Knowledge about Chemicals in e-Cigarette Secondhand Vapor and Perceived Harms of Exposure among a National Sample of U.S. Adults

Electronic Cigarette Usage Patterns and Perceptions in Adult Australians

Despite their increasing popularity, and Australia's unique regulatory environment, how and why Australian adults use e-cigarettes and their perceptions of their safety, efficacy and regulation have not been extensively reported before. In this study, we screened 2217 adult Australians with the aim of assessing these questions in a sample of current or former e-cigarette users. A total of 505 out of 2217 respondents were current or former e-cigarette users, with only these respondents completing the full survey. Key findings of this survey included the high proportion of respondents who indicated they were currently using e-cigarettes (307 out of 2217 = 13.8%), and the high proportion of current e-cigarette users that were also smokers (74.6%). The majority of respondents used e-liquids containing nicotine (70.3%), despite it being illegal in Australia without a prescription, and the majority bought their devices and liquids in Australia (65.7%). Respondents reported using e-cigarettes in a variety of places, including inside the home, inside public places (where it is illegal to smoke tobacco cigarettes), and around other people-which has implications for second and third hand exposures. A significant proportion of current e-cigarette users (30.6%) thought that e-cigarettes were completely safe to use long-term, although in general, there was a large amount of uncertainty/ambivalence with respect to perceptions of e-cigarette safety and efficacy as smoking cessation tools. This study shows that e-cigarette use is common in Australia, and that appropriate dissemination of unbiased research findings on their safety and efficacy in smoking cessation is urgently required.

Mobile Text Messaging for Tobacco Risk Communication Among Young Adult Community College Students: Randomized Trial of Project Debunk

BACKGROUND

The use of new and emerging tobacco products (NETPs) and conventional tobacco products (CTPs) has been linked to several alarming medical conditions among young adults (YAs). Considering that 96% of YAs own mobile phones, SMS text messaging may be an effective strategy for tobacco risk communication.

OBJECTIVE

Project Debunk is a community-based randomized trial aiming to identify specific types of messages that effectively improve perceived NETP and CTP risk among YAs in community colleges.

METHODS

With YAs recruited offline from 3 campuses at the Houston Community College (September 2016 to July 2017), we conducted a 6-month randomized trial with 8 arms based on the combination of 3 message categories: framing (gain-framed vs loss-framed), depth (simple vs complex), and appeal (emotional vs rational). Participants received fully automated web-based SMS text messages in two 30-day campaigns (2 messages per day). We conducted repeated-measures mixed-effect models stratified by message type received, predicting perceived CTP and NETP risks. Owing to multiple testing with 7 models, an association was deemed significant for P<.007 (.05 divided by 7).

RESULTS

A total of 636 participants completed the baseline survey, were randomized to 1 of 8 conditions (between 73 and 86 participants per condition), and received messages from both campaigns. By the 2-month post campaign 2 assessment point, 70.1% (446/636) completed all outcome measures. By the end of both campaigns, participants had a significant increase in perceived NETP risk over time (P<.001); however, participants had a marginal increase in perceived CTP risk (P=.008). Separately for each group, there was a significant increase in perceived NETP risk among participants who received rational messages (P=.005), those who received emotional messages (P=.006), those who received simple messages (P=.003), and those who received gain-framed messages (P=.003).

CONCLUSIONS

In this trial, YAs had an increase in perceived NETP risk. However, with stratification, we observed a significant increase in perceived NETP risk upon exposure to rational, emotional, simple, and gain-framed messages. In addition, YAs generally had an increase in perceived CTP risk and presented nonsignificant but observable improvement upon exposure to emotional, complex, and loss-framed messages. With the results of this study, researchers and practitioners implementing mobile health programs may take advantage of our tailored messages through larger technology-based programs such as smartphone apps and social media campaigns.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03457480; https://clinicaltrials.gov/ct2/show/NCT03457480.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/10977.

Vaping in the Workplace: Prevalence and Attitudes Among Employed US Adults

Describe workplace vaping, prevalence of observed use, attitudes, and perceptions among US adults.

Electronic Cigarettes: Exposure to Secondhand Vapors at a Long-Term Healthcare Company

INTRODUCTION

Healthcare workers in long term care settings have limited control over their occupational secondhand exposure to electronic cigarettes and other tobacco products.

METHODS

The study aimed to identify the perceived frequency of exposure to exhaled electronic cigarette vapor on healthcare workers within two sites of a long-term healthcare company. An online survey was completed by 149 (out of approximately 500) employees that asked about electronic cigarette personal usage, concerns for exposure, exposure times, and demographic data.

RESULTS

Twelve percent of all survey respondents expressed concerns related to second-hand exposure. Of those exposed, employee estimated exposure time was 2.1 minutes per shift for electronic cigarettes compared to 12.1 minutes per shift for cigarettes/cigars/pipes.

CONCLUSIONS

Overall self-reported secondhand exposure to electronic cigarettes and cigarettes/cigars/pipes was low. To determine a definitive exposure level, quantitative sampling can be done related to chemical exposure via passive inhalation of the smoke and vapor cloud for cigarettes and electronic cigarettes, respectively. Education can be provided to healthcare workers and residents in long-term care facilities regarding risk of exposure to secondhand smoke to alleviate employees concerns with exposure.

Statewide Prevalence of Smoke-Free and Vape-Free Homes, by Tobacco Product Use, Minnesota, 2018

INTRODUCTION

Securing clean indoor air laws is a major tobacco control accomplishment of the past 15 years. The public quickly adopted and supported such policies both in public and private spaces. Clean indoor air is now threatened by the emergence of e-cigarettes. E-cigarette aerosol contains nicotine, heavy metals, and carcinogens, and the long-term effect of secondhand exposure is unknown. Surveillance is necessary to track voluntary rules on smoking and vaping in the home.

METHODS

The Minnesota Adult Tobacco Survey (MATS) is a series of cross-sectional, random-digit-dial telephone surveys on smoking, vaping, and other tobacco-related behaviors, attitudes, and beliefs among Minnesota adults. MATS measured voluntary smoke-free rules in the home in 2014 (N = 9,304) and measured both smoke-free and vape-free home rules in 2018 (N = 6,055).

RESULTS

The prevalence of smoke-free home rules among Minnesota adults in 2018 was 91.5% (95% CI, 90.5%-92.5%), up slightly from 89.3% (95% CI, 88.4%-90.2%) in 2014. In comparison, 84.0% (95% CI, 82.7%-85.3%) reported vape-free home rules. Although 70.0% (95% CI, 66.0%-73.0%) of smokers in 2018 reported smoke-free home rules, only 23.3% (95% CI, 15.0%-31.6%) of e-cigarette users reported vape-free home rules. Living with children younger than 18 years significantly increased the odds of having smoke-free and vape-free home rules.

CONCLUSION

Although widespread adoption of voluntary smoke-free and vape-free home rules demonstrates a positive change in social norms, most e-cigarette users allow vaping in their homes, including those who live with children younger than 18. Tracking voluntary smoke-free and vape-free home rules and efforts to encourage them are important to improve the public's health.

Home smoking and vaping policies among US adults: results from the Population Assessment of Tobacco and Health (PATH) study, wave 3

We examined the prevalence of home smoking and vaping restrictions among US adults, and compared home policy differences for smoking and vaping among vapers, smokers, and dual users. Secondary data from the Population Assessment of Tobacco and Health (PATH) Study Wave 3 (2015-2016) with 28,148 adults were analyzed using weighted multivariable logistic regression models that account for complex sampling design to compare differences in home policies among non-users, vapers only, smokers only, and dual users. Compared to never-users, current vapers who were ex-smokers and dual users were more likely to allow home vaping (aOR = 11.06, 95% CI: 8.04-15.21; aOR = 6.44, 95% CI: 5.01-8.28) and smoking (aOR = 1.62, 95% CI: 1.19-2.22; aOR = 3.58, 95% CI: 2.88-4.45). Current smokers were more likely to allow vaping (aOR = 3.53, 95% CI: 3.06-4.06) and smoking (aOR = 4.27, 95% CI: 3.73-4.89) inside the home than never-users. Current vapers who never smoked were more likely to allow vaping inside the home than never-users (aOR = 2.45, 95% CI: 1.53-3.93). Vapers reported much lower rates of vape-free home policies relative to both their smoke-free home policies and to vape-free home policies among smokers. Vapers may be using e-cigarettes in hopes of harm reduction, but interpreting "harm reduction" as safe, thus exposing non-users in their homes to second- and thirdhand aerosols. This underscores the need to healthcare providers to extend intervention with vapers to include implementing vape-free home policies.

Electronic cigarette survey characteristics

Introduction

Electronic cigarettes (EC) remain a controversial topic with uncertainty about harm reduction in current smokers, their efficacy in smoking cessation, their potential for addiction, the need for regulation, and the type of information needed to educate the public about the benefits and hazards of EC. Multiple medical institutions and organizations have conducted surveys to investigate the demographics and perceptions of EC consumers in adult and youth populations. However, it is unknown whether these surveys use consistent, reliable, or accurate measures for EC use.

Methods

We analyzed 13 survey articles identified during a review of the use of EC during smoking cessation programs to determine the characteristic features of the surveys and to determine how frequently they satisfied the measurement of important core items suggested by recent articles.

Results

Our analysis focused on 13 studies. These studies represented the work of 13 separate research groups and were published in 10 different biomedical journals with a median impact factor score of 4.1. The median number of participants in the studies was 2,624 (Q1-Q3: 662-6,356); the number of participants ranged from 179 to 19,414. The median number of e-cigarette users in the surveys was 840 (Q1-Q3: 256-3,849). All studies provided clear study goals in their introduction. Five surveys used on-line methods to collect information; four studies provided limited information about the reliability of their data. All studies reported study outcomes and considered limitations. Five studies had limited external validity. None of the surveys collected a complete set of core information recommended by recent authorities on survey methodology for EC.

Conclusions

The surveys reviewed in this project had significant variability in study design, survey population, and study goals. Consequently, comparisons across studies become difficult and limit the external validity of survey studies on EC.

It's Just Steam: a qualitative analysis of New Zealand ENDS users' perceptions of secondhand aerosol

Introduction

Many smokers who begin using electronic nicotine delivery systems (ENDS) report vaping in settings where they would not have smoked and believe secondhand aerosol (SHA) is simply steam. However, current understanding of how ENDS users differentiate between secondhand smoke and SHA, or how vaping norms develop, is limited.

Methods

We conducted in-depth, semi-structured interviews with 39 current ENDS users (dual users and former smokers, now exclusive ENDS users) from New Zealand to explore participants’ perceptions of SHA. We probed how these perceptions arose and examined implications for vaping practices and policy. We managed the data using NVivo V.11 and used a thematic analysis approach to interpret the transcripts.

Results

Participants had limited understanding of SHA, its constituents or its possible effects on others. They drew on the absence of harm information, and their sensory experiences and perceptions of others’ views of vaping, to support the conclusion that SHA posed few, if any, risks to bystanders. Yet despite this perception, some felt they should recognise others’ rights to clean air and most would not vape around children to avoid setting an example.

Conclusions

In the absence of trusted information, participants used sensory heuristics to rationalise their ENDS practices. Policy-makers face the challenge of correcting misperceptions about SHA without deterring full transition from smoking to ENDS use. They could consider including vaping in current smoke-free area policies; this measure would signal that SHA is not harmless, and could protect clean-air settings and reduce potential normalisation of vaping among non-smokers.

Early-life exposure to electronic cigarettes: cause for concern

Electronic nicotine delivery systems, or ENDS, are devices that heat and aerosolise a solution of propylene glycol, glycerine, nicotine, and flavourings. They have only achieved widespread use in the past 5 years or so, and therefore evidence around their potential to effect health is scarce. Importantly, they are often viewed as safer than tobacco cigarettes, meaning that at-risk populations, including pregnant women, might be more inclined to use them. No human studies, however, have assessed the potential for maternal ENDS use to effect the health of a developing baby. Experimental research suggests that nicotine alone is likely to adversely affect the fetus. Further, there is a misconception that ENDS do not produce second-hand aerosols. This misconception might put infants and young children at risk because their parents are more likely to use ENDS around them than they are to use tobacco cigarettes. Emerging evidence also proposes that nicotine and other substances produced by ENDS can deposit onto surfaces, and subsequently be exposed to infants and children; a process known as third-hand exposure. Finally, ENDS are often refillable, and instances of accidental poisonings of children who drink nicotine-containing refills have occurred. Thus, there are a multitude of ways that, with respect to early-life exposures and health, ENDS are a cause for concern.

Validation of mobile phone text messages for nicotine and tobacco risk communication among college students: A content analysis

INTRODUCTION

In the United States, young adults have the highest prevalence of tobacco use. The dissemination of mobile phone text messages is a growing strategy for tobacco risk communication among young adults. However, little has been done concerning the design and validation of such text messages. The Texas Tobacco Center of Regulatory Science (Texas-TCORS) has developed a library of messages based on framing (gain- or loss-framed), depth (simple or complex) and appeal (emotional or rational). This study validated the library based on depth and appeal, identified text messages that may need improvement, and explored new themes.

METHODS

The library formed the study sample (N=976 messages). The Linguistic Inquiry and Word Count (LIWC) software of 2015 was used to code for word count, word length and frequency of emotional and cognitive words. Analyses of variance, logistic regression and scatter plots were conducted for validation.

RESULTS

In all, 874 messages agreed with LIWC-coding. Several messages did not agree with LIWC. Ten messages designed to be complex indicated simplicity, while 51 messages designed to be rational exhibited no cognitive words. New relevant themes were identified, such as health (e.g. ‘diagnosis’, ‘cancer’), death (e.g. ‘dead’, ‘lethal’) and social connotations (e.g. ‘parents’, ‘friends’).

CONCLUSIONS

Nicotine and tobacco researchers can safely use, for young adults, messages from the Texas-TCORS library to convey information in the intended style. Future work may expand upon the new themes. Findings will be utilized to develop new campaigns, so that risks of nicotine and tobacco products can be widely disseminated.