 PMCID: PMC10638470 DOI: 10.1037/pha0000660] [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] [Indexed: 05/12/2023]
Abstract
Electronic cigarette (e-cigarette) use has become increasingly common among combustible cigarette users, and dual use may represent a more severe type of nicotine addiction. Experiencing pain is one prevalent domain that may be important to understand quit processes and behavior among dual users. Although most past research on pain and nicotine/tobacco has focused on combustible cigarette use, initial work on e-cigarette users has found that greater pain severity is associated with higher levels of dependence and negative thinking patterns about e-cigarette use. Yet, there has been no effort to explore the experience of pain among dual users in terms of perceived barriers for quitting combustibles or e-cigarettes. The present study sought to examine pain interference among dual combustible and e-cigarette users in terms of perceived barriers for quitting among 138 (45.9% female; Mage = 35.96 years, SD = 7.16) adult dual users (i.e., users of both combustible cigarette and e-cigarettes). Hierarchical linear regression models indicated that pain interference was significantly associated with both perceived barriers for cessation of combustible cigarettes and perceived barriers for cessation of e-cigarettes. Overall, the present investigation served as an initial evaluation of the role of pain interference in terms of perceived barriers for quitting combustible and e-cigarettes among adult daily dual users. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Lorra Garey
- Department of Psychology, University of Houston, Boston, MA, USA
- HEALTH Institute, University of Houston, Boston, MA, USA
| | - Tanya Smit
- Department of Psychology, University of Houston, Boston, MA, USA
| | - Andre Bizier
- Department of Psychology, University of Houston, Boston, MA, USA
| | | | - Joseph W. Ditre
- Department of Psychology, Syracuse University, Boston, MA, USA
| | - Andrew H. Rogers
- Department of Psychology, University of Houston, Boston, MA, USA
| | - Jafar Bakhshaie
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Pamella Nizio
- Department of Psychology, University of Houston, Boston, MA, USA
- HEALTH Institute, University of Houston, Boston, MA, USA
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Boston, MA, USA
- HEALTH Institute, University of Houston, Boston, MA, USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center
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13
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Phan L, Choi K. Awareness of electronic cigarette industry practices and their associations with anti-electronic cigarette attitudes among susceptible US young adults. Tob Control 2023:tc-2023-058245. [PMID: 38071582 PMCID: PMC11161553 DOI: 10.1136/tc-2023-058245] [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: 06/29/2023] [Accepted: 11/18/2023] [Indexed: 04/07/2024]
Abstract
BACKGROUND Public education exposing cigarette industry practices have been effective in changing attitudes and preventing smoking among young people. It is unclear how much young adults are aware of e-cigarette industry practices, and how this awareness relates to anti-e-cigarette attitudes. We examined demographic correlates of awareness of e-cigarette industry practices and anti-e-cigarette attitudes, and the association between awareness of these practices with anti-e-cigarette attitudes. METHODS A US sample of young adults aged 18-30 years who do not use commercial tobacco products but are susceptible to e-cigarette use were cross-sectionally surveyed through online panel services from August 2021 to January 2022. Respondents reported their demographics, awareness of cigarette industry practices, awareness of e-cigarette industry practices and their level of agreement with four anti-e-cigarette attitude statements. We used multivariable linear regressions to examine demographic associations and the relationship between awareness of e-cigarette industry practices with each anti-e-cigarette attitude, adjusting for demographics and awareness of cigarette industry practices. RESULTS Generally, Hispanic and Black young adults (vs White) and those with DISCUSSION Public education exposing e-cigarette industry practices may promote anti-e-cigarette attitudes among susceptible young adults who do not use commercial tobacco products. Future research should investigate the utility of anti-e-cigarette industry messaging.
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Affiliation(s)
- Lilianna Phan
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA
- Department of Community Health and Prevention, Dornsife School of Public Health and Division of Graduate Nursing, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA
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14
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Tackett AP, Han DH, Peraza N, Whaley RC, Mason T, Cahn R, Hong K, Pang R, Monterosso J, Page MK, Goniewicz ML, Leventhal AM. Effects of 'Ice' flavoured e-cigarettes with synthetic cooling agent WS-23 or menthol on user-reported appeal and sensory attributes. Tob Control 2023:tc-2023-058125. [PMID: 37940405 DOI: 10.1136/tc-2023-058125] [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: 04/28/2023] [Accepted: 10/24/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND This clinical experiment tested the effects of exposure to e-cigarettes with WS-23 or menthol cooling additives on user appeal and sensory attributes, and, secondarily, whether WS-23 effects generalised across base characterising flavour, nicotine concentration, or nicotine/tobacco product use status. METHODS In this within-participant double-blind experiment, adult tobacco/nicotine users administered standardised puffs of 18 different e-cigarette solutions in randomised sequences using a pod-style device. Each of three base characterising e-cigarette flavour solutions ('bold tobacco', 'mango,' 'wintergreen') in both 2% and 4% concentrations of nicotine benzoate salt were manipulated by adding either: (1) Menthol (0.5%), (2) WS-23 (0.75%) or (3) No cooling agent. After each administration, participants rated 3 appeal and 5 sensory attributes (0-100 scales). RESULTS Participants (n=84; M(SD)=38.6 (13.6) years old) were either exclusive e-cigarette (25.0%), cigarette (36.9%) or dual (38.1%) users. WS-23 versus no coolant products produced higher liking, willingness to use again, smoothness, and coolness and lower disliking, bitterness, and harshness ratings (|B|difference range: 4.8 to 20.1; ps<0.005). Menthol (vs no coolant) increased willingness to use again and reduced harshness and coolness (ps<0.05). Flavours with WS-23 (vs menthol) were rated as smoother, cooler and less harsh (ps<0.05). Coolant effects did not differ by base flavour, nicotine concentration, or tobacco use status. CONCLUSIONS Adding synthetic coolant WS-23 to e-cigarettes appears to make the vaping user experience more appealing, regardless of characterising base flavour. Regulatory agencies should be aware that the manufacturing process of adding synthetic coolants may increase the attractiveness of various e-cigarette products.Cite Now.
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Affiliation(s)
- Alayna P Tackett
- Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Dae Hee Han
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
- Institute for Addiction Science, Univeresity of Southern California, Los Angeles, CA, USA
| | - Natalia Peraza
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Reid C Whaley
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Tyler Mason
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, California, USA
| | - Rael Cahn
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, California, USA
| | - Kurt Hong
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, California, USA
- Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Raina Pang
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - John Monterosso
- Institute for Addiction Science, Univeresity of Southern California, Los Angeles, CA, USA
- Department of Psychology, University of Southern California, Los Angeles, California, USA
| | - Michelle K Page
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Maciej Lukasz Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Adam M Leventhal
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
- Institute for Addiction Science, Univeresity of Southern California, Los Angeles, CA, USA
- Department of Psychology, University of Southern California, Los Angeles, California, USA
- USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA
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15
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Sachdeva J, Karunananthan A, Shi J, Dai W, Kleinman MT, Herman D, Kloner RA. Flavoring Agents in E-cigarette Liquids: A Comprehensive Analysis of Multiple Health Risks. Cureus 2023; 15:e48995. [PMID: 38111420 PMCID: PMC10726647 DOI: 10.7759/cureus.48995] [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] [Accepted: 11/15/2023] [Indexed: 12/20/2023] Open
Abstract
The availability of a wide range of flavored e-cigarettes is one of the primary reasons for vaping initiation and persistent use among adolescents and young people. This plethora of flavors available on the market are crafted using different flavoring agents such as cinnamaldehyde, vanillin, benzaldehyde, ethyl maltol, menthol, and dimethylpyrazine. Recent studies have brought to light the potential risks associated with e-cigarette flavoring agents and their effects on various organ systems, both with and without nicotine. Research has demonstrated that flavoring agents can induce inflammation, endothelial dysfunction, epithelial barrier disruption, oxidative stress, DNA damage, electrophysiological alterations, immunomodulatory effects, and behavioral changes, even independently of nicotine. Notably, these negative outcomes adversely affect cardiovascular system by reducing cell viability, decreasing endothelial nitric oxide synthase, nitric oxide bioavailability, soluble guanylyl cyclase activity and cyclic guanosine monophosphate accumulation, impairing endothelial proliferation and tube formation, and altering vasoreactivity resulting in vascular dysfunction. In the heart, these agents decrease parasympathetic activity, induce depolarization of resting membrane potential, loss of rhythmicity, increase isovolumic relaxation time, and change in ventricular repolarization and ventricular tachyarrhythmias. It is found that the specific response elicited by flavoring agents in different organ systems varies depending on the flavor used, the concentration of the flavoring agent, and the duration of exposure. However, the literature on the effects of flavoring agents is currently limited, emphasizing the need for more preclinical and randomized clinical trials to gain a deeper understanding and provide further evidence of the harmful effects of flavored e-cigarette use. In summary, recent research suggests that flavoring agents themselves can have detrimental effects on the body. To fully comprehend these effects, additional preclinical and clinical studies are needed to explore the risks associated with flavored e-cigarette usage.
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Affiliation(s)
- Jaspreet Sachdeva
- Cardiovascular Sciences, Huntington Medical Research Institutes, Pasadena, USA
| | | | - Jianru Shi
- Cardiovascular Sciences, Huntington Medical Research Institutes, Pasadena, USA
| | - Wangde Dai
- Cardiovascular Sciences, Huntington Medical Research Institutes, Pasadena, USA
| | - Michael T Kleinman
- Environmental and Occupational Health, College of Health Sciences, University of California, Irvine, USA
| | - David Herman
- Environmental and Occupational Health, College of Health Sciences, University of California, Irvine, USA
| | - Robert A Kloner
- Cardiovascular Sciences, Huntington Medical Research Institutes, Pasadena, USA
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16
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Leventhal AM, Tackett AP, Whitted L, Jordt SE, Jabba SV. Ice flavours and non-menthol synthetic cooling agents in e-cigarette products: a review. Tob Control 2023; 32:769-777. [PMID: 35483721 PMCID: PMC9613790 DOI: 10.1136/tobaccocontrol-2021-057073] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 04/19/2022] [Indexed: 01/21/2023]
Abstract
E-cigarettes with cooling flavours have diversified in ways that complicate tobacco control with the emergence of: (1) Ice-hybrid flavours (eg, 'Raspberry Ice') that combine cooling and fruity/sweet properties; and (2) Products containing non-menthol synthetic cooling agents (eg, Wilkinson Sword (WS), WS-3, WS-23 (termed 'koolada')). This paper reviews the background, chemistry, toxicology, marketing, user perceptions, use prevalence and policy implications of e-cigarette products with ice-hybrid flavours or non-menthol coolants. Scientific literature search supplemented with industry-generated and user-generated information found: (a) The tobacco industry has developed products containing synthetic coolants since 1974, (b) WS-3 and WS-23 are detected in mass-manufactured e-cigarettes (eg, PuffBar); (c) While safe for limited oral ingestion, inhalational toxicology and health effects from daily synthetic coolant exposure are unknown and merit scientific inquiry and attention from regulatory agencies; (d) Ice-hybrid flavours are marketed with themes incorporating fruitiness and/or coolness (eg, snow-covered raspberries); (e) WS-23/WS-3 concentrates also are sold as do-it-yourself additives, (f) Pharmacology research and user-generated and industry-generated information provide a premise to hypothesise that e-cigarette products with ice flavours or non-menthol cooling agents generate pleasant cooling sensations that mask nicotine's harshness while lacking certain aversive features of menthol-only products, (g) Adolescent and young adult use of e-cigarettes with ice-hybrid or other cooling flavours may be common and cross-sectionally associated with more frequent vaping and nicotine dependence in convenience samples. Evidence gaps in the epidemiology, toxicology, health effects and smoking cessation-promoting potential of using these products exist. E-cigarettes with ice flavours or synthetic coolants merit scientific and regulatory attention.
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Affiliation(s)
- Adam M Leventhal
- Institute for Addiction Science, University of Southern California, Los Angeles, California, USA
| | - Alayna P Tackett
- Department of Preventive Medicine, Keck School of Medicine University of Southern California, Los Angeles, California, USA
| | - Lauren Whitted
- Department of Preventive Medicine, Keck School of Medicine University of Southern California, Los Angeles, California, USA
| | - Sven Eric Jordt
- Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
- Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sairam V Jabba
- Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
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17
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Jones CA, Wallace MJ, Bandaru P, Woodbury ED, Mohler PJ, Wold LE. E-cigarettes and arrhythmogenesis: a comprehensive review of pre-clinical studies and their clinical implications. Cardiovasc Res 2023; 119:2157-2164. [PMID: 37517059 PMCID: PMC10578912 DOI: 10.1093/cvr/cvad113] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/21/2023] [Accepted: 06/29/2023] [Indexed: 08/01/2023] Open
Abstract
Electronic cigarette use has grown exponentially in recent years, and while their popularity has increased, the long-term effects on the heart are yet to be fully studied and understood. Originally designed as devices to assist with those trying to quit traditional combustible cigarette use, their popularity has attracted use by teens and adolescents who traditionally have not smoked combustible cigarettes. Acute effects on the heart have been shown to be similar to traditional combustible cigarettes, including increased heart rate and blood pressure. The main components of electronic cigarettes that contribute to these arrhythmic effects are found in the e-liquid that is aerosolized and inhaled, comprised of nicotine, flavourings, and a combination of vegetable glycerin (VG) and propylene glycol (PG). Nicotine can potentially induce both ventricular and atrial arrhythmogenesis, with both the atrial and ventricular effects resulting from the interactions of nicotine and the catecholamines they release via potassium channels. Atrial arrhythmogenesis, more specifically atrial fibrillation, can also occur due to structural alterations, which happens because of nicotine downregulating microRNAs 133 and 590, both post-transcriptional growth factor repressors. Liquid flavourings and the combination of PG and VG can possibly lead to arrhythmic events by exposing users to acrolein, an aldehyde that stimulates TRPA1 that in turn causes a change towards sympathetic activation and autonomic imbalance. The design of these electronic delivery devices is constantly changing; therefore, it has proven extremely difficult to study the long-term effects on the heart caused by electronic cigarettes but will be important to understand given their rising popularity. The arrhythmic effects of electronic cigarettes appear similar to traditional cigarettes as well; however, a comprehensive review has not been compiled and is the focus of this article.
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Affiliation(s)
- Carson A Jones
- Dorothy M. Davis Heart and Lung Research Institute, Wexner Medical Center, The Ohio State University, 473 W 12th Avenue, Columbus, OH 43210, USA
| | - Michael J Wallace
- Dorothy M. Davis Heart and Lung Research Institute, Wexner Medical Center, The Ohio State University, 473 W 12th Avenue, Columbus, OH 43210, USA
| | - Priya Bandaru
- Dorothy M. Davis Heart and Lung Research Institute, Wexner Medical Center, The Ohio State University, 473 W 12th Avenue, Columbus, OH 43210, USA
| | - Emerson D Woodbury
- Dorothy M. Davis Heart and Lung Research Institute, Wexner Medical Center, The Ohio State University, 473 W 12th Avenue, Columbus, OH 43210, USA
| | - Peter J Mohler
- Dorothy M. Davis Heart and Lung Research Institute, Wexner Medical Center, The Ohio State University, 473 W 12th Avenue, Columbus, OH 43210, USA
- Department of Internal Medicine, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Loren E Wold
- Dorothy M. Davis Heart and Lung Research Institute, Wexner Medical Center, The Ohio State University, 473 W 12th Avenue, Columbus, OH 43210, USA
- Division of Cardiac Surgery, Department of Surgery, Wexner Medical Center, The Ohio State University, 473 W 12th Avenue, Room 603, Columbus, OH 43210, USA
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18
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Vilcassim MJR, Jacob D, Stowe S, Fifolt M, Zierold KM. Sex Differences in Electronic Cigarette Device Use Among College Students. J Community Health 2023; 48:585-592. [PMID: 36763311 DOI: 10.1007/s10900-023-01200-0] [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] [Accepted: 01/28/2023] [Indexed: 02/11/2023]
Abstract
Electronic cigarette use (vaping) has reached epidemic levels in the United States among teenagers and young adults. However, there is a paucity of studies that have examined the relationships between e-cigarette device types and user characteristics. Therefore, the main objective of this study was to characterize e-cigarette device use among a college population with a focus on sex differences in preferred vaping device. We employed a Qualtrics-based smartphone/online survey to gather responses on e-cigarette use; including device type, demographics and other related information during the period October 1, 2020 to January 30, 2022 in the Birmingham, AL metropolitan area. Participants were recruited via flyers with a QR code to the survey. The differences in e-cigarette device type used by the characteristics of the university e-cigarette users were assessed using either a Chi-square analysis or Fisher's Test. The magnitude of any association between the characteristics of the participants and vaping device used was analyzed via logistic regression. Out of 394 students who participated in the survey, 61 reported current exclusive e-cigarette use (15.5%) among our 18-24-year-old college student sample. Among vapers; more females reported use of Disposable e-cigarettes or Juul (pod-type) as their primary vaping device compared to males, who preferred Tanks and Mods + other rechargeable e-cigarettes (p < 0.05). Males also vaped more days per week compared to females. Vaping among young college students remains at concerning levels. The primary vaping device used significantly varies by the users' sex, making it an important factor to consider in future studies.
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Affiliation(s)
- M J Ruzmyn Vilcassim
- Department of Environmental Health Sciences, UAB School of Public Health, 1665 University Boulevard, Birmingham, AL, 35233, USA.
| | - Diya Jacob
- School of Health Professions, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Samuel Stowe
- Department of Environmental Health Sciences, UAB School of Public Health, 1665 University Boulevard, Birmingham, AL, 35233, USA
| | - Matthew Fifolt
- Department of Health Policy and Organization, UAB School of Public Health, 1665 University Boulevard, Birmingham, AL, 35233, USA
| | - Kristina M Zierold
- Department of Environmental Health Sciences, UAB School of Public Health, 1665 University Boulevard, Birmingham, AL, 35233, USA
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19
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Corrêa PC. The Lancet COPD Commission: broader questions remain. Lancet 2023; 401:1568. [PMID: 37179113 DOI: 10.1016/s0140-6736(23)00553-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 03/12/2023] [Indexed: 05/15/2023]
Affiliation(s)
- Paulo Crp Corrêa
- Universidade Federal de Ouro Preto, Ouro Preto 35400-000, Brazil; Brazilian Thoracic Society (SBPT), Brasilia 70398-900, Brazil.
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20
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Tackett AP, Barrington-Trimis JL, Leventhal AM. 'Flavour ban approved': new marketing strategies from tobacco-free nicotine pouch maker Zyn. Tob Control 2023; 32:e134-e135. [PMID: 35459750 PMCID: PMC9587134 DOI: 10.1136/tobaccocontrol-2021-057222] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Alayna P Tackett
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Jessica L Barrington-Trimis
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Adam M Leventhal
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
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21
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Han DH, Cho J, Harlow AF, Tackett AP, Vogel EA, Wong M, Barrington-Trimis JL, Lerman C, Unger JB, Leventhal AM. Young adults' beliefs about modern oral nicotine products: Implications for uptake in nonvapers, dual use with e-cigarettes, and use to reduce/quit vaping. Exp Clin Psychopharmacol 2023; 31:455-463. [PMID: 36048111 PMCID: PMC10026537 DOI: 10.1037/pha0000595] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Modern oral nicotine products (ONPs; nontherapeutic nicotine pouches, gums, lozenges, and gummies) may be perceived in ways that could promote uptake in nonvapers, dual use with e-cigarettes, or use to quit vaping. In this cross-sectional digital remote survey of 1,460 respondents aged 21-24 from Southern California, we examined beliefs about ONPs among past-30-day e-cigarette nonusers, users unmotivated to quit vaping, and users motivated to quit vaping. Positive beliefs about ONPs were reported by 31.8% of the overall sample and higher in past-30-day e-cigarette users (with or without quit motivation) than nonusers. Perceiving ONPs to be easy to conceal, convenient, and able to be used where vaping/smoking is not allowed were the most common types of beliefs reported. Among e-cigarette users with quit motivation (n = 142), interest in using ONPs to quit/reduce vaping (44.4%) was higher than interest in using medicinal nicotine gum/lozenges (23.4%), nicotine patch (17.6%), or prescription medications (16.6%). Interest in using ONPs to reduce/quit vaping (vs. no interest) was greater among participants who reported vaping ≥ 20 (vs. < 10) days in the past month, vaping ≥ 10 (vs. < 10) times per day, low/moderate (vs. high) quit vaping self-efficacy, and low/moderate (vs. high) desire to quit vaping. These findings suggest that: (a) appreciable subsets of the young adult population may hold positive beliefs about ONPs that could promote ONP uptake, particularly e-cigarette users and (b) some young adult e-cigarette users may be interested in using ONPs to reduce/quit vaping, particularly frequent vapers with relatively lower self-efficacy and desire to quit vaping. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Dae-Hee Han
- Institute for Addiction Science, University of Southern California
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
| | - Junhan Cho
- Institute for Addiction Science, University of Southern California
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
| | - Alyssa F. Harlow
- Institute for Addiction Science, University of Southern California
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
| | - Alayna P. Tackett
- Institute for Addiction Science, University of Southern California
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California
| | - Erin A. Vogel
- Institute for Addiction Science, University of Southern California
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
| | - Melissa Wong
- Institute for Addiction Science, University of Southern California
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
| | - Jessica L. Barrington-Trimis
- Institute for Addiction Science, University of Southern California
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California
| | - Caryn Lerman
- Institute for Addiction Science, University of Southern California
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California
| | - Jennifer B. Unger
- Institute for Addiction Science, University of Southern California
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California
| | - Adam M. Leventhal
- Institute for Addiction Science, University of Southern California
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California
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22
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Thirlway F. Subculture wars: The struggle for the vape industry. THE BRITISH JOURNAL OF SOCIOLOGY 2023; 74:3-16. [PMID: 36329664 PMCID: PMC10092283 DOI: 10.1111/1468-4446.12981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 08/25/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
Drawing on a 2-year study, I argue that the UK vape industry is engaged in a classificatory struggle between a subcultural industry and its "other", the mainstream industry. I build on Thornton's analysis of club culture to characterize the subcultural vape industry as a community of taste built round a masculine aesthetic and a commitment to authenticity and DIY practice. Its attachment to complex systems and masculine spaces risked excluding customers without specialist knowledge or interest. The mainstream industry included tobacco companies which promoted vaping as a complementary category to smoking, linking their own vaping products to historic meanings of the cigarette as a lifestyle product. This task was hampered by the toxic legacy of combusted tobacco and its increasing reversion to a generic category rather than a branded product. Finally, the success of the price-focused vaping industry has been largely overlooked, but suggests that for most consumers, electronic cigarettes are still a contrasting category to combusted tobacco and are purchased largely on price. I conclude that the exclusion of a feminized, classed "other" is a defining element of subcultural formation, itself an overwhelmingly male mechanism of group identity construction.
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23
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A systematic review of socio-ecological factors influencing current e-cigarette use among adolescents and young adults. Addict Behav 2022; 135:107425. [DOI: 10.1016/j.addbeh.2022.107425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 07/08/2022] [Accepted: 07/10/2022] [Indexed: 12/22/2022]
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24
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Soulet S, Sussman RA. Critical Review of the Recent Literature on Organic Byproducts in E-Cigarette Aerosol Emissions. TOXICS 2022; 10:714. [PMID: 36548547 PMCID: PMC9787926 DOI: 10.3390/toxics10120714] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/03/2022] [Accepted: 11/14/2022] [Indexed: 06/17/2023]
Abstract
We review the literature on laboratory studies quantifying the production of potentially toxic organic byproducts (carbonyls, carbon monoxide, free radicals and some nontargeted compounds) in e-cigarette (EC) aerosol emissions, focusing on the consistency between their experimental design and a realistic usage of the devices, as determined by the power ranges of an optimal regime fulfilling a thermodynamically efficient process of aerosol generation that avoids overheating and "dry puffs". The majority of the reviewed studies failed in various degrees to comply with this consistency criterion or supplied insufficient information to verify it. Consequently, most of the experimental outcomes and risk assessments are either partially or totally unreliable and/or of various degrees of questionable relevance to end users. Studies testing the devices under reasonable approximation to realistic conditions detected levels of all organic byproducts that are either negligible or orders of magnitude lower than in tobacco smoke. Our review reinforces the pressing need to update and improve current laboratory standards by an appropriate selection of testing parameters and the logistical incorporation of end users in the experimental design.
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Affiliation(s)
| | - Roberto A. Sussman
- Institute of Nuclear Sciences, National Autonomous University of Mexico, Mexico City 04510, Mexico
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25
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Struik LL, O'Loughlin EK, Riglea T, O'Loughlin JL. Predictors of past-year e-cigarette use among young adults. Prev Med Rep 2022; 29:101965. [PMID: 36161135 PMCID: PMC9502288 DOI: 10.1016/j.pmedr.2022.101965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 07/04/2022] [Accepted: 08/25/2022] [Indexed: 11/30/2022] Open
Abstract
Predictors of past-year e-cigarette use among young adults at age 30 were studied. Data was drawn from the Nicotine Dependence In Teens (NDIT) cohort. Male sex, friends smoke, tobacco and substance use, and impulsivity predicted use. Higher education and very good/excellent self-rated health were protective. These factors warrant consideration in public health efforts.
Understanding the underpinnings of e-cigarette use among young adults is critical to addressing increasing uptake. We identified predictors of past-year e-cigarette use among young adults in Montreal, Canada. Data on potential predictors were available for 714 young adults participating in the ongoing Nicotine Dependence in Teens Study at age 20 in 2007–08. Past-year e-cigarette use was measured at age 30 in 2017–20. Each potential predictor was studied in a separate multivariable logistic regression model controlling for age, sex, and educational attainment. Male sex, friends who smoke, cigarette smoking, use of other tobacco products, alcohol use, use of marijuana, and impulsivity predicted past-year e-cigarette use. Higher educational attainment and very good/excellent self-rated health were protective. Program and policy makers will need to consider these predictors of e-cigarette use in the design of clinical and public health interventions targeting e-cigarette use in young adults.
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Affiliation(s)
- Laura L. Struik
- School of Nursing, Department of Health and Exercise Sciences, University of British Columbia Okanagan, 1147 Research Road, Kelowna, British Columbia V1V1V7, Canada
- Corresponding author.
| | - Erin K. O'Loughlin
- Department of Exercise Sciences, University of Toronto, 55 Harbord Street, Toronto, Ontario M5S 2W6, Canada
- Carrefour de l’innovation et de l’évaluation en santé, University of Montreal Hospital Research Center, Tour Saint-Antoine, 850 Rue Saint-Denis, Montréal, Québec H2X 0A9, Canada
| | - Teodora Riglea
- Carrefour de l’innovation et de l’évaluation en santé, University of Montreal Hospital Research Center, Tour Saint-Antoine, 850 Rue Saint-Denis, Montréal, Québec H2X 0A9, Canada
| | - Jennifer L. O'Loughlin
- Carrefour de l’innovation et de l’évaluation en santé, University of Montreal Hospital Research Center, Tour Saint-Antoine, 850 Rue Saint-Denis, Montréal, Québec H2X 0A9, Canada
- Département de médecine sociale et préventive, École de santé Publique de l’Université de Montréal, 7101 ave du Parc, Montréal, QC H3N 1X9, Canada
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26
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Donaldson SI, Dormanesh A, Escobedo P, Majmundar A, Kirkpatrick M, Allem JP. The impact of e-cigarette product place in music videos on susceptibility to use e-cigarettes among young adults: An experimental investigation. Addict Behav 2022; 130:107307. [PMID: 35305325 DOI: 10.1016/j.addbeh.2022.107307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/21/2022] [Accepted: 03/12/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Product placement in music videos is a growing promotional strategy. This study examined the impact of e-cigarette product placement and imagery in music videos on susceptibility to use e-cigarettes among young adults. METHODS A non-probability sample of young adults (18 to 24) in Southern California were recruited to participate in an experiment over Zoom. Participants were randomized into a treatment or a control group. The treatment group watched seven music videos with e-cigarette product placement and imagery. The control group watched the same seven music videos with all e-cigarette product placement and imagery digitally removed. Participants completed a questionnaire after watching the music videos. The focus of the analysis was on susceptibility to use e-cigarettes in the future among never users (n = 303). RESULTS Participants in the treatment group who had never used e-cigarettes were more likely to report intentions to try e-cigarettes in the future (OR = 1.94, 95% CI [1.08, 3.54], compared to participants in the control group. Participants in the treatment group who had never used e-cigarettes were more likely to report peer influence (OR = 1.97, 95% CI [1.19, 3.32], compared to participants in the control group. While these subitems of susceptibility to use e-cigarettes were statistically significant, the relationship between the treatment group and the composite measure of susceptibility was not. CONCLUSION Exposure to e-cigarette product placement in music videos may increase young adults' intentions to try e-cigarettes in the future. Federal, state, and local tobacco control regulatory bodies should consider strategies to reduce e-cigarette product placement in music videos.
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27
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Gaiha SM, Lin C, Lempert LK, Halpern-Felsher B. Use Patterns, Flavors, Brands, and Ingredients of Nonnicotine e-Cigarettes Among Adolescents, Young Adults, and Adults in the United States. JAMA Netw Open 2022; 5:e2216194. [PMID: 35612852 PMCID: PMC9133942 DOI: 10.1001/jamanetworkopen.2022.16194] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Nonnicotine e-cigarettes contain chemicals, flavorants, and solvents that have known health harms and/or have not been proven safe for inhalation. OBJECTIVE To evaluate nonnicotine e-cigarette use patterns, including common flavors, brands, and ingredients. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included a convenience sample of US residents aged 13 to 40 years who completed an online survey in November and December 2021. Quota sampling was used for an equal proportion of participants aged 13 to 17 years, 18 to 20 years, and 21 to 40 years, balanced for sex, race, and ethnicity per the latest US Census. MAIN OUTCOMES AND MEASURES Nonnicotine e-cigarette use (ever, past 30- and past 7-day, number of times used, time taken to finish); co-use with nicotine e-cigarettes; age at first try; and flavors, brands, and ingredients used. RESULTS Overall, 6131 participants (mean [SD] age, 21.9 [6.8] years; range, 13-40 years; 3454 [56.3%] identifying as female) completed the survey (55.1% completion rate). Among all participants, 1590 (25.9%) had ever used a nonnicotine e-cigarette, 1021 (16.7%) used one in the past 30 days, and 760 (12.4%) used one in the past 7 days. By age group, 227 of 1630 participants aged 13 to 17 years (13.9%), 497 of 2033 participants aged 18 to 20 years (24.4%), 399 of 1041 participants aged 21 to 24 years (38.3%), and 467 of 1427 participants aged 25 to 40 years (32.7%) had ever used nonnicotine e-cigarettes. Among 1590 participants who had ever used a nonnicotine e-cigarette, 549 (34.5%) had used one more than 10 times; 1017 (63.9%) finished 1 nonnicotine e-cigarette in less than 1 week. Co-use of nonnicotine with nicotine e-cigarettes was reported by 1155 participants (18.8%), 1363 (22.2%) exclusively used nicotine e-cigarettes, and 431 (7.0%) exclusively used nonnicotine e-cigarettes. Most-used flavors were sweet, dessert, or candy (578 [36.3%]); fruit (532 [33.4%]); and mint or menthol (321 [20.2%]); similar flavor patterns were observed for the top 2 flavors among those who used nonnicotine e-cigarettes in the past 30 days, followed by combinations of coffee, alcohol, flower, plant, and mint or menthol flavors by age group. Participants most reported using tetrahydrocannabinol (587 [36.9%]), cannabidiol (537 [33.7%]), melatonin (438 [27.5%]), caffeine (428 [26.9%]), and essential oils (364 [22.9%]) in their nonnicotine e-cigarettes. CONCLUSIONS AND RELEVANCE In this study of adolescents, young adults, and adults, a sizeable proportion reported having used nonnicotine e-cigarettes and co-using them with nicotine e-cigarettes. Surveillance studies should further assess nonnicotine e-cigarette use patterns and regulations, and prevention should be developed to address youth appeal, unsubstantiated health claims, and possible health harms.
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Affiliation(s)
- Shivani Mathur Gaiha
- Stanford Reach Lab, Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Stanford, California
| | - Crystal Lin
- Stanford Reach Lab, Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Stanford, California
| | - Lauren Kass Lempert
- Stanford Reach Lab, Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Stanford, California
| | - Bonnie Halpern-Felsher
- Stanford Reach Lab, Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Stanford, California
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