1
|
Shi J, Yang Y, Zhang T, Liang K, Guo L, Deng R, Liu K, Ren Y. Multiple analyses of main flavor components in reconstituted tobacco and transfer behavior of their key substances during heating. J Sep Sci 2024; 47:e2400250. [PMID: 39034833 DOI: 10.1002/jssc.202400250] [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: 04/01/2024] [Revised: 06/21/2024] [Accepted: 07/02/2024] [Indexed: 07/23/2024]
Abstract
Reconstituted tobacco (RT) is a product made by reprocessing tobacco waste, experiencing a growing demand for heat-not-burn products. The purpose of this study is to analyze the main flavor ingredients in RT aerosol, as well as the transfer behavior of key flavor substances from substrates to aerosol and the concentrations of these compounds in the substrate after heating. First, we demonstrated that the odor of four RT aerosol samples could be distinguished using an electronic nose. Through non-targeted analysis, 93 volatile compounds were detected by gas chromatography-mass spectrometry, and 286 non/semi-volatile compounds were identified by ultra-high-performance liquid electrophoresis chromatography-mass spectrometry in aerosol. Furthermore, we found that the formation of RT aerosol involves primarily evaporation and distillation, however, the total content delivered from unheated RT samples to aerosol remains relatively low due to compound volatility and cigarette filtration. Thermal reactions during heating indicated the pyrolysis of chlorogenic acid to generate catechol and resorcinol, while Maillard reactions involving glucose and proline produced 2,3-dihydro-3,5-dihydroxy-6-methyl-4h-pyran-4-one. The study highlighted that heating RT at approximately 300°C could mitigate the production of harmful substances while still providing a familiar sensory experience with combusted tobacco.
Collapse
Affiliation(s)
- Jianyang Shi
- Harmful Components and Tar Reduction in Cigarette Key Laboratory of Sichuan Province, Chengdu, China
- New Tobacco Products Engineering and Technology Research Center of Sichuan Province, Chengdu, China
| | - Yunxia Yang
- College of Biomass Science and Engineering, Sichuan University, Chengdu, China
| | - Ting Zhang
- Harmful Components and Tar Reduction in Cigarette Key Laboratory of Sichuan Province, Chengdu, China
| | - Kun Liang
- Harmful Components and Tar Reduction in Cigarette Key Laboratory of Sichuan Province, Chengdu, China
- New Tobacco Products Engineering and Technology Research Center of Sichuan Province, Chengdu, China
| | - Linqing Guo
- Harmful Components and Tar Reduction in Cigarette Key Laboratory of Sichuan Province, Chengdu, China
- New Tobacco Products Engineering and Technology Research Center of Sichuan Province, Chengdu, China
| | - Ruijie Deng
- College of Biomass Science and Engineering, Sichuan University, Chengdu, China
| | - Kai Liu
- Harmful Components and Tar Reduction in Cigarette Key Laboratory of Sichuan Province, Chengdu, China
- New Tobacco Products Engineering and Technology Research Center of Sichuan Province, Chengdu, China
| | - Yao Ren
- College of Biomass Science and Engineering, Sichuan University, Chengdu, China
| |
Collapse
|
2
|
Davigo M, Klerx WNM, van Schooten FJ, Opperhuizen A, Remels AHV, Talhout R. Impact of More Intense Smoking Parameters and Flavor Variety on Toxicant Levels in Emissions of a Heated Tobacco Product. Nicotine Tob Res 2024; 26:571-579. [PMID: 38035623 PMCID: PMC11033558 DOI: 10.1093/ntr/ntad238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/13/2023] [Accepted: 11/23/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION IQOS HEETS are promoted as reduced-risk alternatives to cigarettes. Although some studies have investigated the chemical composition of HEETS emissions, little is known on whether toxicant levels in such emissions are affected by different puffing parameters and flavor varieties. This has important implications when assessing actual human exposure, since IQOS users develop a specific and personalized puffing behavior and may use different HEETS variants. METHODS This study measured the levels of nicotine, total particulate matter, carbonyl compounds, and tobacco-specific nitrosamines (TSNAs) in the emissions of nine differently flavored HEETS and two cigarettes (1R6F and Marlboro Red, MR). Emissions from Yellow HEETS, 1R6F, and MR were collected using the World Health Organization Intense smoking regime and four more intense smoking regimes. RESULTS Yellow HEETS aerosol contained lower levels of toxicants compared to 1R6F and MR smoke. More intense smoking regimes increased carbonyl release in cigarette smoke, whereas only higher puff frequency led to lower levels of toxicants in Yellow HEETS aerosol. Some HEETS varieties exhibited higher levels of formaldehyde and TSNAs in their aerosols compared to Yellow HEETS. CONCLUSIONS Puff frequency was identified as the only smoking parameter that significantly lowered the release of almost all toxicants in Yellow HEETS, whereas a combination of higher puff volume and puff duration led to increased levels of some carbonyls. Differences in toxicant levels between various commercially available HEETS have important implications when assessing their health impact, as their consumption might induce different toxicant exposure and health effects. IMPLICATIONS HEETS release about half as much nicotine and substantially lower levels of toxicants compared to cigarettes. Literature data showed that puffing intensity is increased in cigarette smokers switching to HEETS, maybe in reaction to these lower nicotine levels. Our results show a differential impact of increased puff frequency, puff duration, and puff volume in the release of toxicants from HEETS. Thus, industry-independent studies on puff topography are critical to make choices for the most relevant puffing regime for heated tobacco product regulation. Regulators should consider evaluating the health impact of multiple HEETS varieties, as the tobacco filler composition significantly affects the release of certain toxicants.
Collapse
Affiliation(s)
- Michele Davigo
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Department of Pharmacology and Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Walther N M Klerx
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Frederik-Jan van Schooten
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Department of Pharmacology and Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Antoon Opperhuizen
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Department of Pharmacology and Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Office of Risk Assessment and Research, Netherlands Food and Consumer Product Safety Authority (NVWA), Utrecht, The Netherlands
| | - Alexander H V Remels
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Department of Pharmacology and Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Reinskje Talhout
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| |
Collapse
|
3
|
Suzuki H, Aono N, Zhang Y, Yuri K, Bassole Epse Brou MAM, Takemura S, Higashiyama A, Tabuchi T, Fujiyoshi A. Comparison of Publications on Heated Tobacco Products With Conventional Cigarettes and Implied Desirability of the Products According to Tobacco Industry Affiliation: A Systematic Review. Nicotine Tob Res 2024; 26:520-526. [PMID: 37950902 DOI: 10.1093/ntr/ntad205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 08/01/2023] [Accepted: 10/01/2023] [Indexed: 11/13/2023]
Abstract
INTRODUCTION Heated tobacco products (HTPs) have been advertised as "reduced-harm" tobacco products compared to conventional cigarettes (CC); however, no direct evidence supporting HTPs being desirable for human health exists. A previous systematic review reported that evidence on HTPs published in 2017 or earlier was primarily drawn from industry-related papers. We aimed to investigate whether tobacco industry-affiliated studies are more likely to conclude that HTPs are more desirable than CC. METHODS PubMed and Ichushi-Web were searched up to March 15, 2022, for studies on HTPs published in 2017 or after. We selected studies that assessed any measures of HTPs and CC, including secondary analyses using gray literature in English or Japanese. We excluded review articles except for a meta-analysis that met the aforementioned criteria. Data on the authors' affiliations, grant, conflict of interest, category of research subjects, and interpretation were extracted. Research members in two groups independently assessed the papers; discrepancies were solved by discussion between the groups. RESULTS Overall, 134 studies met the criteria. Eighty-seven (64.9%) of them were affiliated with the tobacco industry. Of the 134 studies, 56.3% (49/87) of the industry-affiliated studies versus 19.1% (9/47) of nonindustry-affiliated studies concluded that HTPs were more desirable than CC (p < .01). No study investigated clinically relevant outcomes, such as disease occurrence. CONCLUSIONS Publications on HTPs in the biomedical literature from January 2017 to March 2022 were dominated by tobacco industry-affiliated studies. More than half of them concluded that HTPs were more desirable than CC compared to independent studies. IMPLICATIONS Tobacco industry advertises HTPs as "reduced-harm" tobacco products compared to CC. HTP users tend to consider HTPs as alternative tobacco products less harmful than CC (ie, products for "harm reduction"). Our results demonstrated that papers written by tobacco industry-affiliated authors concluded that HTPs were more desirable than CC compared to papers by independent authors. However, all their judgments were based on surrogate outcomes. Surrogate outcomes are not necessarily linked to clinically relevant outcomes such as disease occurrence. Further studies on HTPs using clinically relevant outcomes are warranted by independent authors from tobacco industry.
Collapse
Affiliation(s)
- Harumitsu Suzuki
- Department of Hygiene, Wakayama Medical University, Wakayama, Japan
| | - Naoki Aono
- Department of Hygiene, Wakayama Medical University, Wakayama, Japan
| | - Yan Zhang
- Department of Hygiene, Wakayama Medical University, Wakayama, Japan
| | - Kuniko Yuri
- Department of Hygiene, Wakayama Medical University, Wakayama, Japan
| | | | - Shigeki Takemura
- Department of Hygiene, Wakayama Medical University, Wakayama, Japan
| | - Aya Higashiyama
- Department of Hygiene, Wakayama Medical University, Wakayama, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Akira Fujiyoshi
- Department of Hygiene, Wakayama Medical University, Wakayama, Japan
| |
Collapse
|
4
|
Kopa-Stojak PN, Pawliczak R. Comparison of the effects of active and passive smoking of tobacco cigarettes, electronic nicotine delivery systems and tobacco heating products on the expression and secretion of oxidative stress and inflammatory response markers. A systematic review. Inhal Toxicol 2024; 36:75-89. [PMID: 38394073 DOI: 10.1080/08958378.2024.2319315] [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: 10/16/2023] [Accepted: 02/09/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVES This work attempts to summarize current knowledge on the effects of active and passive smoking of cigarettes, electronic nicotine delivery systems and tobacco heating products on the expression and secretion of oxidative stress and inflammatory response mediators, and on their possible impact on chronic obstructive pulmonary disease development. MATERIALS AND METHODS The literature was searched by the terms: 'smoking', 'active smoking', 'passive smoking', 'main-stream smoke', 'side-stream smoke', 'secondhand smoke', 'cigarette' 'THP', 'tobacco heating product', 'ENDS', 'electronic nicotine delivery system', 'e-cigarette', 'electronic cigarette', oxidative stress', inflammatory response' and 'gene expression'. RESULTS Cigarette smoking (active and passive) induces oxidative stress and inflammatory response in the airways. We present the effect of active smoking of e-cigarettes (EC) and heat-not-burn (HnB) products on the increased expression and secretion of oxidative stress and inflammatory response markers. However, there is only a limited number of studies on the effect of their second-hand smoking, and those available mainly describe aerosol composition. DISCUSSION The literature provides data which confirm that active and passive cigarette smoking induces oxidative stress and inflammatory response in the airways and is a key risk factor of COPD development. Currently, there is a limited number of data about ENDS and THP active and passive smoking effects on the health of smokers and never-smokers. It is particularly important to assess the effect of such products during long-term use by never-smokers who choose them as the first type of cigarettes, and for never-smokers who are passively exposed to their aerosol.
Collapse
Affiliation(s)
- Paulina Natalia Kopa-Stojak
- Department of Immunopathology, Division of Biomedical Science, Faculty of Medicine, Medical University of Lodz, Lodz, Poland
| | - Rafal Pawliczak
- Department of Immunopathology, Division of Biomedical Science, Faculty of Medicine, Medical University of Lodz, Lodz, Poland
| |
Collapse
|
5
|
Momosaka T, Saito J, Otsuki A, Yaguchi-Saito A, Fujimori M, Kuchiba A, Katanoda K, Takaku R, Shimazu T. Associations of individual characteristics and socioeconomic status with heated tobacco product harmfulness perceptions in Japan: A nationwide cross-sectional study (INFORM Study 2020). J Epidemiol 2024:JE20230177. [PMID: 38191179 DOI: 10.2188/jea.je20230177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024] Open
Abstract
IntroductionIn Japan, heated tobacco products (HTPs) are promoted by the tobacco industry as reduced-risk tobacco products despite the lack of evidence for this claim. This study determined the distribution of HTP-harmfulness perception and identify the explanatory factors associated with the perception of HTP as less harmful than conventional cigarettes.MethodsA nationwide cross-sectional survey was conducted with Japanese people aged 20 years or older (INFORM Study 2020) using a self-administered questionnaire. We performed descriptive analysis and weighted logistic regression analysis to examine the relationship between explanatory factors (e.g., individual characteristics, socioeconomic status, and trusted sources of cancer information) and the perception of HTPs as less harmful.ResultsAmong 3,420 participants (response rate: 35.2%), the proportions of those who perceived HTPs as less harmful were 40.3% and 18.3% for users and non-users of tobacco, respectively. For participants aged 20-39 years, the proportion were 49.9% and 30.4%, respectively. Among 1,160 non-tobacco users who were familiar with HTPs, male, aged under 39 years, and had lower education were associated with the perception of HTPs as less harmful. Trusted sources of cancer information were not associated with the perception of HTPs as less harmful.ConclusionsThis study showed that, among non-tobacco users, being male, aged under 39 years, and lower education were associated with a perception of HTPs as less harmful. Public health stakeholders should provide the latest evidence about HTP harmfulness in their daily practice, and strengthen the regulations on HTP marketing directed at both tobacco- and non-tobacco users.
Collapse
Affiliation(s)
- Takumi Momosaka
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control
- School of International and Public Policy, Hitotsubashi University
| | - Junko Saito
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control
| | - Aki Otsuki
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control
| | - Akiko Yaguchi-Saito
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control
- Faculty of Human Sciences, Tokiwa University
| | - Maiko Fujimori
- Division of Survivorship Research, National Cancer Center Institute for Cancer Control
| | - Aya Kuchiba
- Graduate School of Health Innovation, Kanagawa University of Human Services
- Division of Biostatistical Research, Institution for Cancer Control/Biostatistics Division, Center for Research Administration and Support, National Cancer Center
| | - Kota Katanoda
- Division of Population Data Science, National Cancer Center Institute for Cancer Control
| | - Reo Takaku
- School of International and Public Policy, Hitotsubashi University
| | - Taichi Shimazu
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control
| |
Collapse
|
6
|
Watle SV, Børud B, Laake I, Baranowska-Hustad M, Bryant-Bratlie D, Bekkevold T, Caugant DA, Tunheim G, Næss LM. Antibodies against Neisseria meningitidis serogroups A, C, W and Y in serum and saliva of Norwegian adolescents. Vaccine 2023; 41:6529-6537. [PMID: 37648606 DOI: 10.1016/j.vaccine.2023.08.052] [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: 06/29/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION The incidence of invasive meningococcal disease (IMD) among Norwegian 16-19-year-olds was 1-7/100,000 in the decade before the COVID-19 pandemic, with serogroup Y (MenY) dominance. In contrast to many other European countries, meningococcal vaccines are not part of the national immunisation program (NIP) in Norway. This cross-sectional study aimed to measure the degree of natural immunity against Neisseria meningitidis among adolescents in Norway to evaluate the need for introducing tetravalent meningococcal conjugate vaccine (MCV4) in the NIP. MATERIALS AND METHODS Serum and saliva samples were collected from students in upper and lower secondary schools in Norway in 2018. Samples were analysed for meningococcal capsular polysaccharide (PS)-specific antibodies using a bead-based multiplex immunoassay. PS-specific antibody levels were linked to data on meningococcal carriage, vaccination status and risk factors for carriage (assessed with questionnaire) and analysed by linear regression of log transformed concentrations. A subset of samples from unvaccinated individuals was analysed for serum bactericidal antibodies (SBA). RESULTS A total of 1344 participants, median age 16 years (range 12-24), were included in the study. Overall, 60.9% of the participants were female and 1137 (84.6%) were not vaccinated with MCV4. PS-specific antibody concentrations in serum and saliva were low among unvaccinated individuals for all serogroups and only 6.7-20.0% of the subpopulation with high PS-specific antibodies assessed with SBA had protective levels. Unvaccinated MenY carriers had higher levels of MenY anti-PS IgG in serum and IgA in saliva than those not carrying MenY. Use of Swedish snus was associated with lower anti-PS IgG levels in serum and waterpipe use with lower anti-PS IgG levels in saliva. CONCLUSION Unvaccinated adolescents in Norway have a low degree of natural immunity against the serogroups of N. meningitidis predominating among cases of IMD in this age group. Therefore, introduction of MCV4 for adolescents in the NIP is recommended.
Collapse
Affiliation(s)
- Sara Viksmoen Watle
- Division of Infection Control, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213 Oslo, Norway; Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1078, Blindern, 0316 Oslo, Norway.
| | - Bente Børud
- Division of Infection Control, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213 Oslo, Norway
| | - Ida Laake
- Division of Infection Control, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213 Oslo, Norway
| | - Marta Baranowska-Hustad
- Division of Infection Control, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213 Oslo, Norway
| | - Diane Bryant-Bratlie
- Division of Infection Control, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213 Oslo, Norway
| | - Terese Bekkevold
- Division of Infection Control, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213 Oslo, Norway
| | - Dominique A Caugant
- Division of Infection Control, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213 Oslo, Norway; Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1078, Blindern, 0316 Oslo, Norway
| | - Gro Tunheim
- Division of Infection Control, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213 Oslo, Norway
| | - Lisbeth Meyer Næss
- Division of Infection Control, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213 Oslo, Norway
| |
Collapse
|
7
|
Błach J, Siedliński M, Sydor W. Immunology in COPD and the use of combustible cigarettes and heated tobacco products. Eur J Med Res 2023; 28:397. [PMID: 37794516 PMCID: PMC10548761 DOI: 10.1186/s40001-023-01374-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/18/2023] [Indexed: 10/06/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the most common chronic respiratory diseases, characterised by high morbidity and mortality. COPD is characterised by a progressive decline of lung function caused by chronic inflammatory reactions in the lung tissue due to continual exposure to harmful molecules by inhalation. As prevention plays a very important role in COPD, quitting smoking is the most important factor in reducing the decline in lung function. Unfortunately, many people are unable to break their nicotine addiction. This paper summarises current knowledge about combustible cigarettes (CSs) and alternative tobacco products such as heated tobacco products (HTPs) in COPD. The paper focuses on the immunological aspects of COPD and the influence of tobacco products on lung tissue immunology. There are differences in research results between HTPs and CSs in favour of HTPs. More long-term studies are needed to look at the effects of HTPs, especially in COPD. However, there is no doubt that it would be best for patients to give up their nicotine addiction completely.
Collapse
Affiliation(s)
- Justyna Błach
- Department of Clinical Immunology, UCH, Cracow, Poland.
| | - Mateusz Siedliński
- Department of Internal Medicine and Rural Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Wojciech Sydor
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Cracow, Poland
| |
Collapse
|
8
|
Call for papers on disposable e-cigarettes. Addiction 2023; 118:1831-1832. [PMID: 37482934 DOI: 10.1111/add.16307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
|
9
|
Upadhyay S, Rahman M, Johanson G, Palmberg L, Ganguly K. Heated Tobacco Products: Insights into Composition and Toxicity. TOXICS 2023; 11:667. [PMID: 37624172 PMCID: PMC10459283 DOI: 10.3390/toxics11080667] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/10/2023] [Accepted: 07/20/2023] [Indexed: 08/26/2023]
Abstract
Heated tobacco products (HTPs) are novel products that allow users to inhale nicotine by heating (350 °C) reconstituted tobacco rather than combustion (900 °C) as in conventional cigarettes. HTP sticks containing reconstituted tobacco come in various flavours such as menthol, citrus, etc., like electronic cigarette liquids. Thus, the composition of HTP aerosol will also vary according to the flavouring agents added. Overall, the content of toxic chemicals in HTP aerosol appears to be lower than in cigarette smoke. However, the concentrations of more than twenty harmful and potentially harmful constituents have been reported to be higher in HTP aerosol than in cigarette smoke. Further, several toxic compounds not detected in cigarette smoke are also reported in HTP aerosol. Thus, the risks of HTP use remain unknown. Most of the available data on the composition and health effects of mainstream HTP aerosol exposure are generated by the tobacco industry. Few independent studies have reported short-term pathophysiological effects of HTP use. Currently available HTP toxicity data are mainly on the pulmonary and cardiovascular systems. Moreover, there are no long-term toxicity data and, therefore, the claims of the tobacco industry regarding HTPs as a safer alternative to traditional combustible cigarettes are unsubstantiated. Furthermore, HTP aerosol contains the highly addictive substance nicotine, which is harmful to the adolescent brain, developing foetuses, pregnant women, and also adults. Hence, comprehensive studies addressing the safety profiling related to long-term HTP use are warranted. With this background, the following review summarizes the current state of knowledge on HTP toxicity on four broad lines: composition of mainstream HTP aerosol compared to traditional combustible cigarette smoke, biomarkers of HTP exposure, health effects of HTP exposure, and the harm reduction aspect.
Collapse
Affiliation(s)
- Swapna Upadhyay
- Unit of Integrative Toxicology, Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden; (M.R.); (G.J.); (L.P.)
| | | | | | | | - Koustav Ganguly
- Unit of Integrative Toxicology, Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden; (M.R.); (G.J.); (L.P.)
| |
Collapse
|
10
|
Odani S, Tsuno K, Agaku IT, Tabuchi T. Heated tobacco products do not help smokers quit or prevent relapse: a longitudinal study in Japan. Tob Control 2023:tc-2022-057613. [PMID: 36849258 DOI: 10.1136/tc-2022-057613] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 01/27/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Heated tobacco products (HTPs) are often marketed as a safer alternative to help cigarette smokers quit. We investigated the link between HTP use and smoking cessation and relapse. METHODS 7044 adults (≥20 years old) with at least two observations over three waves (2019-2021) of a longitudinal, nationwide, internet-based survey were classified into current (past 30-day), former and never cigarette smokers. ≥1 month and ≥6 months smoking cessation and smoking relapse at 1-year follow-up were assessed in relation to current HTP use at baseline. Generalised estimating equation models were weighted to account for population differences between HTP users and non-users. Adjusted prevalence ratios (APRs) were computed within population subgroups. RESULTS At baseline, 17.2%, 9.1% and 6.1% of the respondents were current cigarette smokers, HTP users and dual users, respectively. Among current established smokers (having smoked regularly, n=1910), HTP use was significantly associated with a decreased likelihood of ≥1 month cessation within those who reported having used evidence-based cessation measures (APR=0.61), smoking 20+ cigarettes per day (APR=0.62), high school education or less (APR=0.73) and fair/poor health (APR=0.59). Negative associations were also seen for ≥6 months cessation among those aged 20-29 years (APR=0.56) and full-time workers (APR=0.56). Among former smokers (n=2906), HTP use was associated with smoking relapse within those who last smoked >1 year ago (APR=1.54), among women (APR=1.61), those aged 20-29 years (APR=2.09), those reporting high school education or less (APR=2.36), those who were unemployed/retired (AOR=3.31) and never/non-current alcohol users (APR=2.10). CONCLUSION HTP use did not help smokers quit or prevent former smokers from relapsing. HTPs should not be recommended as a cessation aid.
Collapse
Affiliation(s)
- Satomi Odani
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Kanami Tsuno
- School of Health Innovation, Kanagawa University of Human Services, Kawasaki, Japan
| | - Israel T Agaku
- Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| |
Collapse
|
11
|
Zhao L, Shang S, Tian Y, Gao Y, Song Z, Peng L, Li Z, Wang B. Integrative analysis of sensory evaluation and non-targeted metabolomics to unravel tobacco leaf metabolites associated with sensory quality of heated tobacco. FRONTIERS IN PLANT SCIENCE 2023; 14:1123100. [PMID: 36844088 PMCID: PMC9944805 DOI: 10.3389/fpls.2023.1123100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 01/26/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Heated tobacco (Nicotiana tabacum L.) products are heating tobacco plug at a temperature of 350°C and produce different emissions in aerosol and sensory perceptions of tobacco leaf compared with combustible tobacco. Previous study assessed different tobacco varieties in heated tobacco for sensory quality and analyzed the links between sensory scores of the final products and certain chemical classes in tobacco leaf. However, contribution of individual metabolites to sensory quality of heated tobacco remains largely open for investigation. METHODS In present study, five tobacco varieties were evaluated as heated tobacco for sensory quality by an expert panel and the volatile and non-volatile metabolites were analyzed by non-targeted metabolomics profiling. RESULTS The five tobacco varieties had distinct sensory qualities and can be classified into higher and lower sensory rating classes. Principle component analysis and hierarchical cluster analysis showed that leaf volatile and non-volatile metabolome annotated were grouped and clustered by sensory ratings of heated tobacco. Orthogonal projections to latent structures discriminant analysis followed by variable importance in projection and fold-change analysis revealed 13 volatiles and 345 non-volatiles able to discriminate the tobacco varieties with higher and lower sensory ratings. Some compounds such as β-damascenone, scopoletin, chlorogenic acids, neochlorogenic acids, and flavonol glycosyl derivatives had strong contribution to the prediction of sensory quality of heated tobacco. Several lyso-phosphatidylcholine and lyso-phosphatidylethanolamine lipid species, and reducing and non-reducing sugar molecules were also positively related to sensory quality. DISCUSSION Taken together, these discriminating volatile and non-volatile metabolites support the role of leaf metabolites in affecting the sensory quality of heated tobacco and provide new information on the types of leaf metabolites that can be used to predict applicability of tobacco varieties for heated tobacco products.
Collapse
Affiliation(s)
- Lu Zhao
- National Tobacco Genetic Engineering Research Center, Yunnan Academy of Tobacco Agricultural Sciences, Kunming, Yunnan, China
| | - Shanzhai Shang
- Research and Development Center, China Tobacco Yunnan Industrial Co., Ltd., Kunming, Yunnan, China
| | - Yongfeng Tian
- Research and Development Center, China Tobacco Yunnan Industrial Co., Ltd., Kunming, Yunnan, China
| | - Yulong Gao
- National Tobacco Genetic Engineering Research Center, Yunnan Academy of Tobacco Agricultural Sciences, Kunming, Yunnan, China
| | - Zhongbang Song
- National Tobacco Genetic Engineering Research Center, Yunnan Academy of Tobacco Agricultural Sciences, Kunming, Yunnan, China
| | - Lijuan Peng
- Laboratory of Tobacco Chemistry, Yunnan Tobacco Quality Supervision and Test Station, Kunming, Yunnan, China
| | - Zhuolin Li
- Department of Technical Support, Malong Branch of Qujing Tobacco Company, Qujing, Yunnan, China
| | - Bingwu Wang
- National Tobacco Genetic Engineering Research Center, Yunnan Academy of Tobacco Agricultural Sciences, Kunming, Yunnan, China
| |
Collapse
|
12
|
Sparrock LS, Phan L, Chen-Sankey J, Hacker K, Ajith A, Jewett B, Choi K. Heated Tobacco Products: Awareness, Beliefs, Use and Susceptibility among US Adult Current Tobacco Users, 2021. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2016. [PMID: 36767383 PMCID: PMC9915028 DOI: 10.3390/ijerph20032016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 05/31/2023]
Abstract
Limited data exist on the awareness, beliefs, and use of heated tobacco products (HTPs). Data from 1583 U.S. adult (age ≥ 21 years) current tobacco users were collected in 2021. Participants self-reported HTP awareness, beliefs, use, and susceptibility, as well as current tobacco product use and sociodemographics. We used weighted logistic and multinomial regression models to explore their associations. Overall, 23.6% were aware of, 8.9% had ever used, and 3.0% currently used HTPs. Younger individuals (vs. 61+ years), those with annual income $50,000+ (vs. <$50,000), and those currently using electronic vaping products (vs. non-users) were more likely to be aware of, to have ever used, and to currently be using HTPs (p < 0.05). Black individuals (vs. White) were more likely to report ever and current HTP use (p < 0.05). Current cigarette smoking was not associated with HTP awareness and use (p > 0.05). Holding favorable HTP beliefs was associated with susceptibility to and more advanced HTP use statuses (p < 0.05). Sociodemographics associated with HTP use may reflect HTP marketing strategies. The lack of association with cigarette smoking suggests HTPs may be unlikely cigarette substitutes. Addressing favorable HTP-related beliefs may prevent dual use.
Collapse
Affiliation(s)
| | - Lilianna Phan
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD 20892, USA
| | - Julia Chen-Sankey
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ 08901, USA
- School of Public Health, Rutgers Biomedical and Health Sciences, Piscataway, NJ 08854, USA
| | - Kiana Hacker
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD 20892, USA
| | - Aniruddh Ajith
- School of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Bambi Jewett
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD 20892, USA
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD 20892, USA
| |
Collapse
|
13
|
Dempsey R, Rodrigo G, Vonmoos F, Gunduz I, Belushkin M, Esposito M. Preliminary toxicological assessment of heated tobacco products: A review of the literature and proposed strategy. Toxicol Rep 2023; 10:195-205. [PMID: 36748021 PMCID: PMC9898577 DOI: 10.1016/j.toxrep.2023.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/20/2022] [Accepted: 01/18/2023] [Indexed: 01/21/2023] Open
Abstract
Heated tobacco products (HTP) have become increasingly common in many countries worldwide. The principle of heating tobacco, without combustion, to produce a nicotine-containing aerosol with remarkably reduced levels of other known toxins, compared to combusted tobacco cigarettes, is now well established. As these products are intended as alternatives to traditional combusted products, during the early stages of their development, it is important for manufacturers to ensure that the design of the product does not lead to any unintentionally increased or new risk for the consumer, compared to the traditional products that consumers seek to replace. There is limited guidance from tobacco product regulations concerning the requirements for performing such preliminary toxicological assessments. Here, we review the published literature on studies performed on HTPs in the pursuit of such data, outline a proposed approach that is consistent with regulatory requirements, and provide a logical approach to the preliminary toxicological assessment of HTPs.
Collapse
Affiliation(s)
- Ruth Dempsey
- RD Science Speaks Consultancy Sàrl, Le Mont sur Lausanne, Switzerland,Corresponding authors.
| | - Gregory Rodrigo
- PMI R&D, Philip Morris Products S.A., Rue des Usines 56, 2000 Neuchâtel, Switzerland,Corresponding authors.
| | - Florence Vonmoos
- PMI R&D, Philip Morris Products S.A., Rue des Usines 56, 2000 Neuchâtel, Switzerland
| | - Irfan Gunduz
- PMI R&D, Philip Morris Products S.A., Rue des Usines 56, 2000 Neuchâtel, Switzerland
| | - Maxim Belushkin
- PMI R&D, Philip Morris Products S.A., Rue des Usines 56, 2000 Neuchâtel, Switzerland
| | - Marco Esposito
- PMI R&D, Philip Morris Products S.A., Rue des Usines 56, 2000 Neuchâtel, Switzerland
| |
Collapse
|
14
|
Kusonić D, Bijelić K, Kladar N, Božin B, Torović L, Srđenović Čonić B. Comparative Health Risk Assessment of Heated Tobacco Products versus Conventional Cigarettes. Subst Use Misuse 2023; 58:346-353. [PMID: 36630411 DOI: 10.1080/10826084.2022.2161315] [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] [Indexed: 01/12/2023]
Abstract
BACKGROUND Smoking is the largest preventable cause of death in the world with around eight million estimated premature deaths per year. In response to the harmful effects of conventional tobacco products the tobacco industry has launched a new type of products called Heated tobacco products (HTP) and e-cigarettes, which are considered safer for human health than conventional cigarettes. MATERIALS AND METHODS The research was conducted by searching the scientific literature using platforms "Google scholar," "PubMed" and "Science Direct." To compare the non-carcinogenic and carcinogenic risk of HTP products and conventional cigarettes, margin of exposure and lifetime excess cancer risk were calculated using data obtained from a scientific literature search. UNLABELLED HTP products have shown a reduced risk to human health compared to the conventional cigarettes, although they still contain compounds that can be dangerous to human health. There is not enough data obtained from independent studies that could safely indicate that these reduced amounts of toxic chemical entities in the composition of HTP do not induce any harmful effect. CONCLUSION Further research is needed to determine the harmful effects of HTP aerosol, as well as to tighten the legislation that would limit the production, import and distribution of these products worldwide until their safety for human health is confirmed with a sufficient number of transparent and representative results obtained in independent scientific studies.
Collapse
Affiliation(s)
- Dejan Kusonić
- Faculty of Medicine, Department of Pharmacy, University of Novi Sad, Novi Sad, Serbia
| | - Katarina Bijelić
- Faculty of Medicine, Department of Pharmacy, University of Novi Sad, Novi Sad, Serbia
| | - Nebojša Kladar
- Faculty of Medicine, Department of Pharmacy, University of Novi Sad, Novi Sad, Serbia.,Faculty of Medicine, Center for Medical and Pharmaceutical Investigations and Quality Control, University of Novi Sad, Novi Sad, Serbia
| | - Biljana Božin
- Faculty of Medicine, Department of Pharmacy, University of Novi Sad, Novi Sad, Serbia.,Faculty of Medicine, Center for Medical and Pharmaceutical Investigations and Quality Control, University of Novi Sad, Novi Sad, Serbia
| | - Ljilja Torović
- Faculty of Medicine, Department of Pharmacy, University of Novi Sad, Novi Sad, Serbia
| | - Branislava Srđenović Čonić
- Faculty of Medicine, Department of Pharmacy, University of Novi Sad, Novi Sad, Serbia.,Faculty of Medicine, Center for Medical and Pharmaceutical Investigations and Quality Control, University of Novi Sad, Novi Sad, Serbia
| |
Collapse
|
15
|
Effects of Heat-Not-Burn Cigarette Smoking on the Secretion of Saliva and Its Innate Immune System Components. Healthcare (Basel) 2022; 11:healthcare11010132. [PMID: 36611591 PMCID: PMC9819160 DOI: 10.3390/healthcare11010132] [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: 11/07/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
Saliva and salivary antimicrobial proteins play important roles in the innate immunity, which prevents infections of orally invading bacteria and viruses. In this study, we compared the secretion rates of salivary lactoferrin (Lac) and lysozyme (Lys) in heat-not-burn (HNB) cigarette smokers and non-smokers. The analysis population for this study included 212 members of the fire department, including 32 HNB cigarette smokers, 17 paper cigarette smokers, 14 combined HNB and paper cigarette smokers, and 149 non-smokers. Salivary Lac and Lys concentrations were assessed using enzyme immunoassay. Saliva secretion was significantly lower among HNB cigarette smokers (p < 0.01) than among non-smokers. Accompanying this result, salivary Lac and Lys secretion rates were significantly lower among smokers, particularly HNB cigarette smokers, than among non-smokers (all p < 0.01). Our findings suggest a possible adverse effect of HNB cigarette on the amount of Lac and Lys released into the oral cavity.
Collapse
|
16
|
Chapman F, Sticken ET, Wieczorek R, Pour SJ, Dethloff O, Budde J, Rudd K, Mason E, Czekala L, Yu F, Simms L, Nahde T, O'Connell G, Stevenson M. Multiple endpoint in vitro toxicity assessment of a prototype heated tobacco product indicates substantially reduced effects compared to those of combustible cigarette. Toxicol In Vitro 2022; 86:105510. [DOI: 10.1016/j.tiv.2022.105510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/22/2022] [Accepted: 10/31/2022] [Indexed: 11/13/2022]
|
17
|
Levy DT, Cadham CJ, Li Y, Yuan Z, Liber AC, Oh H, Travis N, Issabakhsh M, Sweanor DT, Sánchez-Romero LM, Meza R, Cummings KM. A Decision-Theoretic Public Health Framework for Heated Tobacco and Nicotine Vaping Products. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13431. [PMID: 36294011 PMCID: PMC9602493 DOI: 10.3390/ijerph192013431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/22/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
Markets for nicotine vaping products (NVPs) and heated tobacco products (HTPs) have grown as these products became positioned as harm-reduction alternatives to combusted tobacco products. Herein, we present a public health decision-theoretic framework incorporating different patterns of HTP, NVP, and cigarette use to examine their impacts on population health. Our framework demonstrates that, for individuals who would have otherwise smoked, HTP use may provide public health benefits by enabling cessation or by discouraging smoking initiation and relapse. However, the benefits are reduced if more harmful HTP use replaces less harmful NVP use. HTP use may also negatively impact public health by encouraging smoking by otherwise non-smokers or by encouraging initiation or relapse into smoking. These patterns are directly influenced by industry behavior as well as public policy towards HTPs, NVPs, and cigarettes. While substantial research has been devoted to NVPs, much less is known about HTPs. Better information is needed to more precisely define the health risks of HTPs compared to cigarettes and NVPs, the relative appeal of HTPs to consumers, and the likelihood of later transitioning to smoking or quitting all products. While our analysis provides a framework for gaining that information, it also illustrates the complexities in distinguishing key factors.
Collapse
Affiliation(s)
- David T. Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Christopher J. Cadham
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Yameng Li
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Zhe Yuan
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Alex C. Liber
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Hayoung Oh
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Nargiz Travis
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Mona Issabakhsh
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - David T. Sweanor
- Centre for Health Law, Policy & Ethics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Faculty of Law, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | | | - Rafael Meza
- Department of Integrative Oncology, BC Cancer Institute, Vancouver, BC V5Z1L3, Canada
| | - K. Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of Charleston, Charleston, SC 29425, USA
| |
Collapse
|
18
|
Fried ND, Oakes JM, Whitehead AK, Lazartigues E, Yue X, Gardner JD. Nicotine and novel tobacco products drive adverse cardiac remodeling and dysfunction in preclinical studies. Front Cardiovasc Med 2022; 9:993617. [PMID: 36277777 PMCID: PMC9582354 DOI: 10.3389/fcvm.2022.993617] [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: 07/13/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022] Open
Abstract
Background The heart undergoes structural and functional changes in response to injury and hemodynamic stress known as cardiac remodeling. Cardiac remodeling often decompensates causing dysfunction and heart failure (HF). Cardiac remodeling and dysfunction are significantly associated with cigarette smoking. Although cigarette smoking has declined, the roles of nicotine and novel tobacco products (including electronic cigarettes and heat-not-burn tobacco) in cardiac remodeling are unclear. In this perspective, we present evidence demonstrating maladaptive cardiac remodeling in nicotine-exposed mice undergoing hemodynamic stress with angiotensin (Ang)-II infusion and review preclinical literature linking nicotine and novel tobacco products with cardiac remodeling and dysfunction. Methods Adult, male C57BL/6J mice were exposed to room air or chronic, inhaled nicotine for 8 weeks. A subset of mice was infused with Ang-II via subcutaneous osmotic mini-pumps during the final 4 weeks of exposure. Left ventricular structure and function were assessed with echocardiography. Results Chronic, inhaled nicotine abrogated Ang-II-induced thickening of the left ventricular posterior wall, leading to reduced relative wall thickness. Ang-II infusion was associated with increased left ventricular mass index in both air- and nicotine-exposed mice. Conclusions These changes suggest a phenotypic shift from concentric hypertrophy to eccentric hypertrophy in nicotine-exposed, hemodynamically-stressed mice which could drive HF pathogenesis. These findings join a growing body of animal studies demonstrating cardiac remodeling and dysfunction following nicotine and electronic cigarette exposure. Further exploration is necessary; however, clinicians and researchers should not overlook these emerging products as potential risk factors in the pathogenesis of cardiac remodeling and associated diseases including HF.
Collapse
Affiliation(s)
- Nicholas D. Fried
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Joshua M. Oakes
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Anna K. Whitehead
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Eric Lazartigues
- Department of Pharmacology & Experimental Therapeutics, Louisiana State University Health Sciences Center, New Orleans, LA, United States,Cardiovascular Center of Excellence, New Orleans, LA, United States,Neuroscience center of Excellence, Louisiana State University Health Sciences Center, New Orleans, LA, United States,Southeast Louisiana Veterans Health Care Systems, New Orleans, LA, United States
| | - Xinping Yue
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Jason D. Gardner
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, LA, United States,*Correspondence: Jason D. Gardner
| |
Collapse
|
19
|
Rahman M, Irmler M, Introna M, Beckers J, Palmberg L, Johanson G, Upadhyay S, Ganguly K. Insight into the pulmonary molecular toxicity of heated tobacco products using human bronchial and alveolar mucosa models at air-liquid interface. Sci Rep 2022; 12:16396. [PMID: 36180488 PMCID: PMC9525689 DOI: 10.1038/s41598-022-20657-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 09/16/2022] [Indexed: 11/09/2022] Open
Abstract
Heated tobacco products (HTP) are novel nicotine delivery products with limited toxicological data. HTP uses heating instead of combustion to generate aerosol (HTP-smoke). Physiologically relevant human bronchial and alveolar lung mucosa models developed at air-liquid interface were exposed to HTP-smoke to assess broad toxicological response (n = 6-7; ISO puffing regimen; compared to sham; non-parametric statistical analysis; significance: p < 0.05). Elevated levels of total cellular reactive oxygen species, stress responsive nuclear factor kappa-B, and DNA damage markers [8-hydroxy-2'-deoxyguanosine, phosphorylated histone H2AX, cleaved poly-(ADP-Ribose) polymerase] were detected in HTP-smoke exposed bronchial and/or alveolar models. RNA sequencing detected differential regulation of 724 genes in the bronchial- and 121 genes in the alveolar model following HTP-smoke exposure (cut off: p ≤ 0.01; fold change: ≥ 2). Common enriched pathways included estrogen biosynthesis, ferroptosis, superoxide radical degradation, xenobiotics, and α-tocopherol degradation. Secreted levels of interleukin (IL)1ꞵ and IL8 increased in the bronchial model whereas in the alveolar model, interferon-γ and IL4 increased and IL13 decreased following HTP-smoke exposure. Increased lipid peroxidation was detected in HTP-smoke exposed bronchial and alveolar models which was inhibited by ferrostatin-1. The findings form a basis to perform independent risk assessment studies on different flavours of HTP using different puffing topography and corresponding chemical characterization.
Collapse
Affiliation(s)
- Mizanur Rahman
- Unit of Integrative Toxicology, Institute of Environmental Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Martin Irmler
- Institute of Experimental Genetics, Helmholtz Zentrum München, Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH), 85764, Neuherberg, Germany
| | - Micol Introna
- Unit of Integrative Toxicology, Institute of Environmental Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Johannes Beckers
- Institute of Experimental Genetics, Helmholtz Zentrum München, Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH), 85764, Neuherberg, Germany.,German Center for Diabetes Research (DZD E.V.), 85764, Neuherberg, Germany.,Chair of Experimental Genetics, Technical University of Munich, 85354, Freising, Germany
| | - Lena Palmberg
- Unit of Integrative Toxicology, Institute of Environmental Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Gunnar Johanson
- Unit of Integrative Toxicology, Institute of Environmental Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Swapna Upadhyay
- Unit of Integrative Toxicology, Institute of Environmental Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden.
| | - Koustav Ganguly
- Unit of Integrative Toxicology, Institute of Environmental Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden.
| |
Collapse
|
20
|
Iida H, Yamaguchi S, Goyagi T, Sugiyama Y, Taniguchi C, Matsubara T, Yamada N, Yonekura H, Iida M. Consensus statement on smoking cessation in patients with pain. J Anesth 2022; 36:671-687. [PMID: 36069935 PMCID: PMC9666296 DOI: 10.1007/s00540-022-03097-w] [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: 06/05/2022] [Accepted: 08/13/2022] [Indexed: 11/30/2022]
Abstract
Smoking is closely associated with the development of various cancers and tobacco-related illnesses such as cardiovascular and respiratory disorders. However, data are scarce on the relationship between smoking and both acute and chronic pain. In addition to nicotine, tobacco smoke contains more than 4000 different compounds. Although nicotine is not the sole cause of smoking-induced diseases, it plays a critical role in pain-related pathophysiology. Despite the acute analgesic effects of nicotine, long-term exposure leads to tolerance and increased pain sensitivity due to nicotinic acetylcholine receptor desensitization and neuronal plastic changes. The purpose of smoking cessation interventions in smoking patients with pain is primarily not only to reduce their pain and associated limitations in activities of daily living, but also to improve the outcomes of underlying pain-causing conditions and reduce the risks of tobacco-related disorders. This statement aims to summarize the available evidence on the impact of smoking on pain and to inform medical professionals of the significance of smoking cessation in patients with pain.
Collapse
Affiliation(s)
- Hiroki Iida
- Working Group on the Role of Smoking Cessation in Pain Relief, The Japan Society of Pain Clinicians (JSPC), Tokyo, Japan. .,Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine, Gifu, Japan. .,Anesthesiology and Pain Relief Center, Central Japan International Medical Center, 1-1 Kenkonomachi, Minokamo, Gifu, 505-8510, Japan.
| | - Shigeki Yamaguchi
- Working Group on the Role of Smoking Cessation in Pain Relief, The Japan Society of Pain Clinicians (JSPC), Tokyo, Japan.,Department of Anesthesiology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Toru Goyagi
- Working Group on the Role of Smoking Cessation in Pain Relief, The Japan Society of Pain Clinicians (JSPC), Tokyo, Japan.,Department of Anesthesiology, Akita University Hospital, Akita, Japan
| | - Yoko Sugiyama
- Working Group on the Role of Smoking Cessation in Pain Relief, The Japan Society of Pain Clinicians (JSPC), Tokyo, Japan.,Department of Woman Doctor Active Support in Perioperative Medicine, Gifu University Graduate School of Medicine, Gifu, Japan.,Anesthesiology and Pain Relief Center, Central Japan International Medical Center, 1-1 Kenkonomachi, Minokamo, Gifu, 505-8510, Japan
| | - Chie Taniguchi
- Working Group on the Role of Smoking Cessation in Pain Relief, The Japan Society of Pain Clinicians (JSPC), Tokyo, Japan.,College of Nursing, Aichi Medical University, Nagakute, Japan
| | - Takako Matsubara
- Working Group on the Role of Smoking Cessation in Pain Relief, The Japan Society of Pain Clinicians (JSPC), Tokyo, Japan.,Department of Physical Therapy, Faculty of Rehabilitation, Kobe Gakuin University, Kobe , Japan
| | - Naoto Yamada
- Working Group on the Role of Smoking Cessation in Pain Relief, The Japan Society of Pain Clinicians (JSPC), Tokyo, Japan.,Department of Anesthesiology, Iwate Medical University Hospital, Iwate, Japan
| | - Hiroshi Yonekura
- Working Group on the Role of Smoking Cessation in Pain Relief, The Japan Society of Pain Clinicians (JSPC), Tokyo, Japan.,Department of Anesthesiology and Pain Medicine, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Mami Iida
- Working Group on the Role of Smoking Cessation in Pain Relief, The Japan Society of Pain Clinicians (JSPC), Tokyo, Japan.,Department of Internal Medicine, Gifu Prefectural General Medical Center, Gifu, Japan
| |
Collapse
|
21
|
Yu SJ, Kwon MK, Choi W, Son YS. Preliminary study on the effect of using heat-not-burn tobacco products on indoor air quality. ENVIRONMENTAL RESEARCH 2022; 212:113217. [PMID: 35381261 DOI: 10.1016/j.envres.2022.113217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/25/2022] [Accepted: 03/27/2022] [Indexed: 06/14/2023]
Abstract
In this study, the effect of the use of heat-not-burn (HnB) products on indoor air quality (IAQ) was evaluated. To do this, the concentrations of nicotine, propylene glycol (PG), and vegetable glycerin (VG) directly emitted when using HnB products were analyzed and compared to those from conventional cigarettes. Furthermore, the levels of VOCs, aldehydes, nanoparticle, and particulate matter (PM) detected when subjects used HnB products in the exposure chamber were evaluated the effect on IAQ. As a result, the range of nicotine levels transferred by HnB products (0.8-1.2 mg cigarette-1) is lower than that by conventional cigarettes (2.4-3.6 mg cigarette-1). On the other hand, the range of VG levels emitted from HnB products (3.1-5.9 mg cigarette-1) were higher than that emitted from conventional cigarettes (0.6-3.0 mg cigarette-1). In addition, although the amount generated from HnB products was small compared to those from conventional cigarettes, various kinds of VOCs, aldehydes, nanoparticle and PM were produced, and these were confirmed to affect IAQ.
Collapse
Affiliation(s)
- Seong-Ji Yu
- Division of Earth Environmental System Science, Pukyong National University, 45, Yongso-ro, Nam-gu, Busan, 48513, South Korea
| | - Min-Ku Kwon
- Division of Earth Environmental System Science, Pukyong National University, 45, Yongso-ro, Nam-gu, Busan, 48513, South Korea
| | - Wonsik Choi
- Department of Environmental Atmospheric Sciences, Pukyong National University, 45, Yongso-ro, Nam-gu, Busan, 48513, South Korea
| | - Youn-Suk Son
- Department of Environmental Engineering, Pukyong National University, 45, Yongso-ro, Nam-gu, Busan, 48513, South Korea.
| |
Collapse
|
22
|
Lau YK, Okawa S, Meza R, Katanoda K, Tabuchi T. Nicotine dependence of cigarette and heated tobacco users in Japan, 2019: a cross-sectional analysis of the JASTIS Study. Tob Control 2022; 31:e50-e56. [PMID: 33741741 PMCID: PMC9340029 DOI: 10.1136/tobaccocontrol-2020-056237] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/28/2020] [Accepted: 01/06/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Japan is currently the biggest market of heated tobacco products (HTPs) in the world. Little is known about nicotine dependence among HTP users. Thus, the objective was to assess the association of type of tobacco use and time-to-first-use, a marker of nicotine dependence. METHODS A cross-sectional analysis of the 2019 data from an internet cohort study was conducted. The analytical sample consisted of 2147 current (≥1 day use in the past 30 days) HTP and/or conventional cigarette users, aged 25+ years. Marginal structural binomial regression was used to estimate nicotine dependence prevalence ratios (PRs) for each category of tobacco use (exclusive daily cigarette, exclusive HTP (≥1 day), dual HTP+daily cigarette, dual HTP+non-daily cigarette), relative to exclusive, non-daily cigarette smoking. RESULTS Using a 5 min cut-off for time-to-first-use, the prevalence of nicotine dependence was higher among dual users of HTP and daily cigarettes (PR=1.38; 95% CI: 1.05 to 1.82) and exclusive, daily cigarette users (PR=1.48; 95% CI: 1.15 to 1.91), relative to exclusive, non-daily cigarette users. However, nicotine dependence among exclusive HTP users, and dual HTP+non-daily cigarette users, did not differ from that of exclusive, non-daily cigarette users. When using 15 and 30 min cut-offs, all types of users, including exclusive HTP, had higher levels of nicotine dependence relative to exclusive, non-daily cigarette users. CONCLUSIONS Regardless of HTP use, daily cigarette users had higher prevalence of nicotine dependence compared with non-daily cigarette users. Exclusive HTP users had similar (or potentially higher) dependence compared with exclusive, non-daily cigarette users. Longitudinal studies are needed to interrogate the public health implications of growing HTP use worldwide.
Collapse
Affiliation(s)
- Yan Kwan Lau
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Sumiyo Okawa
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Rafael Meza
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Kota Katanoda
- Division of Cancer Statistics Integration, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| |
Collapse
|
23
|
Ji H, Jin Z. Analysis of six aromatic amines in the mainstream smoke of tobacco products. Anal Bioanal Chem 2022; 414:4227-4234. [PMID: 35410388 PMCID: PMC9124649 DOI: 10.1007/s00216-022-04075-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 11/07/2022]
Abstract
Aromatic amines are a class of carcinogenic compounds in tobacco smoke that are listed on the FDA list of harmful and potentially harmful constituents (HPHCs). A method using solid-phase microextraction-coupled to gas chromatography-triple quadrupole mass spectrometry (SPME headspace GC-MS/MS) was developed and validated for the quantitative determination of six aromatic amines, including 1-aminonaphthalene (1-AN), 2-aminonaphthalene (2-AN), 3-aminobiphenyl (3-ABP), 4-aminobiphenyl (4-ABP), o-toluidine (o-TOL), and o-anisidine (o-ANI), in the mainstream smoke of cigarettes, cigars, and heated tobacco products. The method developed here combines high sensitivity with simple sample preparation and has demonstrated satisfactory linearity for all six aromatic amines with correlation coefficients greater than 0.9994. The limits of detection range and the limits of quantitation range were 12-96 pg/mL and 41-320 pg/mL, respectively. Their recoveries and coefficients of variation (CV%) were 90-112% and 2.1-6.6%, respectively. The new SPME headspace GC/MS/MS method has been successfully applied to measure the contents of the six aromatic amines in the mainstream smoke of cigarettes, cigars, and heated tobacco products.
Collapse
Affiliation(s)
- Huihua Ji
- Kentucky Tobacco Research and Development Center, University of Kentucky, Lexington, KY, 40546, USA.
| | - Zhenyu Jin
- Kentucky Tobacco Research and Development Center, University of Kentucky, Lexington, KY, 40546, USA
| |
Collapse
|
24
|
El-Kaassamani M, Yen M, Talih S, El-Hellani A. Analysis of mainstream emissions, secondhand emissions and the environmental impact of IQOS waste: a systematic review on IQOS that accounts for data source. Tob Control 2022; 33:tobaccocontrol-2021-056986. [PMID: 35568394 DOI: 10.1136/tobaccocontrol-2021-056986] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 05/05/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To highlight the general features of IQOS literature focusing on the chemical analysis of IQOS emissions. DATA SOURCES PubMed, Web of Science and Scopus databases were searched on 8 November 2021 using the terms 'heated tobacco product', 'heat-not-burn', 'IQOS' and 'tobacco heating system' with time restriction (2010-2021). The search yielded 5480 records. STUDY SELECTION Relevant publications on topics related to IQOS assessment were retrieved (n=341). Two reviewers worked separately and reached agreement by consensus. DATA EXTRACTION Data on author affiliation and funding, article type and date of publication were extracted. Publications were categorised depending on their focus and outcomes. Data on IQOS emissions from the chemical analysis category were extracted. DATA SYNTHESIS Of the included publications, 25% were published by Philip Morris International (PMI) affiliates or PMI-funded studies. PMI-sponsored publications on emissions, toxicology assessments and health effects were comparable in number to those reported by independent research, in contrast to publications on IQOS use, market trends and regulation. Data on nicotine yield, carbonyl emissions, other mainstream emissions, secondhand emissions and IQOS waste were compared between data sources to highlight agreement or disagreement between PMI-sponsored and independent research. CONCLUSIONS Our analysis showed agreement between the data sources on nicotine yield from IQOS under the same puffing conditions. Also, both sources agreed that IQOS emits significantly reduced levels of some emissions compared with combustible cigarettes. However, independent studies and examination of PMI's data showed significant increases in other emissions from and beyond the Food and Drug Administration's harmful and potentially harmful constituents list.
Collapse
Affiliation(s)
- Malak El-Kaassamani
- Department of Chemistry, American University of Beirut Faculty of Arts and Sciences, Beirut, Lebanon
| | - Miaoshan Yen
- Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Soha Talih
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Mechanical Engineering, American University of Beirut Faculty of Engineering and Architecture, Beirut, Lebanon
| | - Ahmad El-Hellani
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
- Division of Environmental Health Sciences, The Ohio State University College of Public Health, Columbus, Ohio, USA
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| |
Collapse
|
25
|
Different Effects of Cigarette Smoke, Heated Tobacco Product and E-Cigarette Vapour on Orbital Fibroblasts in Graves' Orbitopathy; a Study by Real Time Cell Electronic Sensing. Molecules 2022; 27:molecules27093001. [PMID: 35566351 PMCID: PMC9102878 DOI: 10.3390/molecules27093001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/28/2022] [Accepted: 05/05/2022] [Indexed: 11/17/2022] Open
Abstract
Thyroid autoimmunity in Graves’ disease (GD) is accompanied by Graves’ orbitopathy (GO) in 40% of the cases. Orbital fibroblasts (OF) play a key role in the pathogenesis and cigarette smoking is a known deteriorating factor. Alongside conventional cigarettes (CC) new alternatives became available for smokers, including heated tobacco products (HTP) and E-cigarettes (ECIG). We aimed to study the cellular effects of smoke extracts (SE) in orbital fibroblasts. Primary OF cultures from GO and NON-GO orbits were exposed to different concentrations of SE (1%, 50%) and the changes were followed using Real Time Cell Electronic Sensing (RT-CES). Untreated GO and NON-GO cells had different maximum cell index (CI) values of 3.3 and 2.79 respectively (p < 0.0001). CC, HTP and ECIG treated NON-GO fibroblasts exhibited peak CIs of 2.62, 3.32 and 3.41 while treated GO cells’ CIs were higher, 5.38, 6.25 and 6.33, respectively (p < 0.0001). The metabolic activity (MTT) decreased (p < 0.001) and hyaluronan production doubled (p < 0.02) after 50% of CC SE treatment in all cell cultures. GO fibroblasts were more sensitive to low concentration SE then NON-GO fibroblasts (p < 0.0001). The studied SEs exerted different effects. RT-CES is a sensitive technique to detect the effects of very low concentration of SE on fibroblasts.
Collapse
|
26
|
Sciuscio D, Calvino-Martin F, Kumar A, Langston TB, Martin E, Marescotti D, Mathis C, Hoeng J, Peitsch MC, Smith DC, Gogova M, Vanscheeuwijck P, Lee KM. Toxicological Assessment of Flavor Ingredients in E-Vapor Products. FRONTIERS IN TOXICOLOGY 2022; 4:878976. [PMID: 35516526 PMCID: PMC9065440 DOI: 10.3389/ftox.2022.878976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/29/2022] [Indexed: 11/17/2022] Open
Abstract
Many flavor ingredients are often used in potentially reduced-risk tobacco products (such as e-vapor products). Although most are “generally recognized as safe (GRAS)” when used in food, there is limited information available on their long-term health effects when delivered by inhalation. While obtaining route-of-exposure-specific toxicological data on flavor ingredients is critical to product evaluation, the large number of individual flavor ingredients available and their potential combinations render classical toxicological assessment approaches impractical, as they may require years of preclinical investigations and thousands of laboratory animals. Therefore, we propose a pragmatic approach in which flavor ingredients are initially assigned to groups of structurally related compounds (Flavor Groups), from which flavor group representatives (FGR) are then selected and tested individually and as a mixture in vitro and in vivo. The premise is that structurally related compounds would have comparable metabolic and biological activity and that the data generated using FGRs could support the toxicological assessment of other structurally related flavor ingredients of their respective Flavor Groups. This approach is explained in a step-wise manner and exemplified by a case study, along with its strengths, limitations as well as recommendations for further confirmatory testing. Once completed, this FGR approach could significantly reduce the time and resources required for filling the data gap in understanding the health risks of many flavor ingredients while also minimizing the need for laboratory animals.
Collapse
Affiliation(s)
- Davide Sciuscio
- PMI R&D, Philip Morris Products S.A., Neuchâtel, Switzerland
- *Correspondence: Davide Sciuscio,
| | | | | | | | - Elyette Martin
- PMI R&D, Philip Morris Products S.A., Neuchâtel, Switzerland
| | | | - Carole Mathis
- PMI R&D, Philip Morris Products S.A., Neuchâtel, Switzerland
| | - Julia Hoeng
- PMI R&D, Philip Morris Products S.A., Neuchâtel, Switzerland
| | | | | | - Maria Gogova
- Altria Client Services LLC, Richmond, VA, United States
| | | | | |
Collapse
|
27
|
The World of Oral Cancer and Its Risk Factors Viewed from the Aspect of MicroRNA Expression Patterns. Genes (Basel) 2022; 13:genes13040594. [PMID: 35456400 PMCID: PMC9027895 DOI: 10.3390/genes13040594] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/17/2022] [Accepted: 03/23/2022] [Indexed: 01/27/2023] Open
Abstract
Oral cancer is one of the leading causes of death worldwide, with a reported 5-year survival rate of around 50% after treatment. Epigenetic modifications are considered to have a key role in oral carcinogenesis due to histone modifications, aberrant DNA methylation, and altered expression of miRNAs. MicroRNAs (miRNAs) are small non-coding RNAs that have a key role in cancer development by regulating signaling pathways involved in carcinogenesis. MiRNA deregulation identified in oral cancer has led to the idea of using them as potential biomarkers for early diagnosis, prognosis, and the development of novel therapeutic strategies. In recent years, a key role has been observed for risk factors in preventing and treating this malignancy. The purpose of this review is to summarize the recent knowledge about the altered mechanisms of oral cancer due to risk factors and the role of miRNAs in these mechanisms.
Collapse
|
28
|
Kim SCJ, Friedman TC. A New Ingenious Enemy: Heat-Not-Burn Products. Tob Use Insights 2022; 15:1179173X221076419. [PMID: 35237081 PMCID: PMC8883376 DOI: 10.1177/1179173x221076419] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/11/2022] [Indexed: 11/21/2022] Open
Abstract
While cigarette smoking is still a major source of morbidity and mortality, e-cigarette usage is skyrocketing, and the tobacco industry is finding new ways to market nicotine. With updated published research highlighting the dangers of cigarette smoking and now vaping, the industry has been developing new techniques and devices that circumvent this research to hook users on tobacco and nicotine. The FDA allowed Philip Morris International (PMI) to sell their heat not burn tobacco products known as iQOS in 2019. By 2019, 49 countries had permitted the sale of iQOS. This commentary summarizes the recent research on heat not burn cigarettes, also known as heated tobacco products and their effects on public policy. We urge policy makers to consider the research published regarding these new products and prevent the widespread use of these products that will harm public health.
Collapse
Affiliation(s)
- Samuel CJ Kim
- Department of Internal Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA
- Friends Research Institute, Cerritos, CA, USA
| | - Theodore C Friedman
- Department of Internal Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA
- Friends Research Institute, Cerritos, CA, USA
| |
Collapse
|
29
|
Alarabi AB, Lozano PA, Khasawneh FT, Alshbool FZ. The effect of emerging tobacco related products and their toxic constituents on thrombosis. Life Sci 2022; 290:120255. [PMID: 34953893 PMCID: PMC9118784 DOI: 10.1016/j.lfs.2021.120255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/07/2021] [Accepted: 12/14/2021] [Indexed: 02/03/2023]
Abstract
Although conventional cigarette smoking is declining, emerging tobacco related products (ETRPs) are currently gaining ground, especially among the youth. These products include electronic cigarettes, waterpipes/hookah, cigars/cigarillo, smokeless tobacco, and heat-not-burn cigarettes. The observed increase in the use of ETRPs is multifactorial and complex but appears to be mainly driven by efforts from the major tobacco companies to reinvent themselves, and present more appealing and allegedly safe(r) tobacco products. However, it is becoming apparent that these products produce substantial amounts of toxic chemicals, many of which have been shown to exert negative health effects, including in the context of the cardiovascular system. Thus, there has been research efforts, albeit limited in general, to characterize the health impact of these products on occlusive/thrombotic cardiovascular diseases (CVD). In this review, we will discuss the potential impact of ETRPs on thrombosis-based CVD. Specifically, we will review how these products and the major chemicals they produce and/or emit can trigger key players in the process of thrombosis, namely inflammation, oxidative stress, platelets, coagulation, and the vascular endothelium, and the relationship between these effects.
Collapse
Affiliation(s)
- Ahmed B Alarabi
- Department of Pharmacy Practice, Irma Lerma Rangel College of Pharmacy Texas A&M University, Kingsville, TX, USA
| | - Patricia A Lozano
- Department of Pharmacy Practice, Irma Lerma Rangel College of Pharmacy Texas A&M University, Kingsville, TX, USA
| | - Fadi T Khasawneh
- Department of Pharmaceutical Sciences, Irma Lerma Rangel College of Pharmacy Texas A&M University, Kingsville, TX, USA.
| | - Fatima Z Alshbool
- Department of Pharmacy Practice, Irma Lerma Rangel College of Pharmacy Texas A&M University, Kingsville, TX, USA.
| |
Collapse
|
30
|
Gu J, Abroms LC, Broniatowski DA, Evans WD. An Investigation of Influential Users in the Promotion and Marketing of Heated Tobacco Products on Instagram: A Social Network Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1686. [PMID: 35162709 PMCID: PMC8835593 DOI: 10.3390/ijerph19031686] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/24/2022] [Accepted: 01/28/2022] [Indexed: 11/16/2022]
Abstract
While an increasing body of the literature has documented the exposure to emerging tobacco products including heated tobacco products (HTPs) on social media, few studies have investigated the various stakeholders involved in the generation of promotional tobacco content. This study constructed a social network of Instagram users who posted IQOS content, a leading HTP brand, between 1 January and 5 April 2021 and identified users who positioned near the center of the network. We identified 4526 unique Instagram users who had created 19,951 IQOS-related posts during the study period. Nearly half of the users (42.1%) were business accounts authorized by Instagram, among which 59.0% belonged to Personal Goods and General Merchandise Stores and 18.1% belonged to Creators and Celebrities. For users with higher in-degree, out-degree, betweenness, and closeness centrality in the network, the majority of them were accounts directly associated with IQOS (e.g., containing "iqos" in username) or related to tobacco business as self-identified in the bio. Our findings further refine the social media marketing presence of tobacco products and suggest that the current self-regulatory efforts led by social media platforms are far from enough.
Collapse
Affiliation(s)
- Jiayan Gu
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA;
| | - Lorien C. Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA;
| | - David A. Broniatowski
- Department of Engineering Management and Systems Engineering, The George Washington University, Washington, DC 20052, USA;
| | - W. Douglas Evans
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA;
| |
Collapse
|
31
|
Palmer AM, Toll BA, Carpenter MJ, Donny EC, Hatsukami DK, Rojewski AM, Smith TT, Sofuoglu M, Thrul J, Benowitz NL. Reappraising Choice in Addiction: Novel Conceptualizations and Treatments for Tobacco Use Disorder. Nicotine Tob Res 2022; 24:3-9. [PMID: 34270729 PMCID: PMC8666123 DOI: 10.1093/ntr/ntab148] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/14/2021] [Indexed: 12/23/2022]
Abstract
The introduction of alternative nicotine and tobacco products (such as e-cigarettes, heat-not-burn devices, nicotine pouches) warrants an updated framework from which to conceptualize tobacco use disorder (TUD). The following review provides considerations for TUD within the context of novel products. Historically, the tobacco industry falsely claimed that cigarettes were not addictive or harmful and that those who smoked simply chose to do so. This generated an inaccurate lay perception that smoking is a free or informed choice. Research on nicotine pharmacology demonstrates the powerful addictive potential of nicotine, which is shaped by dose, speed of delivery, and other constituents generated. In addition, non-pharmacologic reinforcers motivate and maintain tobacco use behaviors for both traditional cigarettes and novel products. The negative consequences of combustible tobacco use are well known; however, these outcomes may differ for alternative products. Strategies used for combustible product cessation may be adapted for novel products, and treatment recommendations for TUD should be made within the context of a harm reduction framework wherein alternative product use may be the desired outcome. Providers must therefore be willing to modify their perceptions of products and treatment recommendations accordingly. Better public health outcomes are accomplished through promotion of abstinence from combustible smoking. For those who cannot wean from nicotine entirely, switching to less risky modes of delivery might be a secondary goal, with an eventual aim of stopping use of the alternative product. Implications: Given the advent of novel, alternative tobacco products, tobacco use disorder (TUD) must be conceptualized within a contemporary framework that includes harm reduction and alternative outcomes. The unique contributions of nicotine pharmacology, non-pharmacologic reinforcers, and consequences of use can be used to inform treatments for TUD with the ultimate goal of improving the health of individuals who use tobacco.
Collapse
Affiliation(s)
- Amanda M Palmer
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
- Department of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Benjamin A Toll
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Matthew J Carpenter
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Eric C Donny
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Alana M Rojewski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Tracy T Smith
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Mehmet Sofuoglu
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Johannes Thrul
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Neal L Benowitz
- Clinical Pharmacology Research Program, Division of Cardiology, Department of Medicine, University of California, San Francisco, CA, USA
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA, USA
| |
Collapse
|
32
|
Wang H, Chen H, Huang L, Han S, Wang L, Li S, Liu M, Zhang M, Fu Y, Tian Y, Liu T, Shi Z, Hou H, Hu Q. Novel Solvent-Free Extraction Method for Analyzing Tobacco Heating Product Aerosols: An Analytical and In Vitro Toxicological Five-Way Product Comparison. Chem Res Toxicol 2021; 34:2460-2470. [PMID: 34747590 DOI: 10.1021/acs.chemrestox.1c00224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Harmful and potentially harmful constituents (HPHCs) in tobacco smoke are thought to be responsible for the increased health risks. Tobacco heating products (THPs) heat tobacco instead of burning it to achieve significantly fewer toxicants than conventional cigarettes. To assess the toxicity of THP aerosols, it is often desirable to extract the main constituents using a solvent method. In this study, we developed a high-speed centrifugal method for extracting the total particulate matter (TPM) from THPs to quantitatively compare the toxicity of different THPs and conventional cigarettes. Its TPM extraction efficiency exceeded 85%, and the primary aerosol components and typical HPHCs were comparable to those of the solvent method. The TPMs extracted from five THPs were subjected to 14 in vitro toxicology assessments, and the results were compared with those of a 3R4F reference cigarette. Physical separation can improve biases from solvent selectivity and potential interactions between solvent and aerosol constituents. By eliminating solvent influence, the extraction method could achieve high-dose exposures, enabling the toxicity comparison of different THPs. The relative toxicity of the THPs differed under different dosage units, including the TPM concentration, nicotine equivalent, and puff number.
Collapse
Affiliation(s)
- Hongjuan Wang
- China National Tobacco Quality Supervision and Test Center, Zhengzhou 450001, China
- Key Laboratory of Tobacco Biological Effects, Zhengzhou 450001, China
- Joint Laboratory of Heated Tobacco Product Safety Evaluation, Zhengzhou 450001, China
| | - Huan Chen
- China National Tobacco Quality Supervision and Test Center, Zhengzhou 450001, China
- Key Laboratory of Tobacco Biological Effects, Zhengzhou 450001, China
- Joint Laboratory of Heated Tobacco Product Safety Evaluation, Zhengzhou 450001, China
| | - Long Huang
- China National Tobacco Quality Supervision and Test Center, Zhengzhou 450001, China
- Key Laboratory of Tobacco Biological Effects, Zhengzhou 450001, China
- Joint Laboratory of Heated Tobacco Product Safety Evaluation, Zhengzhou 450001, China
| | - Shulei Han
- China National Tobacco Quality Supervision and Test Center, Zhengzhou 450001, China
- Key Laboratory of Tobacco Biological Effects, Zhengzhou 450001, China
- Joint Laboratory of Heated Tobacco Product Safety Evaluation, Zhengzhou 450001, China
| | - Lulu Wang
- China National Tobacco Quality Supervision and Test Center, Zhengzhou 450001, China
- Key Laboratory of Tobacco Biological Effects, Zhengzhou 450001, China
- Joint Laboratory of Heated Tobacco Product Safety Evaluation, Zhengzhou 450001, China
| | - Shigang Li
- China National Tobacco Quality Supervision and Test Center, Zhengzhou 450001, China
- Key Laboratory of Tobacco Biological Effects, Zhengzhou 450001, China
- Joint Laboratory of Heated Tobacco Product Safety Evaluation, Zhengzhou 450001, China
| | - Min Liu
- China National Tobacco Quality Supervision and Test Center, Zhengzhou 450001, China
- Key Laboratory of Tobacco Biological Effects, Zhengzhou 450001, China
- Joint Laboratory of Heated Tobacco Product Safety Evaluation, Zhengzhou 450001, China
| | - Manying Zhang
- China National Tobacco Quality Supervision and Test Center, Zhengzhou 450001, China
- Key Laboratory of Tobacco Biological Effects, Zhengzhou 450001, China
- Joint Laboratory of Heated Tobacco Product Safety Evaluation, Zhengzhou 450001, China
| | - Yaning Fu
- China National Tobacco Quality Supervision and Test Center, Zhengzhou 450001, China
- Key Laboratory of Tobacco Biological Effects, Zhengzhou 450001, China
- Joint Laboratory of Heated Tobacco Product Safety Evaluation, Zhengzhou 450001, China
| | - Yushan Tian
- China National Tobacco Quality Supervision and Test Center, Zhengzhou 450001, China
- Key Laboratory of Tobacco Biological Effects, Zhengzhou 450001, China
- Joint Laboratory of Heated Tobacco Product Safety Evaluation, Zhengzhou 450001, China
| | - Tong Liu
- China National Tobacco Quality Supervision and Test Center, Zhengzhou 450001, China
- Key Laboratory of Tobacco Biological Effects, Zhengzhou 450001, China
- Joint Laboratory of Heated Tobacco Product Safety Evaluation, Zhengzhou 450001, China
| | - Zhihao Shi
- China National Tobacco Quality Supervision and Test Center, Zhengzhou 450001, China
- Key Laboratory of Tobacco Biological Effects, Zhengzhou 450001, China
- Joint Laboratory of Heated Tobacco Product Safety Evaluation, Zhengzhou 450001, China
| | - Hongwei Hou
- China National Tobacco Quality Supervision and Test Center, Zhengzhou 450001, China
- Key Laboratory of Tobacco Biological Effects, Zhengzhou 450001, China
- Joint Laboratory of Heated Tobacco Product Safety Evaluation, Zhengzhou 450001, China
| | - Qingyuan Hu
- China National Tobacco Quality Supervision and Test Center, Zhengzhou 450001, China
- Key Laboratory of Tobacco Biological Effects, Zhengzhou 450001, China
- Joint Laboratory of Heated Tobacco Product Safety Evaluation, Zhengzhou 450001, China
| |
Collapse
|
33
|
Nishino K, Tamai K, Orita K, Hashimoto Y, Nakamura H. Heated Tobacco Products Impair Cell Viability, Osteoblastic Differentiation, and Bone Fracture-Healing. J Bone Joint Surg Am 2021; 103:2024-2031. [PMID: 34730563 DOI: 10.2106/jbjs.20.02227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The negative impact of cigarette smoking on bone union has been well documented. However, the impact of heated tobacco product (HTP) use on bone fracture-healing remains unclear. The present study investigated the effect of HTPs on preosteoblast viability, osteoblastic differentiation, and fracture-healing and compared the effects with those of conventional combustible cigarettes. METHODS Cigarette smoke extracts (CSEs) were generated from combustible cigarettes (cCSE) and HTPs (hCSE). CSE concentrations were standardized by assessing optical density. Preosteoblast (MC3T3-E1) cells were incubated with normal medium, cCSE, or hCSE. The cell viability was assessed via MTT assay. After osteoblastic differentiation of CSE-exposed cells, alkaline phosphatase (ALP) activity was assessed. To assess the in vivo effects of CSEs, a femoral midshaft osteotomy was performed in a rat model; thereafter, saline solution, cCSE, or hCSE was injected intraperitoneally, and bone union was assessed on the basis of micro-computed tomography (μCT) and biomechanical analysis 4 weeks later. RESULTS MC3T3-E1 cell viability was reduced in a time and concentration-dependent manner when treated with either cCSE or hCSE. ALP activity after osteoblastic differentiation of cCSE-treated cells was significantly lower than that of both untreated and hCSE-treated cells (mean and standard deviation, 452.4 ± 48.8 [untreated], 326.2 ± 26.2 [cCSE-treated], and 389.9 ± 26.6 [hCSE-treated] mol/L/min; p = 0.002). Moreover, the levels of osteoblastic differentiation in untreated and hCSE-treated cells differed significantly (p < 0.05). In vivo assessment of the femoral midshaft cortical region revealed that both cCSE and hCSE administration significantly decreased bone mineral content 4 weeks after surgery compared with levels observed in untreated animals (107.0 ± 11.9 [untreated], 94.5 ± 13.0 [cCSE-treated], and 89.0 ± 10.1 mg/cm3 [hCSE-treated]; p = 0.049). Additionally, cCSE and hCSE-exposed femora had significantly lower bone volumes than unexposed femora. Biomechanical analyses showed that both cCSE and hCSE administration significantly decreased femoral maximum load and elastic modulus (p = 0.015 and 0.019). CONCLUSIONS HTP use impairs cell viability, osteoblastic differentiation, and bone fracture-healing at levels comparable with those associated with combustible cigarette use. CLINICAL RELEVANCE HTP use negatively affects bone fracture-healing to a degree similar to that of combustible cigarettes. Orthopaedic surgeons should recommend HTP smoking cessation to improve bone union.
Collapse
Affiliation(s)
- Kazuya Nishino
- Department of Orthopedics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | | | | | | | | |
Collapse
|
34
|
Miller CR, Sutanto E, Smith DM, Hitchman SC, Gravely S, Yong HH, Borland R, O'Connor RJ, Cummings KM, Fong GT, Hyland A, Quah ACK, Goniewicz ML. Characterizing heated tobacco product use among adult cigarette smokers and nicotine vaping product users in the 2018 ITC Four Country Smoking & Vaping Survey. Nicotine Tob Res 2021; 24:493-502. [PMID: 34669964 DOI: 10.1093/ntr/ntab217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 10/19/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Heated tobacco products (HTP) have diversified global tobacco markets, and user characteristics remain understudied. This study evaluated sociodemographic characteristics, nicotine-related perceptions and behaviors of current HTP users within a sample of adult (18+ years) nicotine users across four countries. METHODS Data were from current smokers or nicotine vaping product (NVP; known as "e-cigarettes") users from Canada, England, the United States and Australia (n=11,421) who participated in the 2018 ITC Four Country Smoking and Vaping Survey. Current (at-least-monthly) HTP users were characterized (n=441), and weighted multivariable logistic regressions examined correlates of HTP use. RESULTS Compared to non-users, current HTP users were younger (mean age: 44.4 vs 31.0 years; p<0.001) and had higher socioeconomic status (p<0.001). A majority of current HTP users used HTPs non-daily (daily: 40.3% vs non-daily: 59.7%). Most HTP users concurrently used both cigarettes and NVPs (90.5%). Among concurrent cigarette-HTP-NVP users, 36.2% used all three products daily. Use of other combusted tobacco products (cigars, cigarillos, pipe, waterpipe/hookah), cannabis, and binge drinking were each associated with current HTP use. HTP use was more common among smokers intending to quit within 6 months or reporting a quit attempt in the past 18 months, and vapers who had experienced negative side effects. CONCLUSION HTP users in this sample tended to be younger and more affluent. Most reported concurrent use of multiple nicotine products and other substances. Those cigarette smokers who used HTPs appeared more interested in smoking cessation, while some characteristics of concurrent HTP-NVP users were suggestive of dissatisfaction with NVPs. IMPLICATIONS Few studies have scrutinized characteristics of HTP early-adopters in emerging markets. Our results indicate that in 2018, characteristics of established nicotine users who adopted HTP use in four high-income Western countries mirror those of HTP users in East Asian markets (South Korea and Japan) where HTPs are popular. HTP users reported high levels of concurrent use of non-cigarette combusted tobacco products (e.g., cigars, pipe tobacco). These findings point to the need for future longitudinal studies of HTP use given the implications of those use patterns on the harm reduction potential of HTPs. HTP user characteristics may yield important information to consider in regulation of these products.
Collapse
Affiliation(s)
- Connor R Miller
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Edward Sutanto
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Danielle M Smith
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Sara C Hitchman
- Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Hua-Hie Yong
- School of Psychology, Deakin University, Geelong, Victoria, Australia.,Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Ron Borland
- Cancer Council Victoria, Melbourne, Victoria, Australia.,School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada.,School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.,Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Anne C K Quah
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| |
Collapse
|
35
|
Phillips-Waller A, Przulj D, Pesola F, Smith KM, Hajek P. Nicotine Delivery and User Ratings of IQOS Heated Tobacco System Compared With Cigarettes, Juul, and Refillable E-Cigarettes. Nicotine Tob Res 2021; 23:1889-1894. [PMID: 33983450 PMCID: PMC8496472 DOI: 10.1093/ntr/ntab094] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 05/11/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Reduced-risk nicotine products are more likely to replace smoking if they match cigarettes in nicotine delivery and user satisfaction. AIMS AND METHODS We examined the nicotine delivery profile and user ratings of IQOS heated tobacco system and compared it with own brand cigarettes (OBC), Juul, and refillable e-cigarettes (EC).Participants (N = 22) who were daily vapers smoking <1 cigarette per day on average, attended after overnight abstinence from smoking and vaping, to test at separate sessions OBC, IQOS, and Juul. Eight participants also tested two refillable EC using e-liquid with 20 mg/mL nicotine. At each session, a baseline blood sample was taken before participants used the product ad libitum for 5 minutes. Further samples were taken at 2, 4, 6, 8, 10, and 30 minutes. Maximum nicotine concentration (Cmax), time to Cmax (Tmax), and nicotine delivered over 30 minutes (AUC0->30) were calculated. Participants rated their urge to smoke and product characteristics. RESULTS IQOS delivered less nicotine than OBC (AUC0->30: z = -2.73, p = .006), and than Juul (AUC0->30: z = -3.08, p = .002; Cmax: z = -2.65, p = .008), and received less favorable ratings than Juul (effect on urges to smoke: z = -3.23, p = .001; speed of urge relief: z = -2.75, p = .006; recommendation to friends: z = -2.45, p = .014). Compared with refillable EC, IQOS delivered nicotine faster (Tmax: z = -2.37, p = .018), but received less favorable overall ratings (recommended to friends: z = -2.32, p = .021). CONCLUSIONS IQOS' pharmacokinetic profile suggests that it may be less effective than Juul for smoking cessation, but at least as effective as refillable EC; although participants, who were experienced vapers rather than IQOS users, preferred refillable EC. IMPLICATIONS Because IQOS provided less efficient nicotine delivery than cigarettes and Juul in this sample, and also had a weaker effect on urges to smoke than Juul, it could be less helpful than Juul in assisting such dual users, and possibly smokers generally, to switch to an alternative product. IQOS, however, provided nicotine faster than refillable EC products, although participants preferred EC.
Collapse
Affiliation(s)
| | - Dunja Przulj
- Health and Lifestyle Research Unit, Queen Mary University of London, London, UK
| | - Francesca Pesola
- Health and Lifestyle Research Unit, Queen Mary University of London, London, UK
| | - Katie Myers Smith
- Health and Lifestyle Research Unit, Queen Mary University of London, London, UK
| | - Peter Hajek
- Health and Lifestyle Research Unit, Queen Mary University of London, London, UK
| |
Collapse
|
36
|
Jo S, Kim HC, Lustig N, Chen G, Lee JH. Mixed-effects multilevel analysis followed by canonical correlation analysis is an effective fMRI tool for the investigation of idiosyncrasies. Hum Brain Mapp 2021; 42:5374-5396. [PMID: 34415651 PMCID: PMC8519860 DOI: 10.1002/hbm.25627] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
We report that regions-of-interest (ROIs) associated with idiosyncratic individual behavior can be identified from functional magnetic resonance imaging (fMRI) data using statistical approaches that explicitly model individual variability in neuronal activations, such as mixed-effects multilevel analysis (MEMA). We also show that the relationship between neuronal activation in fMRI and behavioral data can be modeled using canonical correlation analysis (CCA). A real-world dataset for the neuronal response to nicotine use was acquired using a custom-made MRI-compatible apparatus for the smoking of electronic cigarettes (e-cigarettes). Nineteen participants smoked e-cigarettes in an MRI scanner using the apparatus with two experimental conditions: e-cigarettes with nicotine (ECIG) and sham e-cigarettes without nicotine (SCIG) and subjective ratings were collected. The right insula was identified in the ECIG condition from the χ2 -test of the MEMA but not from the t-test, and the corresponding activations were significantly associated with the similarity scores (r = -.52, p = .041, confidence interval [CI] = [-0.78, -0.17]) and the urge-to-smoke scores (r = .73, p <.001, CI = [0.52, 0.88]). From the contrast between the two conditions (i.e., ECIG > SCIG), the right orbitofrontal cortex was identified from the χ2 -tests, and the corresponding neuronal activations showed a statistically meaningful association with similarity (r = -.58, p = .01, CI = [-0.84, -0.17]) and the urge to smoke (r = .34, p = .15, CI = [0.09, 0.56]). The validity of our analysis pipeline (i.e., MEMA followed by CCA) was further evaluated using the fMRI and behavioral data acquired from the working memory and gambling tasks available from the Human Connectome Project.
Collapse
Affiliation(s)
- Sungman Jo
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Republic of Korea
| | - Hyun-Chul Kim
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Republic of Korea.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Niv Lustig
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Republic of Korea
| | - Gang Chen
- Scientific and Statistical Computing Core, NIMH/NIH/DHHS, Bethesda, Maryland
| | - Jong-Hwan Lee
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Republic of Korea
| |
Collapse
|
37
|
Znyk M, Jurewicz J, Kaleta D. Exposure to Heated Tobacco Products and Adverse Health Effects, a Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6651. [PMID: 34205612 PMCID: PMC8296358 DOI: 10.3390/ijerph18126651] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/25/2022]
Abstract
Heated tobacco products (HTP) are a form of nicotine delivery intended to be an alternative to traditional cigarettes. HTP tobacco products are sold to consumers as a less harmful alternative to traditional cigarettes, both for users and bystanders. The actual impact of HTP on the health of users and its overall impact on public health is still not fully known. A systematic search of the literature was carried out to identify relevant studies published in English from 2015 to February 2021. The following databases were used: PubMed, Scopus, Elsevier and ClinicalKey. 25 studies (independent and sponsored by the tobacco industry) were considered. The analysis of exposure biomarkers and cardiovascular and respiratory biomarkers showed differences between smokers and people using heated tobacco products. Improvements in clinically relevant risk markers, especially cholesterol, sICAM-1, 8-epi-PGF2α, 11-DTX-B2, HDL and FEV1, were observed compared to persistent cigarette smokers. On the other hand, exposure to IQOS has been reported to alter mitochondrial function, which may further exaggerate airway inflammation, airway remodeling and lung cancer. These products have the potential to increase oxidative stress and increase respiratory tract infections by increasing microbial adherence to the respiratory tract. Our review suggests that HTP products may be products with a reduced risk of chronic diseases, including respiratory and cardiovascular diseases and cancer compared to traditional smoking, although in the case of non-smokers so far, they may pose a risk of their occurrence. Research seems to be necessary to assess the frequency of HTP use and its potential negative health effects.
Collapse
Affiliation(s)
- Małgorzata Znyk
- Department of Hygiene and Epidemiology, Medical University of Lodz, 90-647 Lodz, Poland; (J.J.); (D.K.)
| | | | | |
Collapse
|
38
|
Sawa M, Ushiyama A, Inaba Y, Uchiyama S, Hattori K, Ogasawara Y, Ishii K. A newly developed aerosol exposure apparatus for heated tobacco products for in vivo experiments can deliver both particles and gas phase with high recovery and depicts the time-dependent variation in nicotine metabolites in mouse urine. Nicotine Tob Res 2021; 23:2145-2152. [PMID: 34111284 DOI: 10.1093/ntr/ntab123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 06/08/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION There is no standardized aerosol exposure apparatus to deliver heated tobacco products (HTPs) for in vivo experiments. Therefore, we developed a novel HTPs aerosol exposure apparatus for mice and demonstrated that nicotine and other chemicals in HTPs aerosol generated by the apparatus can be delivered to mice which replicate human smoke. METHODS The amounts of nicotine, tar, and carbon monoxide (CO) in IQOS (Marlboro Regular HeatSticks™) aerosol generated by two types of apparatuses were determined. C57BL/6N mice were exposed to IQOS aerosol, followed by determination of the urinary nicotine metabolites. Further, the skin surface temperature of mice was monitored to confirm the vasoconstriction action of nicotine. RESULTS The amounts of chemicals in IQOS aerosol by the novel air push-in inhalation apparatus for HTPs (APIA) was equivalent to that of the analytical vaping machine (LM4E) [1.60 ± 0.08 (APIA) vs 1.46 ± 0.07 mg/stick (LM4E) in nicotine and 0.55 ± 0.04 (APIA) vs 0.45 ± 0.01 mg/stick (LM4E) in CO]. After mice were exposed to IQOS aerosol by APIA, the urinary nicotine metabolites levels were determined; peak values in cotinine and 3-hydroxycotinine were 6.82 μg/mg creatinine at 1 h after exposure and 32.9 μg/mg creatinine at 2 h after exposure, respectively. The skin surface temperature decreased and was lower (33.5°C ± 0.5°C) at 30 min than before exposure (37.6°C ± 0.8°C). CONCLUSIONS The new apparatus for HTPs aerosol exposure to mice showed good performances in terms of both chemical analysis of collected aerosol and fluctuations in the urinary nicotine metabolites.
Collapse
Affiliation(s)
- Marie Sawa
- Department of Hygienic Chemistry, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo, 204-8588, Japan
| | - Akira Ushiyama
- Department of Environmental Health, National Institute of Public Health,2-3-6 Minami, Wako, Saitama, 351-0197 Japan
| | - Yohei Inaba
- Department of Environmental Health, National Institute of Public Health,2-3-6 Minami, Wako, Saitama, 351-0197 Japan
| | - Shigehisa Uchiyama
- Department of Environmental Health, National Institute of Public Health,2-3-6 Minami, Wako, Saitama, 351-0197 Japan
| | - Kenji Hattori
- Department of Hygienic Chemistry, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo, 204-8588, Japan
| | - Yuki Ogasawara
- Department of Analytical Biochemistry, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo, 204-8588, Japan
| | - Kazuyuki Ishii
- Department of Hygienic Chemistry, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo, 204-8588, Japan
| |
Collapse
|
39
|
Heated Tobacco Products: Awareness and Ever Use Among U.S. Adults. Am J Prev Med 2021; 60:684-691. [PMID: 33518430 DOI: 10.1016/j.amepre.2020.11.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/30/2020] [Accepted: 11/20/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Heated tobacco products, also referred to as heat-not-burn tobacco, are among the latest products introduced to the market by the tobacco industry. However, data on heated tobacco product awareness and use from population-based probability surveys are limited. This study examines heated tobacco product awareness and ever use among U.S. adults. METHODS This study used data (n=42,477) from the 2019 Tobacco Use Supplement to the Current Population Survey, analyzed in 2020. Descriptive statistics, including a weighted prevalence of heated tobacco product awareness and ever use, were estimated. The awareness and ever use of heated tobacco products were also estimated by age, sex, cigarette smoking status, E-cigarette use status, and other tobacco product use status. Multivariable logistic regression examined the individual characteristics associated with the awareness and ever use of heated tobacco products. RESULTS Overall, approximately 8.6% of U.S. adults were aware of heated tobacco products. Awareness was higher among participants who were younger, male, cigarette smokers, E-cigarette users, and other tobacco product users. Ever use of heated tobacco products was uncommon among U.S. adults (0.51%) but more prevalent among E-cigarette users and cigarette smokers. In the general adult populations, the odds of ever use of heated tobacco products were significantly higher among cigarette smokers (AOR=2.19, 95% CI=1.63, 2.94), E-cigarette smokers (AOR=2.70, 95% CI=1.71, 4.25), and other tobacco product users (AOR=1.69, 95% CI=1.30, 2.20). CONCLUSIONS Although the ever use of heated tobacco products is uncommon among U.S. adults, recent regulatory approval of the marketing of IQOS as modified risk tobacco products may increase use. Therefore, ongoing monitoring of heated tobacco products use and their long-term health consequences are important for informing future decision making.
Collapse
|
40
|
Hershberger AR, Studebaker A, Whitt ZT, Fillmore M, Kahler CW, Cyders MA. An Experimental Test of the Relationship between Electronic Nicotine Delivery System Use and Alcohol Consumption. Alcohol Clin Exp Res 2021; 45:808-818. [PMID: 33547653 PMCID: PMC8076069 DOI: 10.1111/acer.14566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 01/26/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Increasing research shows that the use of electronic nicotine delivery systems (ENDS) is associated with a higher rate and quantity of alcohol consumption. METHODS The present study used a 2-session, within-subjects design to experimentally examine the relationship between ENDS use and laboratory ad libitum alcohol consumption. A total of N = 31 (mean age = 28.71, SD = 11.17; 45.2% women; 54.8% White/Caucasian) healthy adults from the community who use ENDS and endorsed liking beer completed the study, which included a beer consumption taste-test task that assessed the volume of beer consumed by the participants across 2 counterbalanced sessions: 1 in which concurrent ENDS use was allowed and 1 in which it was not. All analyses controlled for age, race, and gender. RESULTS The effect of ENDS condition on the volume of beer consumed was not statistically significant, F(1, 30) = 0.03, p = 0.86). Results of linear mixed modeling showed that ENDS puffs were significantly related to alcohol sips (estimate = 0.23, SE = 0.07, p = 0.002) across the ad libitum session. CONCLUSIONS Overall, ENDS use did not increase alcohol consumption; however, the data suggest that ENDS puffs might act as a prime for beer sips or that these 2 behaviors are linked through habit. Future studies should more fully measure and compare global and event-level data on ENDS and alcohol use as they might show disparate patterns of relationships.
Collapse
Affiliation(s)
| | - Amanda Studebaker
- Department of Psychology, Indiana University Purdue University Indianapolis
| | - Zachary T. Whitt
- Department of Psychology, Indiana University Purdue University Indianapolis
| | - Mark Fillmore
- Departmet of Psychology, University of Kentucky, Lexington, KY
| | - Christopher W. Kahler
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| | - Melissa A. Cyders
- Department of Psychology, Indiana University Purdue University Indianapolis
| |
Collapse
|
41
|
Dusautoir R, Zarcone G, Verriele M, Garçon G, Fronval I, Beauval N, Allorge D, Riffault V, Locoge N, Lo-Guidice JM, Anthérieu S. Comparison of the chemical composition of aerosols from heated tobacco products, electronic cigarettes and tobacco cigarettes and their toxic impacts on the human bronchial epithelial BEAS-2B cells. JOURNAL OF HAZARDOUS MATERIALS 2021; 401:123417. [PMID: 32763707 DOI: 10.1016/j.jhazmat.2020.123417] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/29/2020] [Accepted: 07/05/2020] [Indexed: 06/11/2023]
Abstract
The electronic cigarettes (e-cigs) and more recently the heated tobacco products (HTP) provide alternatives for smokers as they are generally perceived to be less harmful than conventional cigarettes. However, it is crucial to compare the health risks of these different emergent devices, in order to determine which product should be preferred to substitute cigarette. The present study aimed to compare the composition of emissions from HTP, e-cigs and conventional cigarettes, regarding selected harmful or potentially harmful compounds, and their toxic impacts on the human bronchial epithelial BEAS-2B cells. The HTP emitted less polycyclic aromatic hydrocarbons and carbonyls than the conventional cigarette. However, amounts of these compounds in HTP aerosols were still higher than in e-cig vapours. Concordantly, HTP aerosol showed reduced cytotoxicity compared to cigarette smoke but higher than e-cig vapours. HTP and e-cig had the potential to increase oxidative stress and inflammatory response, in a manner similar to that of cigarette smoke, but after more intensive exposures. In addition, increasing e-cig power impacted levels of certain toxic compounds and related oxidative stress. This study provides important data necessary for risk assessment by demonstrating that HTP might be less harmful than tobacco cigarette but considerably more harmful than e-cig.
Collapse
Affiliation(s)
- Romain Dusautoir
- Univ. Lille, CHU Lille, Institut Pasteur de Lille, ULR 4483, IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, F-59000, Lille, France.
| | - Gianni Zarcone
- Univ. Lille, CHU Lille, Institut Pasteur de Lille, ULR 4483, IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, F-59000, Lille, France.
| | - Marie Verriele
- IMT Lille Douai, Univ. Lille, SAGE, F-59000, Lille, France.
| | - Guillaume Garçon
- Univ. Lille, CHU Lille, Institut Pasteur de Lille, ULR 4483, IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, F-59000, Lille, France.
| | | | - Nicolas Beauval
- Univ. Lille, CHU Lille, Institut Pasteur de Lille, ULR 4483, IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, F-59000, Lille, France.
| | - Delphine Allorge
- Univ. Lille, CHU Lille, Institut Pasteur de Lille, ULR 4483, IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, F-59000, Lille, France.
| | | | - Nadine Locoge
- IMT Lille Douai, Univ. Lille, SAGE, F-59000, Lille, France.
| | - Jean-Marc Lo-Guidice
- Univ. Lille, CHU Lille, Institut Pasteur de Lille, ULR 4483, IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, F-59000, Lille, France.
| | - Sébastien Anthérieu
- Univ. Lille, CHU Lille, Institut Pasteur de Lille, ULR 4483, IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, F-59000, Lille, France.
| |
Collapse
|
42
|
Queloz S, Etter JF. A survey of users of the IQOS tobacco vaporizer: perceived dependence and perceived effects on cigarette withdrawal symptoms. J Addict Dis 2020; 39:208-214. [PMID: 33336625 DOI: 10.1080/10550887.2020.1847994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Tobacco vaporizers are devices that heat tobacco without burning it. There is currently a scarcity of studies about the addictiveness of tobacco vaporizers or their effects on cigarette withdrawal symptoms. GOALS To assess the perceived dependence of users of tobacco vaporizers and the perceived effects of these products on cigarette withdrawal symptoms. METHODS Enrollment of participants through the internet from 2016 to 2018. Participants were self-selected visitors to an anti-addiction website, current and past users of tobacco vaporizers aged ≥18. RESULTS We included 139 users of IQOS tobacco vaporizers. All participants were current (49.6%) or former cigarette smokers at the time when they began to use the tobacco vaporizer. Among the 135 current users, the median dependence on vaporizers was 80 on a scale from 0-100 (25th and 75th percentiles: 50 and 90), and 63.6% reported being somewhat to totally afraid of becoming dependent on the vaporizer. Half (51%) reported that they were less dependent on vaporizers than on combustible cigarettes, 43.8% were equally dependent on both products and 5.2% were more dependent on vaporizers than on cigarettes. Only one cigarette withdrawal symptom was reported by participants, "craving" for combustible cigarettes, and among respondents who experienced craving, 83.9% found that the IQOS vaporizer relieved it "a lot" to "totally". CONCLUSIONS In this self-selected online sample of IQOS users, the perceived dependence on this tobacco vaporizer was relatively high and almost two thirds of respondents were afraid of becoming dependent on IQOS. Most participants perceived that IQOS relieved the craving to smoke combustible cigarettes.
Collapse
Affiliation(s)
- Sébastien Queloz
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jean-François Etter
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| |
Collapse
|
43
|
Nicotine pharmacokinetics of electronic cigarettes: A pooled data analysis from the literature. Toxicol Rep 2020; 8:84-95. [PMID: 33437651 PMCID: PMC7786013 DOI: 10.1016/j.toxrep.2020.12.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 12/11/2022] Open
Abstract
Evaluating the pharmacokinetics of nicotine absorption from electronic cigarettes. Nicotine absorption into the blood is influenced by several factors. These include e-liquid composition, user behavior and device characteristics. Any regulation of nicotine levels in e-liquids should reflect this heterogeneity.
Several regulatory initiatives around the world restrict the amount of nicotine permitted in electronic cigarette liquids in an attempt to reproduce the nicotine delivery of combusted tobacco products, such as cigarettes, and or reduce the risk of consumers absorbing too much nicotine into their body at one time. Such an approach, however, assumes that (i) there is a strong correlation between the levels of nicotine in electronic cigarette liquids and nicotine intake into the body and (ii) that this correlation holds true across the various different types of electronic cigarette devices currently available on the market. In order to test these hypotheses, this study examines the available scientific literature on nicotine intake from electronic cigarettes, as measured by levels in the blood. Analysis of the published data reveals that nicotine absorption into the body is influenced by a combination of many factors, including electronic cigarette liquid composition, user behavior and device characteristics. Notably, it was observed that open-tank (refillable) electronic cigarettes, which often enable users to vary device power, can deliver high nicotine levels to consumers, sometimes at greater doses than a conventional tobacco cigarette, even at the lower nicotine liquid concentrations typically available. For electronic cigarettes to be viable alternative choices to smoking, they should provide consumers with an equally satisfying experience, including in terms of nicotine absorption into the body. Therefore, any regulation seeking to restrict the amount of nicotine in electronic cigarette liquids should take all the factors influencing nicotine intake into account.
Collapse
|
44
|
Yumoto T, Hamaguchi H, Mae S, Nakao A. Potentially fatal ingestion of heat-not-burn cigarettes successfully treated by gastric lavage. J Am Coll Emerg Physicians Open 2020; 1:1709-1711. [PMID: 33392579 PMCID: PMC7771750 DOI: 10.1002/emp2.12283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/10/2020] [Accepted: 09/24/2020] [Indexed: 11/14/2022] Open
Abstract
Newly introduced heat-not-burn or electronic cigarettes can cause lethal nicotine intoxication if ingested at higher doses. Although routine gastric lavage is not recommended, it should be considered if the amount of intoxicant is lethal. A 59-year-old man with a history of depression was brought to our emergency department after intentional ingestion of 8 heat-not-burn cigarettes, which were estimated to contain a total of 100 mg of nicotine. Abdominal computed tomography confirmed the gastric contents, detecting multiple stick-like and rod-shaped high-density structures. Gastric lavage was performed to minimize absorption of the potentially lethal nicotine dose. The patient exhibited only mild gastrointestinal symptoms. Emergency physicians should be aware of this novel heat-not-burn cigarette and its toxicity.
Collapse
Affiliation(s)
- Tetsuya Yumoto
- Department of Emergency MedicineKasaoka Daiichi HospitalKasaokaOkayamaJapan
- Department of Emergency, Critical Care, and Disaster MedicineOkayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesKitaOkayamaJapan
| | - Hisashi Hamaguchi
- Department of Emergency MedicineKasaoka Daiichi HospitalKasaokaOkayamaJapan
- Department of Medical EducationKurashiki Central HospitalKurashikiOkayamaJapan
| | - Souichiro Mae
- Department of Emergency MedicineKasaoka Daiichi HospitalKasaokaOkayamaJapan
- Emergency and Critical Care CenterKurashiki Central HospitalKurashikiOkayamaJapan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster MedicineOkayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesKitaOkayamaJapan
| |
Collapse
|
45
|
Kiyohara K, Tabuchi T. Use of heated tobacco products in smoke-free locations in Japan: the JASTIS 2019 study. Tob Control 2020; 31:tobaccocontrol-2020-055951. [PMID: 33199542 DOI: 10.1136/tobaccocontrol-2020-055951] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/17/2020] [Accepted: 09/22/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE We aimed to examine the use of heated tobacco products (HTPs) in locations where cigarette smoking was not allowed, and to explore the factors associated with such use among Japanese HTP users. METHODS An internet-based self-reported questionnaire survey was conducted in 2019 as part of the Japan Society and New Tobacco Internet Survey. The study subjects were respondents who self-reported having used HTPs in the last year. The proportions of those who had ever used or frequently used HTPs in locations where tobacco smoking was not allowed in the last year were calculated. These locations included home, restaurants and workplaces. Furthermore, potential factors associated with HTP use in such smoke-free locations were examined using multivariable logistic regression analyses. RESULTS The proportion of HTP users who had ever used HTPs in smoke-free locations in the last year was 20.7% (148/716) at home, 11.8% (128/1081) in restaurants and 11.9% (113/950) in workplaces. The proportion of those who had frequently used HTPs in those locations was 9.5% (68/716) at home, 4.8% (52/1081) in restaurants and 8.0% (76/950) in workplaces. The statistically significant factors associated with HTP use varied by location. Generally, respondents who thought HTP use was not forbidden in places where tobacco smoking is forbidden were likely to use HTPs in such locations. CONCLUSION In Japan, a considerable number of people used HTPs in locations where tobacco smoking was not allowed. Policymakers should establish clear rules about use of HTPs in smoke-free environments.
Collapse
Affiliation(s)
- Kosuke Kiyohara
- Department of Food Science, Otsuma Women's University, Tokyo, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Osaka, Japan
| |
Collapse
|
46
|
Fried ND, Gardner JD. Heat-not-burn tobacco products: an emerging threat to cardiovascular health. Am J Physiol Heart Circ Physiol 2020; 319:H1234-H1239. [PMID: 33006919 DOI: 10.1152/ajpheart.00708.2020] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Cigarette smoking is at all-time lows globally, but the use of electronic cigarettes has increased profoundly. Recent reports of electronic cigarette or vaping use-associated lung injury may lead individuals to explore novel methods of nicotine consumption, such as heat-not-burn devices. IQOS from Philip Morris, a heat-not-burn device, became available for purchase in the United States in October 2019. Philip Morris claims that 8.8 million people have abandoned traditional cigarettes in favor of IQOS; however, evidence suggests that it may act as a gateway or complement to cigarette smoking, rather than a replacement. Surveys indicate that 96% of Korean IQOS users also smoke cigarettes, and 45% of Italian users of IQOS had never smoked cigarettes. In the United States, Canada, and England, susceptibility of youth to trying IQOS was slightly lower than electronic cigarettes, but higher than cigarette smoking. Heat-not-burn products produce mainstream and second-hand emissions of harmful chemicals, including nicotine, particulate matter, benzene, acrolein, and tobacco-specific nitrosamines. The levels of these emissions, despite being less than those of traditional cigarettes, are potentially harmful to cardiovascular health. A study of current smokers showed similar acute effects of heat-not-burn tobacco products and traditional cigarettes on heart rate, blood pressure, and arterial stiffness. Rats exposed to IQOS had similar vascular endothelial function impairment to those exposed to cigarettes. Heat-not-burn aerosol exposure of cultured macrophages elicited increased oxidative stress, although less than that induced by cigarette smoke. Further studies are needed to better understand the cardiovascular effects of heat-not-burn tobacco products.
Collapse
Affiliation(s)
- Nicholas D Fried
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Jason D Gardner
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| |
Collapse
|
47
|
Corona G, Sansone A, Pallotti F, Ferlin A, Pivonello R, Isidori AM, Maggi M, Jannini EA. People smoke for nicotine, but lose sexual and reproductive health for tar: a narrative review on the effect of cigarette smoking on male sexuality and reproduction. J Endocrinol Invest 2020; 43:1391-1408. [PMID: 32323225 DOI: 10.1007/s40618-020-01257-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/11/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To systematically review the impact of smoking habits on cardiovascular (CV) as well as on male sexual and reproductive function and to provide updated evidence on the role of electronic cigarettes (e-Cig) on the same topics. METHODS A comprehensive Medline, Embase, and Cochrane search was performed including the following words: smoking, CV system, CV risk, erectile dysfunction (ED), and male fertility. Publications from January 1, 1969 up to February 29, 2020 were included. RESULTS Smoking has a tremendous negative impact on CV mortality and morbidity. Current smoking behavior is also negatively associated with erectile dysfunction (ED) and impaired sperm parameters. E-Cig can release significantly lower concentrations of harmful substances when compared to regular combustible cigarettes. Whether or not the latter can result in positive CV, sexual, and fertility outcomes is still under study. Preliminary studies showed that exposure to e-Cig leads to lower vascular damage when compared to the traditional cigarette use. However, data on the long-term effects of e-Cig are lacking. Similarly, preliminary data, obtained in animal models, have suggested a milder effect of e-Cig on erectile function and sperm parameters. CONCLUSION Available evidence showed that e-Cig are much less dangerous when compared to the traditional tobacco use. However, it should be recognized that the risk related to e-Cig is still higher when compared to that observed in non-smoking patients. Hence, e-Cig should be considered as a potential tool, in the logic of harm reduction, to reduce the CV, sexual and fertility risk in patients refractory to the fundamental, healthy choice to definitively quit smoking.
Collapse
Affiliation(s)
- G Corona
- Medical Department, Endocrinology Unit, Maggiore-Bellaria Hospital, Azienda-Usl Bologna, Bologna, Italy
| | - A Sansone
- Chair of Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - F Pallotti
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - A Ferlin
- Unit of Endocrinology and Metabolism, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - R Pivonello
- Division of Endocrinology, Università Degli Studi Di Napoli "Federico II", Naples, Italy
| | - A M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - M Maggi
- Department of Experimental, Clinical and Biomedical Sciences, Endocrinology Unit, University of Florence, Florence, Italy
| | - E A Jannini
- Chair of Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy.
- Center of Excellence for the Acceleration of Harm Reduction (CoEHAR), University of Catania, Catania, Italy.
| |
Collapse
|
48
|
Cerrai S, Potente R, Gorini G, Gallus S, Molinaro S. What is the face of new nicotine users? 2012-2018 e-cigarettes and tobacco use among young students in Italy. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 86:102941. [PMID: 32949900 DOI: 10.1016/j.drugpo.2020.102941] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/31/2020] [Accepted: 09/04/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND With increased use of electronic-nicotine delivery devices (e-cigarettes) and non-cigarettes tobacco products (heated tobacco products, shisha, moist snuff/snus) among adolescents, the percentage of Italian students who use nicotine products is at its highest level of the past ten years, even though prevention and anti-smoking policies have produced tangible results in decreasing tobacco smoking prevalence. This cross-sectional study examined trends in exclusive and dual smoking, identified new poly-consumption patterns and profiled old and new nicotine users. METHODS We used the annual cross-sectional ESPAD® Italia survey which sampled students (aged 15-19), currently used for surveillance and monitoring of at risk population, between 2012 and 2018 (N = 170,974) to describe Italian trends in exclusive cigarette, exclusive vaping, and dual cigarette and vaping use. . For the 2018 sample, patterns of poly-consumption were described, and a multinomial logistic regression (N = 15,732) estimated characteristics associated with exclusive and dual cigarette and vaping use. RESULTS The lifetime prevalence of cigarette smokers slightly decreased from 60.9% in 2012 to 56.9% in 2018, whereas the proportion of vaping users substantially increased from 32.9% in 2013 to 52.0% in 2018. Combining cigarette and vaping use, these trends result in an increase in the lifetime prevalence of any use from 60.8% in 2013 to 66.2% in 2018. Three out of every 10 minors have experienced smoking and/or vaping, and younger students were more prone to be dual users. Overall, current vapers were generally less prone to risky behaviours. CONCLUSION In contrast to a slight decrease in cigarette smoking, the prevalence of Italian students approaching old and/or new smoking habits in their lifetime is substantially increasing. The popularity of alternative nicotine-based products, particularly e-cigarettes, has increased among teenagers, resulting in a summation of usage patterns rather than a compensation, and attracting a novel slice of young users. The lack of regulation within current drug policy to limit the access to such licit psychoactive substance use, is urgently needed to avoid a future nicotine addicted population.
Collapse
Affiliation(s)
- Sonia Cerrai
- Epidemiology and Health Research Lab, Institute of Clinical Physiology, National Research Council of Italy (IFC-CNR), Pisa, Italy
| | - Roberta Potente
- Epidemiology and Health Research Lab, Institute of Clinical Physiology, National Research Council of Italy (IFC-CNR), Pisa, Italy
| | - Giuseppe Gorini
- Occupational & Environmental Epidemiology Section, Oncologic Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Sabrina Molinaro
- Epidemiology and Health Research Lab, Institute of Clinical Physiology, National Research Council of Italy (IFC-CNR), Pisa, Italy.
| |
Collapse
|
49
|
Kopa PN, Pawliczak R. Menthol additives to tobacco products. Reasons for withdrawing mentholated cigarettes in European Union on 20th may 2020 according to tobacco products directive (2014/40/EU). Toxicol Mech Methods 2020; 30:555-561. [PMID: 32746758 DOI: 10.1080/15376516.2020.1805662] [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] [Indexed: 10/23/2022]
Abstract
Menthol, which is a natural cyclic monoterpene alcohol with a minty smell, is one of the main constituents of essential oils that naturally occur in some aromatic plants, such as Mentha × piperita L. This natural compound shows many biological properties, such as anesthetic, analgesic, antibacterial and antifungal, immunomodulating, and skin penetration-enhancing. It is added to a variety of goods, such as food, oral-care products, OTC products, cosmetics, and tobacco products. Menthol is not just a simple flavoring agent, especially when it comes to tobacco products. Its ability to 'mask' the negative effects of nicotine and its additional positive sensory effects makes it the most common additive in such products. For the customers, mentholated tobacco products may be mistakenly perceived as less harmful for health, which may increase their consumption. However, as the evidence shows, menthol cigarettes are no safer than conventional cigarettes and may lead to more frequent disease exacerbation during prolonged exposure to smoke from such products. In addition, because of its complex interactions with nicotine, menthol may affect smoking behavior and may increase addiction to nicotine. For those reasons, the European Union banned flavored cigarettes (whose sale size reached more than 3% of the total tobacco product market) by implementing the Tobacco Products Directive (2014/40/EU) on 20th May 2020. While the menthol ban was based on health concerns, the ultimate effect on consumers, regarding potential quitting, is yet to be determined.
Collapse
Affiliation(s)
- Paulina Natalia Kopa
- Faculty of Medicine, Department of Immunopathology, Division of Biomedical Science, Medical University of Lodz, Lodz, Poland
| | - Rafał Pawliczak
- Faculty of Medicine, Department of Immunopathology, Division of Biomedical Science, Medical University of Lodz, Lodz, Poland
| |
Collapse
|
50
|
Reilly SM, Cheng T, DuMond J. Method Validation Approaches for Analysis of Constituents in ENDS. TOB REGUL SCI 2020; 6:242-265. [PMID: 32789155 PMCID: PMC7416875 DOI: 10.18001/trs.6.4.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE We assessed how many peer-reviewed publications reporting chemical quantities and/or yields from electronic nicotine delivery systems (ENDS) have included adequate method validation characteristics in the publication for appropriate interpretation of data quality for informing tobacco regulatory science. METHODS We searched 5 databases (Web of Knowledge, PubMed, SciFinder, Embase, EBSCOhost) for ENDS publications between January 2007 and September 2018. Of the 283 publications screened, 173 publications were relevant for analysis. We identified the publications that report a certain degree of control in data quality, ie, the publications that report marginally validated methods (MVMs). MVMs refer to the methods that: (1) report 3 or more International Conference on Harmonisation (ICH) method validation characteristics, (2) state the method was validated, (3) cite their own previous publication(s) that report MVMs, or (4) use a method within the accreditation scope of an accredited laboratory. RESULTS Overall, 97 publications (56%) report MVMs in their studies. This percentage also reflects the publication distribution for the majority of the 28 chemicals measured by MVMs. CONCLUSIONS This study highlights the need for reporting sufficient validation characteristics following appropriate guidance to ensure the accuracy and reliability of the published analytical data for proper data interpretations that may support policy.
Collapse
Affiliation(s)
- Samantha M Reilly
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD
| | - Tianrong Cheng
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD
| | - Jenna DuMond
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD
| |
Collapse
|