Electronic cigarettes as smoking cessation tool: are we there?

Does Quit Smoking Desire Influence E-Cigarette Smoking Behaviour? Malaysian Perspectives

Recent years have witnessed an emerging trend of e-cigarette smoking in Southeast Asia. On the basis of Malaysian perspectives, this cross-sectional study explored the relationship between e-cigarette smoking behaviour and variables such as perceived health benefit, the desire to quit, social acceptance, social impact and product usefulness. Individuals aged 17 years old and older were recruited via purposive convenience sampling, yielding a total sample of 503 respondents. Collected data were analysed via partial least squares-structural equational modelling. The results showed that perceived heath benefit (β = 0.19, P < 0.01), social acceptance (β = 0.23, P < 0.01) and social impact (β = 0.49, P < 0.01) positively influence e-cigarette smoking behaviour. No such effect is exerted by the desire to quit smoking (β = 0.08, P < 0.05) and product usefulness t (β = -0. 10, P < 0.05). Future studies should examine whether demographic variables affect e-cigarette smoking behaviour.

Perceptions of e-cigarettes among Australian adolescents, young adults, and adults

Increases in e-cigarette use are of concern to public health authorities given the harms associated with vaping. Understanding people's perceptions of the risks and benefits of e-cigarette use has the potential to assist with prevention efforts. However, research assessing the perceptions of Australian adolescents and any differences in perceptions between adolescents, young adults, and adults is limited. Additionally, research exploring perceptions of various types of e-cigarettes is lacking. To inform the development of prevention and intervention programs and policies, this study aimed to explore Australians' perceptions of the risks and benefits associated with e-cigarette use and whether perceptions differ by age and user status. A sample of 4,617 Australians aged 12 + years completed an online survey that assessed (i) smoking and e-cigarette user status, (ii) e-cigarette risk perceptions, (iii) beliefs about e-cigarettes as a smoking cessation tool, and (iv) positive e-cigarette outcome expectancies. Across all age groups, respondents perceived non-nicotine and flavoured e-cigarettes as less harmful than nicotine e-cigarettes. Significantly more adolescents and young adults than adults held positive outcome expectancies, and a substantial minority of non-users and never users in all age groups believed that using e-cigarettes confers social and mental health benefits. Given the potential benefits they perceived to be associated with e-cigarette use, a substantial proportion of adolescent and young adult never users may be vulnerable to initiation. These findings highlight the importance of (i) adequately communicating the risks associated with non-nicotine e-cigarette use and (ii) addressing misperceptions about use, especially among youth.

Impact of Electronic Cigarettes on the Upper Aerodigestive Tract: A Comprehensive Review for Otolaryngology Providers

Objective

The use and effects of electronic (e)-cigarettes (e-cigs) are particularly relevant for otolaryngology providers as tobacco plays a major role in benign and malignant diseases of the upper aerodigestive tract. This review aims to (1) summarize the recent policies regarding e-cigs and important patterns of use and (2) serve as a comprehensive resource for clinical providers on the known biologic and clinical effects of e-cigs on the upper aerodigestive tract.

Data Sources

PubMed/MEDLINE.

Review Methods

We conducted a narrative review on (1) general information on e-cig use and informative findings in the lower respiratory system and a comprehensive review on (2) the effects of e-cigs on cell and animal models and the clinical implications of these products on human health as is relevant to otolaryngology.

Conclusions

Although e-cigs are likely less harmful than conventional cigarettes, preliminary research on e-cigs suggest several deleterious effects including in the upper aerodigestive tract. Due to this, there has been increased interest in restricting e-cig usage, particularly among the adolescent population, and caution in recommending e-cigs to current smokers.

Implications for Practice

Chronic e-cig use is likely to have clinical implications. It is critical for otolaryngology providers to be aware of the rapidly changing regulations and use patterns regarding e-cigs and how e-cigs influence human health, particularly with regards to the upper aerodigestive tract, to accurately council patients regarding potential risks and benefits of use.

Awareness About and E-Cigarette Use Among Adults in 15 Low- and Middle-Income Countries, 2014-2018 Estimates From Global Adult Tobacco Surveys

INTRODUCTION

E-cigarette (EC) use is seldom reported from low- and middle-income countries (LMICs). We report the prevalence of "awareness" about EC, its use, and distribution of EC use by sociodemographic factors and cigarette smoking (CS) status.

AIMS AND METHODS

We analyzed Global Adult Tobacco Survey data in Bangladesh, China, Costa Rica, Ethiopia, India, Kazakhstan, Mexico, Philippines, Romania, Russia, Senegal, Ukraine, Turkey, Uruguay, and Viet Nam during 2014-2018. The weighted prevalence of "awareness" (heard about), "ever" (even once), and "current" (daily/nondaily) EC use among never, current, and former cigarette smokers and quit ratios (past smokers/ever smokers) was estimated. Association of EC use with sociodemographic, and CS, was explored by multilevel regression.

RESULTS

Overall, prevalence of "awareness," "ever," and "current" ECs use was 19.3% (95% confidence interval [CI] 27.4, 31.1), 2.6% (95% CI 2.4, 2.8), and 0.7% (95% CI 0.6, 0.8), respectively. In most countries, "ever use" <10%, and "current use" was about 1% except Romania (4.4%) and Russia (3.5%). "Current use" was 0.1%, 2.9%, and 3.1% among never, current, and former smokers, respectively. "Current" and "ever" EC use was higher among current and former than never smokers (2.8% and 3.1% vs. 0.1%; 9.9% and 10.9% vs. 0.7%), respectively. Current EC use was associated with male sex, urban residence and younger age, higher education, and wealth. "Quit attempts" (aOR 1.3, 95% CI 1.2, 1.5) and cigarettes smoked per day (aOR 1.6, 95% CI 1.4, 1.9) were associated with "ever use."

CONCLUSIONS

EC use was low in most countries. "Dual use" was common among current smokers and the quit ratio was higher among ECs users.

IMPLICATIONS

EC use is increasing in high-income countries (HICs) where regulations on ECs are usually permissive. Evidence on the individual- or population-level impact of ECs on CS cessation is inconclusive. Little is known about the prevalence of EC use in LMICs where regulations are nonexistent or less restrictive. Studying the distribution of EC use rates by population subgroups, CS status, and quit ratios for CS among EC users will assist the formulation of EC regulatory policies. We provide comparable nationally representative prevalence estimates of "awareness" about and, use of ECs to serve as a benchmark for future monitoring. EC use was associated with the attempt to quit CS and smoking >10 cigarettes per day. However, "dual use" was common, and the quit ratio for CS was higher among EC users. EC use was very low relative to HICs. Nevertheless, comprehensive EC regulatory policies should be implemented to prevent the escalation of EC use by targeting population subgroups such as young adults, educated and wealthier individuals.

E-liquid purchase as a function of workplace restriction in the experimental tobacco marketplace

E-cigarette use is prohibited in most smoke-free environments. The effect of this policy on tobacco consumption could be examined using the Experimental Tobacco Marketplace (ETM). The ETM allows observation of policy on smokers' purchasing behavior under conditions that simulate "real-world" circumstances. A within-subject design was used to evaluate the effect of workplace policy (Vaping Allowed vs. Not Allowed) and nicotine concentration (24 mg/mL vs. 0 mg/mL) on tobacco product consumption. Participants (n = 31) completed one sampling and two ETM/workplace sessions per week for 2 weeks. During the sampling session, participants were given an e-cigarette with a 2-day supply of a commercially available e-liquid of their preferred flavor. Before purchasing, participants were informed whether e-cigarette use was permitted. During the four ETM sessions, participants purchased for the following 24 hr, including the 4-hr work shift that started immediately after buying products in the ETM. The workplace session consisted of data entry tasks in a mock office environment. Participants could use any purchased tobacco products during two 15-min breaks. Condition order was counterbalanced. The results show that permitting E-cigarette use in the workplace increased e-liquid purchase on average, but nicotine concentration had no effect on e-liquid demand. Cigarette demand was unaltered across conditions. The present study suggests that allowing e-cigarette use in the workplace would increase demand for e-liquid regardless of nicotine strength. However, it would not change conventional cigarette demand. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

E-cigarette device type and combustible tobacco use: Results from a pooled analysis of 10,482 youth

INTRODUCTION

To understand whether using a certain e-cigarette device is more strongly associated with risk of combustible tobacco use among youth.

METHODS

We conducted multivariable logistic regression analyses using cross-sectional data from 4 samples of youth in Connecticut and California (N = 10,482; ages 13-24), separately for each study using the total sample and the sample of past-month e-cigarette users, to understand the association between e-cigarette device type and past-month combustible tobacco use, while controlling for age, sex, race/ethnicity, socioeconomic status, school, and past-month marijuana use. Then, we conducted meta-analyses to calculate pooled associations for adolescents, young adults, and all individuals combined.

RESULTS

Among the total sample, combustible tobacco use was associated with any e-cigarette device use (vs. no e-cigarette use) in the pooled analysis across all studies. Among past-month e-cigarette users, combustible tobacco use across all studies was 15.8%- 61.5%. Pooled associations among past-month e-cigarette users showed that using disposable devices (vs. pods; AOR=2.83, 95% CI: 1.73-4.61) and multiple devices most frequently (vs. pods; AOR=2.13, 95% CI: 1.16-3.90) was associated with greater odds of combustible tobacco use. Pooled associations also found that using multiple devices (vs. a single device) in the past month was associated with greater odds of combustible tobacco use (AOR 2.33, 95% CI: 1.74, 3.14).

DISCUSSION

Using disposable e-cigarettes and multiple devices is associated with greater likelihood of combustible tobacco use among e-cigarette using youth. Future research should elucidate the trajectory of e-cigarette device used and combustible tobacco use among youth to inform prevention and product regulation.

Knowledge and attitudes on smoking cessation of e-cigarettes: a mixed-methods study of pharmacy students in Surabaya, Indonesia

Background

Pharmacy students as candidates for health workers who will take part in smoking cessation. Knowledge and attitudes of smoking cessation can help map the behavior of pharmacists in the future. This study aimed to explore knowledge and attitudes on smoking cessation of e-cigarettes with the mixed methods study of pharmacist students.

Method

This research was conducted in Januari-Juni 2021 in Surabaya. The research design was mix-method with sequential explanatory strategy. The variables were knowledge and attitudes on smoking cessation of e-cigarettes. The sample in this qualitative approach was derived from a sample of quantitative data. Respondents were interviewed in depth until the data reached the saturation level in order to obtain good and usable qualitative data.

Results

This study involved 31 respondents. The highest level of knowledge about dangers of e-cigarettes, especially related to nicotine (100% of respondents answered correctly). The highest positive level of attitude about dangers of e-cigarettes, especially e-cigarettes harmful to passive smokers (27% of respondents had positive attitude). Cigarettes were harmful to lung and cardiovascular health, regarding the dangers of passive smoking, some agree and disagree. Non-smokers didn't need to be recommended for e-cigarettes, e-cigarettes can be recommended for tobacco smokers, e-cigarettes cause addiction, and e-cigarettes can be a good recommendation for those who want to carry out smoking cessation. Regulation of e-cigarettes in Indonesia was considered to be lacking and needs to be improved.

Conclusions

Pharmacist students have a high level of knowledge and a positive attitude towards smoking cessation.

Immediate physiological effects of acute electronic cigarette use in humans: A systematic review and meta-analysis

BACKGROUND

Electronic cigarettes (e-cigs) are widely used devices that were initially created to aid in smoking cessation. However, their acute physiological effects are unclear and there have been a number of E-cig and Vaping Acute Lung Injury (EVALI) events reported.

RESEARCH QUESTION

What are the immediate physiological effects (i.e. cardiovascular, respiratory or blood-based responses) of acute e-cig usage in humans?

STUDY DESIGN AND METHODS

PubMed, Web of Science, Cochrane and Scopus databases were searched for English or French peer-reviewed articles published until May 20, 2021 and measuring at least one physiological parameter before and after using an e-cig. The study followed PRISMA guidelines and assessed article quality using the Downs and Black checklist. Independent extraction was conducted by two reviewers. Data were pooled using random-effect models. Sensitivity analysis and meta-regressions were performed to explore heterogeneity.

MAIN OUTCOMES

Systolic and diastolic blood pressure, heart rate, augmentation index (AIx75), fraction of exhaled nitric oxide (FeNO), and spirometry were the most frequently assessed parameters and were therefore chosen for meta-analyses.

RESULTS

Of 19823 articles screened, 45 articles were included for the qualitative synthesis, and 27 articles (919 patients) were included in meta-analyses. Acute use of nicotine e-cig was associated with increased heart rate(SMD = 0.71; 95%CI 0.46-0.95), systolic blood pressure (SMD = 0.38; 95%CI 0.18-0.57), diastolic blood pressure (SMD = 0.52; 95%CI 0.33-0.70), and augmentation index AIx75 (SMD = 0.580; 95%CI 0.220-0.941), along with decreased FeNO (SMD = -0.26; 95%CI -0.49 to -0.04). E-cig exposure wasn't associated with significant changes in any spirometry measure.

INTERPRETATION

Acute use of nicotine e-cigs was associated with statistically significant cardiovascular and respiratory responses. These devices have a physiological impact that could be clinically relevant, especially in terms of cardiovascular morbidity. However, the direct consequences of long-term e-cig use needs to be further explored.

A pilot investigation of e-cigarette use and smoking behaviour among patients with chronic airway disease or respiratory symptoms

Background

This pilot study aimed to investigate the current status of e‐cigarettes (ECs) use patterns among patients with chronic airway disease or chronic respiratory symptoms and the effects of ECs use on respiratory and mental health.

Methods

A cross‐sectional survey was conducted at the outpatient clinic of eight teaching hospitals in South Korea between November 2019 and December 2019. All adult ECs users (19 years and above) who visited the outpatient clinic as a patient with chronic airway disease or chronic respiratory symptoms were eligible to participate in this study.

Results

A total of 51 subjects responded to the survey. Most of the participants were male (92.2%) and the mean age was 41.8 years. Dominant airway diseases were asthma and chronic obstructive pulmonary disease. Most of the subjects had a history of cigarette smoking, and 19 subjects were dual users of current cigarettes and ECs. Most of the subjects started ECs use due to health‐related reasons. When comparing exclusive ECs users and dual users, St. George's respiratory questionnaire (SGRQ) scores, the proportion of cases with moderate to severe depressive symptoms, and average Fagerstrom test for nicotine dependence scores for ECs were higher in dual users than exclusive ECs users (mean 4.64 vs. 2.38, p = 0.006), respectively.

Conclusion

Most of the subjects started ECs use due to health concerns, but dual users have more respiratory symptoms and higher nicotine dependence in this pilot study. One hypothesis that comes from these results is that greater nicotine dependence may influence behaviours, habits, and views about ECs. These preliminary observations need confirmation in a large cohort.

Development, Validation, and Application of a Novel Method for the Analysis of Vitamin E Acetate and Other Tocopherols in Aerosol Emissions of E-Cigarettes, or Vaping Products Associated With Lung Injury

E-cigarette, or vaping, product (EVP) use has increased dramatically in the United States over the last 4 years, particularly in youth and young adults. Little information is available on the chemical contents of these products. Typically, EVPs contain an active ingredient such as nicotine, CBD, or THC dissolved in a suitable solvent that facilitates aerosol generation. One EVP solvent, vitamin E acetate (VEA), has been measured in EVP liquids associated with lung injury. However, no validated analytical methods for measuring VEA in the aerosol from these devices was previously available. Therefore, we developed a high throughput isotope dilution LC-MS/MS method to simultaneously measure VEA and three other related tocopherols in aerosolized EVP samples. The assay was precise, with VEA repeatability ranging from 4.0 to 8.3% and intermediate precision ranging from 2.5 to 6.7%. Similar precision was obtained for the three other tocopherols measured. The LODs for the four analytes ranged from 8.85 × 10⁻⁶ to 2.28 × 10⁻⁵ μg analyte per mL of aerosol puff volume, and calibration curves were linear (R² > 0.99). This method was used to analyze aerosol emissions of 147 EVPs associated with EVALI case patients. We detected VEA in 46% of the case-associated EVPs with a range of 1.87 × 10⁻⁴–74.1 µg per mL of aerosol puff volume and mean of 25.1 µg per mL of aerosol puff volume. Macro-levels of VEA (>0.1% w/w total aerosol particulate matter) were not detected in nicotine or cannabidiol (CBD) products; conversely 71% of the EVALI associated tetrahydrocannabinol (THC) products contained macro-levels of VEA. Trace levels of other tocopherol isoforms were detected at lower rates and concentrations (α-tocopherol: 41% detected, mean 0.095 µg analyte per mL of aerosol puff volume; γ-tocopherol: 5% detected, mean 0.0193 µg analyte per mL of aerosol puff volume; δ-tocopherol: not detected). Our results indicate that VEA can be efficiently transferred to aerosol by EVALI-associated EVPs vaped using a standardized protocol.

Characterizing alternative and emerging tobacco product transition of use behavior on Twitter

OBJECTIVE

The objective of this study was to develop an inductive coding approach specific to characterizing user-generated social media conversations about transition of use of different tobacco and alternative and emerging tobacco products (ATPs).

RESULTS

A total of 40,206 tweets were collected from the Twitter public API stream that were geocoded from 2018 to 2019. Using data mining approaches, these tweets were then filtered for keywords associated with tobacco and ATP use behavior. This resulted in a subset of 5718 tweets, with 657 manually annotated and identified as associated with user-generated conversations about tobacco and ATP use behavior. The 657 tweets were coded into 9 parent codes: inquiry, interaction, observation, opinion, promote, reply, share knowledge, use characteristics, and transition of use behavior. The highest number of observations occurred under transition of use (43.38%, n = 285), followed by current use (39.27%, n = 258), opinions about use (0.07%, n = 46), and product promotion (0.06%, n = 37). Other codes had less than ten tweets that discussed these themes. Results provide early insights into how social media users discuss topics related to transition of use and their experiences with different and emerging tobacco product use behavior.

The Association Between Health Literacy and Tobacco Use: Results from a Nationally Representative Survey

Dual use of conventional cigarettes and electronic cigarettes presents an emerging public health issue. Previous research has demonstrated a negative relationship between health literacy and conventional cigarette (CIG) use. However, the relationship between health literacy and e-cigarette (ECIG) use remains unclear. This studies examines the possible association of health literacy and CIG, ECIG, or dual use. A multinomial regression was used to model the association between health literacy and current CIG use, current ECIG use, or dual tobacco use status using state-optional data from the 2016 Behavioral Risk Factor Surveillance System (BRFSS; N = 40,404). One-third of the sample (N = 13,478; 33.3%) had initiated tobacco use. Approximately 36.6% of participants exclusively used cigarettes. A smaller proportion of participants were dual users of ECIG and CIGs (7.0%) and e-cigarette exclusive users (4.5%). After adjusting for covariates, higher levels of oral health literacy was associated with lower odds of current dual use. However, there was no significant association between written HL and either conventional cigarette use or electronic cigarette use or after adjusting for covariates. Oral messaging around the dangers of CIG use may be effective at lowering odds of CIG or dual use, especially for those with higher levels of HL. Further research is needed to examine how to best disseminate information regarding the health risks of ECIGs.

Association of e-cigarette advertising with e-cigarette and cigarette use among US adults

AIMS

To estimate the association of e-cigarette advertisement exposure with e-cigarette and cigarette use behavior among US adults.

DESIGN

Data from the 2013-14 National Adult Tobacco Survey (NATS) were linked to Kantar Media and National Consumer Study data to construct measures of e-cigarette advertisements on TV and in magazines. The relationship between advertisement measures and outcomes was estimated using logistic and Poisson regressions, controlling for socio-demographics, state cigarette taxes and state and year fixed-effects.

SETTING

United States.

PARTICIPANTS/CASES

A total of 98 746 adults aged ≥ 18 years who responded to the 2013-14 NATS.

MEASUREMENTS

The independent variables of interest were the number of e-cigarette advertisements in magazines to which an adult was exposed in the past 6 months and the number of e-cigarette advertisements on TV to which an adult was exposed in the past 6 months. Outcomes were awareness of e-cigarettes, ever e-cigarette use, current e-cigarette use, current cigarette use and number of cigarettes smoked per month.

FINDINGS

Exposure to one additional e-cigarette advertisement on TV was associated with a 0.18, 0.13 and 0.03 percentage point increase, respectively, in awareness, ever use and current use of e-cigarettes among all adults (P < 0.05). This exposure also was associated with a 0.11 percentage point increase in current cigarette use among all adults and an increase in cigarette consumption of 2.24 cigarettes per month among adults aged ≥ 45 (P < 0.05).

CONCLUSIONS

Exposure to e-cigarette advertising appears to be positively associated with the use of e-cigarettes and cigarettes among adults of all ages, and with increased cigarette consumption among older adults.

Stroke, Smoking and Vaping: The No-Good, the Bad and the Ugly

Both stroke and smoking continue to be major public health crises in the United States, with stroke being the third and fourth leading cause of death among women and men, respectively. The goal of this review will be to provide clinicians a succinct overview regarding the epidemiology, economics, and biology of stroke in the setting of smoking and electronic cigarette use. Special attention will be given to the escalating public health crisis of electronic cigarette use, emphasizing mechanistic relationships of stroke and lung injury. Readers will be made aware of the need for continued scientific advancement and study regarding these relationships, as well as the need for improved governmental and public health efforts to curb these ongoing public health crises.

No evidence of differences in smoking levels, nicotine dependence, carbon monoxide or motivational indices between cigarette smokers and cigarette + e-cigarette dual users in two samples

Concurrent use of electronic cigarettes (e-cigarettes) as an alternative source of nicotine may lead to lower smoke exposure, tobacco addiction and reinforcing value of conventional combustible cigarettes. In two different cohorts, we characterized smokers, dual cigarette/e-cigarette users, and e-cigarette-only users in terms of sociodemographic, motives and patterns of e-cigarette use. Differences in smoking-related characteristics and reinforcing value of cigarettes between smokers and e-cigarette dual users were also examined. Two cohorts comprising 339 community adults [Sample 1; aged 18-65] and 293 young adult binge drinkers [Sample 2; aged 19-24] were recruited in Hamilton, Ontario. All participants provided expired carbon monoxide (CO) samples and completed an assessment battery including the Fagerström Test of Nicotine Dependence (FTND), the Wisconsin Inventory of Smoking Dependence Motives (WISDM), and the Cigarette Purchase Task (CPT). In both samples, smoking rate, CO level, FTND, WISDM, and CPT responses did not significantly differ between smokers and dual users. Compared to e-cigarette-only individuals, dual users from the two cohorts reported a greater use of e-cigarettes for quitting smoking, but dual product consumers exhibited no significant differences in motivation for change relative to combustible-only smokers. Relative to smokers, e-cigarette dual users did not show lower levels of smoking, lower severity of cigarette addiction and reinforcing value of cigarettes in these samples. These findings suggest that concurrent e-cigarette use does not affect combustible tobacco use or motivation, or reduce its harms.

Acute administration of nicotine induces transient elevation of blood pressure and increases myocardial infarct size in rats

Aims

We investigated the acute effects of nicotine on myocardial infarct size, no reflow, hemodynamics and cardiac function in an acute myocardial ischemia and reperfusion infarction rat model.

Main methods

Female Sprague-Dawley rats (n = 23/group) received an intravenous loading dose of nicotine at 2.0 μg/kg/min or saline control for 30 min before starting coronary artery occlusion, then followed by a maintenance dose 0.35 μg/kg/min of nicotine to the end of 30 min occlusion and 3 h reperfusion.

Key findings

At baseline, there was no difference in systolic blood pressure (BP in mmHg) (nicotine, 69.0 ± 2.7; control, 69.3 ± 4.4; p = NS) or diastolic BP (nicotine, 45.7 ± 3.2; control, 48.2 ± 4.2; p = NS) between groups. Nicotine administration initially increased systolic BP (nicotine, 97.0 ± 8.6; control, 69.2 ± 3.3, p < 0.0001) and diastolic BP (nicotine, 65.6 ± 6.4; control, 47.4 ± 3.1, p = 0.0003) at 10 min after starting injection of the loading dose; BP dropped to control levels in both groups at 30 min. During occlusion and reperfusion, the BP and heart rate were not altered by nicotine. Nicotine significantly increased myocardial infarct size as a percentage of the ischemic risk zone compared to the controls (nicotine, 54.9 ± 1.9; control, 48.6 ± 2.7, p < 0.05), but nicotine did not affect the no-reflow size and heart function.

Significance

While acute nicotine only transiently elevated blood pressure, it did not affect hemodynamic parameters during coronary artery occlusion. Nicotine increased myocardial infarct size, suggesting that the increase in infarct size was not simply due to an increase in oxygen demand due to altered afterload, heart rate, or contractility, but may have been due to a more direct effect on the myocardium.

Vaping-Related Mobile Apps Available in the Google Play Store After the Apple Ban: Content Review

BACKGROUND

In response to health concerns about vaping devices (eg, youth nicotine use, lung injury), Apple removed 181 previously approved vaping-related apps from the App Store in November 2019. This policy change may lessen youth exposure to content that glamorizes vaping; however, it may also block important sources of information and vaping device control for adults seeking to use vaping devices safely.

OBJECTIVE

Understanding the types of nicotine and cannabis vaping-related apps still available in the competing Google Play Store can shed light on how digital apps may reflect information available to consumers.

METHODS

In December 2019, we searched the Google Play Store for vaping-related apps using the keywords "vape" and "vaping" and reviewed the first 100 apps presented in the results. We reviewed app titles, descriptions, screenshots, and metadata to categorize the intended substance (nicotine or cannabis/tetrahydrocannabinol) and the app's purpose. The most installed apps in each purpose category were downloaded and evaluated for quality and usability with the Mobile App Rating Scale.

RESULTS

Of the first 100 apps, 79 were related to vaping. Of these 79 apps, 43 (54%) were specific to nicotine, 3 (4%) were specific to cannabis, 1 (1%) was intended for either, and for the remaining 31 (39%), the intended substance was unclear. The most common purposes of the apps were making do-it-yourself e-liquids (28/79, 35%) or coils (25/79, 32%), games/entertainment (19/79, 24%), social networking (16/79, 20%), and shopping for vaping products (15/79, 19%). Of the 79 apps, at least 4 apps (5%) paired with vaping devices to control temperature or dose settings, 8 apps (10%) claimed to help people quit smoking using vaping, and 2 apps (3%) had the goal of helping people quit vaping.

CONCLUSIONS

The majority of vaping-related apps in the Google Play Store had features either to help users continue vaping, such as information for modifying devices, or to maintain interest in vaping. Few apps were for controlling device settings or assisting with quitting smoking or vaping. Assuming that these Google Play Store apps were similar in content to the Apple App Store apps that were removed, it appears that Apple's ban would have a minimal effect on people who vape with the intention of quitting smoking or who are seeking information about safer vaping via mobile apps.

Risk Factors and Perceptions of E-Cigarette Use Among Selected Users in Johannesburg, South Africa

There is little scientific knowledge about e-cigarette use in South Africa. This study aimed to describe the risk factors and perceptions of selected Johannesburg-based users of e-cigarettes. A self-administered questionnaire was used to collect data from a convenient sample of 188 participants, of which 160 were males and 28 females. The survey results showed that participants used e-cigarettes at home (n = 28/ 14.8%), work (n = 76/ 40.4%), tertiary institutions (n = 50/ 26.5%) and in their vehicles (n = 24/ 12.7%), while (n = 96/ 51%) used the product in the presence of children. 57 participants (30.3%) started using e-cigarettes as a smoking cessation strategy, while 46 (24.4%) used it to manage smoking cravings. Most participants believed that e-cigarettes are addictive (n = 156/ 82.9%) and unhealthy (n = 139/ 73.9%). This study highlights the need and opportunity to improve public health action in the prevention and management of risks posed by e-cigarette products to users and non-users.

Primary and Secondary Prevention of Lung Cancer: Tobacco Treatment

Tobacco dependence is the most consequential target to reduce the burden of lung cancer worldwide. Quitting after a cancer diagnosis can improve cancer prognosis, overall health, and quality of life. Several oncology professional organizations have issued guidelines stressing the importance of tobacco treatment for patients with cancer. Providing tobacco treatment in the context of lung cancer screening is another opportunity to further reduce death from lung cancer. In this review, the authors describe the current state of tobacco dependence treatment focusing on new paradigms and approaches and their particular relevance for persons at risk or on treatment for lung cancer.

Electronic cigarettes and e-cigarette/vaping product use associated lung injury (EVALI)

Electronic cigarettes (e-cigarettes) are noncombustible tobacco products that have been promoted as safer alternatives to conventional cigarettes and beneficial tools for smoking cessation. However, e-cigarettes have been shown to produce aerosols with high concentrations of propylene glycol, glycerol, volatile organic compounds, and free radicals, which can lead to lung damage. Furthermore, e-cigarettes can deliver nicotine at concentrations higher than traditional combustibles, making them highly addictive. As delivery devices became smaller, less expensive, and refillable, the use of e-cigarettes dramatically increased, especially among adolescents and young adults in the United States. This rise in popularity of noncombustible products led to an outbreak of e-cigarette or vaping product use-associated lung injury (EVALI) in the fall of 2019. In this article, we review the history of e-cigarettes and its prevalence among American youth, the EVALI outbreak and clinical presentation of EVALI patients, and recent legislative efforts to regulate e-cigarette use.

Reducing tobacco use among women of childbearing age: Contributions of tobacco regulatory science and tobacco control

Tobacco use has unique, adverse health consequences for reproductive-aged women, particularly should these women become pregnant. Thus, successful efforts to reduce tobacco use among this population have strong potential to improve public health and reduce health disparities. The present review examines contributions to reducing tobacco use among women of childbearing age spanning the domains of tobacco regulatory science and tobacco control from the passage of the Family Smoking Prevention and Tobacco Control Act in 2009 through September 2019. In the domain of tobacco regulatory science, such efforts include research conducted by various National Institutes of Health/Food and Drug Administration (FDA)-supported Tobacco Centers of Regulatory Science, epidemiological surveillance studies, as well as studies examining the potential impact of tobacco regulatory policies currently under consideration by the FDA (e.g., reduced nicotine content cigarettes, health warning labels). Tobacco control efforts within this same 10-year timeframe include developments in pharmacological and psychosocial approaches to promoting tobacco cessation, mHealth interventions, and tobacco control policy. Emerging issues pertinent to ongoing efforts to reduce tobacco use within the domains of both tobacco regulatory science and tobacco control are also reviewed, including e-cigarettes, comorbid health conditions, course of tobacco and other drugs of abuse, and obstacles to the dissemination and implementation of evidence-based treatment and policy. Although the past decade has seen numerous important contributions to reducing tobacco use among reproductive-aged women within both domains, existing obstacles must be surmounted to continue reducing tobacco use and protecting health among this population. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

E-cigarettes and respiratory health: the latest evidence

The E-cigarette market continues to expand at an alarming rate with thousands of flavours available for purchase and continuously evolving devices. Now that it is a multi-billion dollar industry and one without stringent regulation, there is rising concern over the safety of vaping products. Since June 2019, over 2800 cases of E-cigarette-associated acute lung toxicity have been reported in the USA, over 60 of which resulted in death. Many argue that E-cigarettes offer a safer alternative to smoking, but we are evidently far from fully understanding the potential hazards that they pose to respiratory health. Although the risk of an outbreak in the UK has been considered low due to tighter E-cigarette regulations, we cannot fully eliminate the possibility of similar events occurring in the future. With evidence frequently emerging of the harmful effects of E-cigarettes to pulmonary health, there is an urgent need to define the long-term implications of vaping. Studies show that E-cigarette exposure can disrupt pulmonary homeostasis, with reports of gas exchange disturbance, reduced lung function, increased airway inflammation and oxidative stress, downregulation of immunity, and increased risk of respiratory infection. In this review, the latest research on the effect of E-cigarette use on respiratory health will be presented.

Knowledge and attitudes of adolescents to e-cigarettes: an international prospective study

Purpose The aim of the study was to assess the familiarity of adolescents with e-cigarettes. We performed a survey to investigate the frequency of their contact with e-cigarettes, beliefs about this sort of smoking (vaping), and their real knowledge of its effects. Methods The survey was carried out among 1600 high school students in the USA, Israel, Ukraine and Australia. The questionnaire comprised three parts, each with five questions. The first part was designed to assess the frequency of contact with the phenomenon. The second part assessed misconceptions and opinions concerning vaping. The third part questioned the participants' real knowledge of the subject. Results Out of a maximum score of 5, the average score of 4.25 for Part 1 indicated that the participants had frequent contact with e-cigarettes. The score of 3.65 for Part 2 showed that adolescents have both right and wrong beliefs on the subject. Part 3 was completed by 1224 participants (76.5%) while 376 (23.5%) reported a lack of any specific knowledge about vaping. The average score of 3.33 demonstrated that adolescents who completed Part 3 of the survey have incomplete knowledge about e-cigarettes. For the whole cohort of 1600 participants, the average score was 2.80. No significant sex differences were detected. The Ukranian participants had poor knowledge about the dangers of vaping in comparison with the participants in the USA and Australia (p = 0.03). Conclusion While the contact of adolescents with e-cigarettes users is extensive, their actual knowledge remains inadequate. Various school-based smoking risk campaigns face a necessity for further adjustments and improvements.

Welsh Primary Schoolchildren's Perceptions of Electronic Cigarettes: A Mixed Methods Study

There are concerns that the growing popularity of e-cigarettes promotes experimentation among children. Given the influence of the early years on attitude and habit formation, better understanding of how younger children perceive vaping before experimentation begins is needed, to prevent uptake and inform tobacco control strategies. We explored Welsh primary schoolchildren’s (aged 7–11) awareness of e-cigarettes relative to tobacco smoking, their understanding of the perceived risks and benefits and their intentions and beliefs about vaping. Data was collected using a mix of methods in June and July 2017 from 8 purposively selected primary schools across Wales. Four hundred and ninety-five children (52% female) aged 7 years (n = 165), 9 years (n = 185) and 11 years (n = 145) completed a class-administered booklet encompassing a draw and write exercise and survey. Ninety-six children participated in 24 peer discussion groups comprised of 2 boys and 2 girls from each year group. Data were analysed independently and findings triangulated. Survey analyses used frequencies, descriptive statistics and chi-squared tests. Content analysis was undertaken on the draw and write data and peer discussion groups were analysed thematically. Study findings highlight that primary schoolchildren have general awareness of e-cigarettes. Vaping was perceived to be healthier than smoking and there was some recognition that e-cigarettes were used for smoking cessation. Understanding of any health harms was limited. Few children intended to smoke or vape in the future but almost half thought it was okay for grownups. Children’s perceptions were influenced by exposure through family and friends. Findings suggest a need for e-cigarette education in primary schools, to highlight the associated risks of e-cigarette experimentation including the potential for tobacco initiation.

Associations Between Risk Perceptions and Cigarette, E-cigarette, and Dual-Product Use Among Canadian Adolescents

Introduction:

The popularity of e-cigarettes has increased significantly in recent years. E-cigarettes are perceived as less harmful than cigarettes, and both dual-use of cigarette and e-cigarette use is common among adolescents. This study assessed cigarette and e-cigarette risk perception and associations with dual-product use among Canadian adolescents.

Methods:

We used data from the 2016-2017 Canadian Student Tobacco, Alcohol, and Drugs Survey. Perceived risks of cigarette and e-cigarette use were classified into 4 categories: “high-risk perception,” “high-e-cigarette-risk and low-cigarette-risk perception,” “low-e-cigarette-risk and high-cigarette-risk perception,” and “low-risk perception.” Adjusted odds ratios (aOR) were estimated from multinomial logistic regression.

Results:

Of the population, 92% perceived high risk from cigarettes, and 65% from e-cigarettes. Compared to students with low-risk perception, those with high-risk perception of both products had lower odds of dual-use (aOR: 0.21; 95% confidence interval [CI]: 0.15, 0.28), cigarette-only use (aOR: 0.33; 95% CI: 0.25, 0.45), and e-cigarette-only use (aOR: 0.64; 95% CI: 0.51, 0.79) relative to nonusers. Adolescents with high-e-cigarette and low-cigarette-risk perception had higher odds of e-cigarette-only use, relative to nonusers. Those with high-risk perception were more likely to be e-cigarette-only users relative to cigarette-only users.

Conclusion:

Results highlight that high perceived risk is associated with lower odds of use. However, those with a high-risk perception of both products had higher odds of e-cigarette use relative to cigarette-only users; as did those with high-e-cigarette and low-cigarette-risk perception, relative to nonusers. Future research should assess ways of communicating the risks of adolescent tobacco use.

Impact of electronic nicotine delivery systems and other respondent characteristics on tobacco use transitions among a U.S. national sample of women of reproductive age

BACKGROUND

Identifying predictors of tobacco use patterns that differ in harm among reproductive-aged women may inform efforts to protect women and children against adverse health impacts of tobacco use.

METHODS

Changes in tobacco use patterns were examined among women (18-49 years) who completed Wave 1 (W1) and Wave 2 (W2), or W2 and Wave 3 (W3) of the U.S. Population Assessment of Tobacco and Health (PATH, 2013-2016) study, and were using cigarettes, filtered cigars and/or cigarillos in the first wave over which data were included for that respondent (Time 1; T1). We examined the proportion of respondents whose tobacco use transitions from T1 to Time 2 (T2) were harm-maintaining (continued using combusted tobacco), harm-reducing (transitioned to electronic nicotine delivery systems (ENDS), or harm-eliminating (quit tobacco). Multinomial logistic regressions (with harm-maintaining as the baseline category) were conducted to examine associations between ENDS use, demographic, and psychosocial characteristics with each transition.

RESULTS

A majority of women (83 %) exhibited harm-maintaining transitions, followed by harm-eliminating (14.7 %) and harm-reducing (2.3 %) transitions. Use of ENDS at T1 was associated with increased odds of harm reduction and decreased odds of harm elimination. Younger women were more likely to make both harm-reducing and harm-eliminating transitions. Increased educational attainment, identifying as Black or Hispanic, increased psychiatric symptoms, and pregnancy were associated with harm elimination, whereas living at or above poverty was associated with harm reduction.

CONCLUSIONS

Study results contribute new information on the impact of ENDS, sociodemographic characteristics, psychiatric symptoms, and pregnancy on tobacco use transitions among reproductive-aged women.

A Summary of In Vitro and In Vivo Studies Evaluating the Impact of E-Cigarette Exposure on Living Organisms and the Environment

Worldwide use of electronic cigarettes has been rapidly expanding over recent years, but the long-term effect of e-cigarette vapor exposure on human health and environment is not well established; however, its mechanism of action entails the production of reactive oxygen species and trace metals, and the exacerbation of inflammation, which are associated with potential cytotoxicity and genotoxicity. The present study examines the effects of selected liquid chemicals used in e-cigarettes, such as propylene glycol/vegetable glycerin, nicotine and flavorings, on living organisms; the data collected indicates that exposure to e-cigarette liquid has potentially detrimental effects on cells in vitro, and on animals and humans in vivo. While e-liquid exposure can adversely influence the physiology of living organisms, vaping is recommended as an alternative for tobacco smoking. The study also compares the impact of e-cigarette liquid exposure and traditional cigarette smoke on organisms and the environmental impact. The environmental influence of e-cigarette use is closely connected with the emission of airborne particulate matter, suggesting the possibility of passive smoking. The obtained data provides an insight into the impact of nicotine delivery systems on living organisms and the environment.

Flavor Preference and Systemic Immunoglobulin Responses in E-Cigarette Users and Waterpipe and Tobacco Smokers: A Pilot Study

Electronic cigarette (e-cigarette) use has had an exponential increase in popularity since the product was released to the public. Currently, there is a lack of human studies that assess different biomarker levels. This pilot study attempts to link e-cigarette and other tobacco product usage with clinical respiratory symptoms and immunoglobulin response. Subjects completed surveys in order to collect self-reported data on tobacco product flavor preferences. Along with this, plasma samples were collected to test for immunoglobulin G (IgG) and E (IgE) levels. Our pilot study’s cohort had a 47.9% flavor preference towards fruit flavors and a 63.1% preference to more sweet flavors. E-cigarette and traditional cigarette smokers were the two subject groups to report the most clinical symptoms. E-cigarette users also had a significant increase in plasma IgE levels compared to non-tobacco users 1, and dual users had a significant increase in plasma IgG compared to non-tobacco users 2, cigarette smokers, and waterpipe smokers. Our pilot study showed that users have a preference toward fruit and more sweet flavors and that e-cigarette and dual use resulted in an augmented systemic immune response.

E-Cigarettes: Harmful or Harm-Reducing? Evaluation of a Novel Online CME Program for Health Care Providers

AIM

Patients are asking health care providers about e-cigarettes, vaping, and other electronic nicotine delivery systems (ENDS). Provider advice on ENDS has varied greatly, suggesting a need for evidence-based continuing medical education (CME).

SETTING

A novel free online CME course was developed on ENDS risks and benefits, product types (e.g., vape pens, pods), and screening and counseling best practices for adults, adolescents, and different smoker profiles (e.g., daily, social).

PARTICIPANTS

From January 2017 through June 2018, 1061 individuals accessed the course: 46% physicians, 7% physician assistants, 7% nurse practitioners, 15% nurses, 4% pharmacists, and 28% allied health/student/other; 41% were international.

PROGRAM DESCRIPTION

The course was built from observed online patient-provider interactions. Through video role-plays, expert interviews, and interactive activities, the course engaged learners in the evidence on ENDS. Completers earned 1.5 CME units.

PROGRAM EVALUATION

A total of 555 health care providers earned 832.5 CME units. Pre- to post-test scores significantly increased from 57 to 90%; 76% rated the course as above average (41%) or outstanding (35%); 99% indicated the course was free of commercial bias.

DISCUSSION

Addressing the growing need for balanced provider education on ENDS, this interactive online CME engaged learners and increased knowledge on devices and evidence-based cessation approaches.

Changing patterns in E-cigarette use among Minnesota adults between 2014 and 2018

Minnesota has observed declining combustible tobacco use and a large increase in e-cigarette use among youth and young adults. Less is known about adult e-cigarette users' frequency of use, smoking status, use of flavors, and demographic differences. The Minnesota Adult Tobacco Survey (MATS) is a cross-sectional, random digit-dial telephone survey representative of Minnesotans aged 18 and over. MATS measured e-cigarette use in 2014 (N = 9304) and 2018 (N = 6065). In 2018, 6.0% of adult Minnesotans used an e-cigarette in the past 30 days; this was unchanged from 2014 (5.9%). While past 30-day e-cigarette use declined for current smokers (2014: 27.3%; 2018: 16.1% p < 0.001), it increased for never smokers (2014: 1.2%; 2018: 4.4% p < 0.001) and 18-24-year-olds (2014: 12.8%; 2018: 21.9% p = 0.001). Daily e-cigarette use increased from 2014 to 2018 for current smokers (p = 0.001), 25-44-year-olds (p < 0.001), females (p = 0.001), and those with a high-school education (p = 0.006). Among e-cigarette users in 2018, use of flavored e-cigarettes was associated with smoking status (p = 0.041), age (p < 0.001), and using e-cigarettes to quit smoking (p = 0.011). E-cigarettes appeal primarily to younger adults. Of concern are increases in never smokers initiating e-cigarette use, increasing their exposure to nicotine, addiction, and the risk of future combustible tobacco use. Simultaneously, fewer smokers are using e-cigarettes but those who do are using them more frequently. Use of flavored e-cigarettes was common and correlated with interest in quitting combustible cigarettes. These findings can inform recent calls for additional tobacco control policy and programs aimed at reducing e-cigarette use.

Pilot study to inform young adults about the risks of electronic cigarettes through text messaging

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Text messaging is a potentially powerful tool for informing the public about risks.

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After 16 texts, the perceived risk of using e-cigarettes was significantly increased.

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Tobacco risk communication via texts could help guide healthful choices.

Introduction

Young adults are rapidly adopting electronic cigarette (e-cigarette) use. The popularity of e-cigarettes among young people can be attributed to heavy industry advertising and misleading health claims. Data indicate that young e-cigarette users who have never used conventional cigarettes may transition toward smoking combustible cigarettes. Communicating e-cigarette risks via text messaging is limited. This pilot study assessed the impact of exposure to 16 text messages on e-cigarette knowledge and risk perception. The short text messages delivered to participants conveyed e-cigarette use may lead to addiction to nicotine and explained the latest health-related findings.

Methods

A two-group randomized pretest and posttest study was conducted among 95 racially, ethnically diverse young adults recruited from vocational training programs. Fifty percent of participants were randomized to receive either gain- or loss-framed messages. Knowledge and risk perceptions about e-cigarettes and tobacco use were assessed pre- and post-message exposure.

Results

Participants had a mean age of 20.8 years, SD = 1.7. Current use of e-cigarettes was reported by 10.5% (10/95) and 27.4% (26/95) used a variety of other tobacco products. Findings revealed significant increases in knowledge about e-cigarettes after exposure to the messages (range for ps: p < 04 to p < 0.0001). A statistically significant increase in perceived e-cigarette risk was found post-exposure (p = 0.002). Participants randomized to gain-framed messages reported a significantly higher perceived risk of using e-cigarettes post-exposure than did those who received loss-framed messages (p = 0.02).

Conclusions

This was a small-scale pilot requiring additional evidence to support the effectiveness of text messaging for increasing e-cigarette knowledge and risk perception. Future research may apply text messages to test new ways to educate young populations about tobacco use and consider addressing these messages to specific subgroups at high risk of use such as non-college bound young adults.

Beliefs, Attitudes, and Confidence to Deliver Electronic Cigarette Counseling among 1023 Chinese Physicians in 2018

Background: The use of electronic cigarettes (e-cigarettes) is gaining popularity, so it is important to evaluate physicians’ understanding of e-cigarettes. This study assessed the beliefs, attitudes, and confidence in e-cigarette counseling among Chinese physicians and explored the factors related to asking patients about e-cigarette use. Methods: Physicians from across China were invited to participate in a questionnaire survey using the platform provided by DXY (www.dxy.cn) in 2018. In total, 1023 physicians completed the online survey. Descriptive analyses were used to characterize the participants, and multivariate logistic regression analyses were applied to identify predictors of physicians’ asking about patients’ e-cigarette use. Results: Only 46.3% of respondents agreed that e-cigarettes had adverse health effects, and 66.8% indicated that e-cigarettes can be regarded as a type of smoking cessation treatment. We found that 61.3% thought it was important to discuss e-cigarettes with patients, and 71.7% reported feeling confident about their ability in counseling about e-cigarettes. Respondents who had used e-cigarettes (OR = 2.05; 95% CI: 1.16–2.63), had received training about e-cigarettes (OR = 3.13; 95% CI: 2.17–4.52), or were confident about their ability to answer patients’ question about e-cigarettes (OR = 2.45; 95% CI: 1.65–3.65) were more likely to ask patients about e-cigarette use. Physicians who showed a supportive attitude toward using e-cigarettes to quit smoking (OR = 0.79; 95% CI: 0.63–0.99) were less likely to ask about patients’ e-cigarettes use frequently. Conclusions: Chinese physicians appeared to ignore the adverse health effects of e-cigarettes, and considered e-cigarettes as a smoking cessation treatment. Comprehensive training and regulations are needed to help physicians incorporate the screening of e-cigarette use into routine practice and provide patients truthful information as new data emerge.

Knowledge and Beliefs of E-Cigarettes Among Physicians in Poland

BACKGROUND Electronic nicotine delivery systems, including electronic cigarettes (e-cigarettes) are gaining popularity. The objectives of this study were to assess the knowledge and beliefs about e-cigarettes among physicians in Poland. MATERIAL AND METHODS A questionnaire-based survey was conducted among physicians attending mandatory courses delivered at the School of Public Health, Centre of Postgraduate Medical Education (Warsaw, Poland). The questionnaire included 24 questions concerning beliefs and attitudes about e-cigarettes. RESULTS Data were obtained from 412 physicians (64.3% females; aged 31.9±5.7 years) with a response rate of 82.4%. Among participants, 99.8% were aware of e-cigarettes. The main sources of information about e-cigarettes were: news stories (67.2%) or points of sale of e-cigarettes (67.6%). Approximately half of respondents (50.2%) declared moderate knowledge about e-cigarettes, and over three-quarters (78.1%) declared willingness to learn more about e-cigarettes. The majority (96.5%) of participants agreed with the statement that e-cigarette use is harmful to the user's health, and most (80.5%) agreed that exhaled e-cigarette aerosol is harmful to bystanders. The statement that e-cigarettes could be "gateway" to conventional smoking was supported by 87% of participants. Only 11.5% of physicians agreed that e-cigarettes should be recommended as a smoking cessation method. CONCLUSIONS Physicians in Poland perceive e-cigarettes as harmful and addictive. Physicians' knowledge about e-cigarettes is mostly based on non-scientific sources, which points out the urgent need to develop national smoking cessation guidelines regulating the issue of e-cigarettes based on scientific evidence.

A cross sectional survey of smoking characteristics and quitting behaviour from a sample of homeless adults in Great Britain

BACKGROUND

Smoking is a key contributor to health and social inequalities and homeless smoking prevalence rates are 4 times higher than the general population. Research on homelessness and smoking to date has been concentrated predominantly in the US and Australia. This study aimed to describe smoking and quitting behaviour in homeless adult smokers in Great Britain. Data on perceptions of, and willingness to try, e-cigarettes were also gathered.

METHODS

Cross sectional survey of 283 adult smokers accessing homeless support services in Kent, the Midlands, London and Edinburgh. Participants answered a four-part survey: i) demographics; ii) current smoking behaviour and dependence (including the Fagerström Test of Cigarette Dependence [FTCD]); iii) previous quit attempts; and iv) e-cigarettes perceptions.

RESULTS

High levels of cigarette dependence were observed (FTCD: M = 7.78, sd ± 0.98). Although desire to quit was high, most had made fewer than 5 quit attempts and 90% of these lasted less than 24 h. 91.5% reported that others around them also smoked. Previous quit methods used included cold turkey (29.7%), NRT (24.7%), varenicline (22.3%) and bupropion (14.5%). 34% were willing or able to spend £20 or more for an e-cigarette and 82% had tried one in the past although 54% reported that they preferred smoking.

CONCLUSION

We observed high nicotine dependence, few long-term quit attempts, strong desire to quit and amenability to both traditional cessation methods and e-cigarettes. Community embedded and non-routine approaches to cessation may be promising avenues promoting engagement with the homeless community. Likely barriers to uptake include low affordability, preference for cigarettes and high numbers of smoking acquaintances.

Electronic cigarettes and cardiovascular health: what do we know so far?

While tobacco cigarette (TC) smoking has continued to drop to all-time lows, the use of electronic cigarettes (ECs), introduced in the US in 2007, has been rising dramatically, especially among youth. In EC emissions, nicotine is the major biologically active element, while levels of carcinogens and harmful combustion products that typify TC smoke are very low or even undetectable. TCs cause cardiovascular harm by activation of inflammatory pathways and oxidative damage, leading to atherogenesis and thrombosis, as well as through sympathetic activation triggering ischemia and arrhythmia. While ECs are generally believed to be safer than TCs, there remain many uncertainties regarding the overall cardiovascular health effects of EC usage. In this review, we discuss the various components of EC smoke and review the potential mechanisms of cardiovascular injury caused by EC use. We also discuss the controversy regarding the increasing epidemic of youth EC use weighed against the use of ECs as a smoking-cessation aid.

In times of tobacco-free nicotine consumption: The influence of nicotine on vascular calcification

BACKGROUND

Smoking remains the most important avoidable cause of global mortality. Even though the number of cigarette smokers declines in first world countries, the uses of alternative nicotine delivery products increase and may even surpass the sells of cigarettes. In this light, the explicit role of nicotine in the development of cardiovascular diseases should be elucidated.

OBJECTIVES

This narrative review attempts to connect current literature about possible effects of nicotine on the environment of the vasculature to the pathogenesis of vascular calcification, focusing on the tunica media of the vessel wall.

METHODS

For this review, papers found on Pubmed and Medline until December 2018 by searching for the keywords nicotine, vascular calcification, oxidative stress, osteoblastic transdifferentiation and matrix degradation were considered.

RESULTS

Nicotine creates an environment that probably facilitates and maybe even induces osteogenic transdifferentiation of VSMC by inflammation, endothelial dysfunction and reactive oxygen species. This process is believed to be a key event in calcification of the tunica media of the vessel wall. Furthermore, nicotine could lead to the formation of nucleation sites for hydroxyapatite by facilitating matrix vesicles and extracellular matrix degradation.

CONCLUSIONS

There is a growing body of evidence implicating that nicotine alone could impair vascular function and lead to vascular calcification. Further research is necessary to elucidate the explicit influence of nicotine on arteriosclerosis.

Parental Dual Use of e-Cigarettes and Traditional Cigarettes

BACKGROUND

E-cigarettes are growing in popularity. Dual use of e-cigarettes and cigarettes is an increasingly common practice, but little is known about patterns of dual use in parents. We sought to describe smoking-related behaviors among dual-users.

METHODS

Parent exit surveys were conducted following their child's visit in 5 control pediatric practices in 5 states participating in the Clinical Effort Against Secondhand Smoke Exposure trial. We examined factors associated with dual use of e-cigarettes and cigarettes versus cigarette-only smokers, assessed by self-report.

RESULTS

Of 1382 smokers or recent quitters screened after their child's visit between April and October 2017, 943 (68%) completed the survey. Of these, 727 parents reported current use of cigarettes; of those, 81 (11.1%) also reported e-cigarette use, meeting the definition of dual use. Compared with cigarette-only smokers, dual users were more likely to have a child younger than 1 year old, planned to quit in the next 6 months, and had tried to quit in the past (had a quit attempt in the past 3 months, called the quitline, or used medicine to quit in the past 2 years; P < .05 for each).

CONCLUSIONS

Parents who use both e-cigarettes and cigarettes may have greater rates of contemplating smoking cessation than parents who only smoke cigarettes. These parents may be using e-cigarettes for harm reduction or as a step toward cessation. Identification of these parents may provide an opportunity to deliver effective treatment, including nicotine-replacement therapies that do not expose infants and children to e-cigarette aerosol.

Electronic Cigarette Use in US Adults at Risk for or with COPD: Analysis from Two Observational Cohorts

BACKGROUND

Electronic cigarettes (e-cigarettes) are battery-operated nicotine-delivery devices used by some smokers as a cessation tool as well as by never smokers.

OBJECTIVE

To determine the usage of e-cigarettes in older adults at risk for or with chronic obstructive pulmonary disease (COPD).

DESIGN

Prospective cohorts.

PARTICIPANTS

COPDGene (N = 3536) and SPIROMICS (N = 1060) subjects who were current or former smokers aged 45-80.

MAIN MEASURES

Participants were surveyed to determine whether e-cigarette use was associated with longitudinal changes in COPD progression or smoking habits.

KEY RESULTS

From 2010 to 2016, participants who had ever used e-cigarettes steadily increased to 12-16%, but from 2014 to 2016 current use was stable at ~5%. E-cigarette use in African-Americans (AA) and whites was similar; however, AA were 1.8-2.9 times as likely to use menthol-flavored e-cigarettes. Current e-cigarette and conventional cigarette users had higher nicotine dependence and consumed more nicotine than those who smoked only conventional cigarettes. E-cigarette users had a heavier conventional cigarette smoking history and worse respiratory health, were less likely to reduce or quit conventional cigarette smoking, had higher nicotine dependence, and were more likely to report chronic bronchitis and exacerbations. Ever e-cigarette users had more rapid decline in lung function, but this trend did not persist after adjustment for persistent conventional cigarette smoking.

CONCLUSIONS

E-cigarette use, which is common in adults with or at risk for COPD, was associated with worse pulmonary-related health outcomes, but not with cessation of smoking conventional cigarettes. Although this was an observational study, we find no evidence supporting the use of e-cigarettes as a harm reduction strategy among current smokers with or at risk for COPD.