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Weinstein D, Jones E, Endrighi R, Hart JL, Walker KL, Borrelli B, Quintiliani LM. "I knew the effects the whole time." Examination of facilitators and barriers to quit vaping among adolescents. Addict Behav 2024; 157:108087. [PMID: 38870591 DOI: 10.1016/j.addbeh.2024.108087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 06/05/2024] [Accepted: 06/07/2024] [Indexed: 06/15/2024]
Abstract
Despite declines in adolescent nicotine vaping during the COVID-19 pandemic, vaping continues to be a public health issue for many adolescents. Most studies on teen reasons for vaping and on barriers and facilitators of vaping were conducted prior to the pandemic. Because teen culture changes so rapidly, and because the pandemic had wide-reaching effects on teens and mental health, it is critical to have a current understanding what helps adolescents to quit vaping (facilitators), as well as what prevents them from quitting (barriers) in order to design effective and engaging interventions. The objective of this qualitative study was to examine reasons for vaping, and barriers and facilitators to quitting vaping among high school age (14-18 years old) students. Students (n = 28; 60.7 % female; 50 % White, 10.7 % Black or African American, 25 % Asian or Asian American, 3.6 % other non-Hispanic; 7.2 % Hispanic; 21.4 % former vapers, 78.6 % current vapers) were recruited online from four regions in the US and participated in one of five online focus groups. We conducted a content analysis of the focus groups using a team-based coding approach. The most frequently cited reasons for vaping were mood, peer influence, and boredom. Results also showed that the stigma of seeking treatment acted as a barrier to quitting vaping, while self-reflection acted as a facilitator. In addition, two factors, peer influence and health effects, served as both barriers and facilitators, depending on the context. Program developers can use this information to design engaging vaping cessation programs intended for adolescents.
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Affiliation(s)
- Daniel Weinstein
- Center for Behavioral Science Research, Boston University Henry M. Goldman School of Dental Medicine, USA
| | - Emily Jones
- Center for Behavioral Science Research, Boston University Henry M. Goldman School of Dental Medicine, USA
| | - Romano Endrighi
- Center for Behavioral Science Research, Boston University Henry M. Goldman School of Dental Medicine, USA
| | - Joy L Hart
- Department of Communication and Christina Lee Brown Envirome Institute, University of Louisville, USA
| | - Kandi L Walker
- Department of Communication and Christina Lee Brown Envirome Institute, University of Louisville, USA
| | - Belinda Borrelli
- Center for Behavioral Science Research, Boston University Henry M. Goldman School of Dental Medicine, USA.
| | - Lisa M Quintiliani
- Section of General Internal Medicine, School of Medicine, Boston University, Boston Medical Center, USA
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East K, Vu G, Sun T, D'Mello K, Perman-Howe PR, Taylor E, Nottage M, Brose LS, Robson D, McNeill A. Harm perceptions across vaping product features: An on-line cross-sectional survey of adults who smoke and/or vape in the United Kingdom. Addiction 2024. [PMID: 38839597 DOI: 10.1111/add.16572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 05/01/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND AND AIMS Vaping products are diverse with a wide variety of features, and popular products change rapidly. This study examined the features and types of vaping products that people who smoke and/or vape perceive contribute to the health harms of vaping. DESIGN, SETTING AND PARTICIPANTS This was a cross-sectional survey co-designed with adults who smoked/vaped and pre-registered. An on-line survey (November 2022) was used of a convenience sample of adults in the United Kingdom who smoked and/or vaped (n = 494). MEASUREMENTS As primary outcomes, respondents were asked to select any of 15 vaping product features they perceived might have any effect on the health harms of vaping (for each: selected, not selected). Independent variables were smoking/vaping status (smoke and vape; vape, formerly smoked; vape, never regularly smoked; smoke, do not currently vape); relative vaping harm perceptions [less harmful than smoking (accurate), equally/more harmful than smoking or do not know/refused (other)]. Binary logistic regressions were used to compare outcomes by current vaping/smoking status and relative harm perceptions, adjusting for age and sex. FINDINGS Most people (54.7%) selected between one and three features. The most frequently selected were nicotine concentration (62.2%) and amount of e-liquid consumed (59.1%), followed by nicotine type (e.g. salt or freebase; 33.0%), source/purchase location (25.3%), flavours (24.7%), temperature to heat e-liquid (21.1%), heat produced by device (20.9%), e-liquid brand (20.9%), amount of emissions (18.6%), device type (e.g. disposable, pod, tank; 17.2%), material of tank (17.0%), power/wattage (13.0%), device brand (8.1%), device size (4.1%) and device weight (2.4%). Higher nicotine concentrations, more e-liquid and salt (versus freebase) nicotine were perceived to confer greater harms. Disposables were perceived as slightly more harmful than reusable devices. There were few differences by current vaping/smoking status and between those with accurate (versus other) harm perceptions of vaping relative to smoking (P > 0.05 for most contrasts, adjusting for age and sex). CONCLUSIONS Certain features and types of vaping products [higher nicotine concentrations, more e-liquid consumed and salt (versus freebase) nicotine] were perceived to confer greater health harms among a sample of UK adults who smoked and/or vaped. Findings are consistent with pervasive misperceptions that nicotine is a major cause of harm, although e-liquid volume is likely to contribute to harms.
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Affiliation(s)
- Katherine East
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Giang Vu
- National Centre for Youth Substance Use Research, University of Queensland, St Lucia, Queensland, Australia
| | - Tianze Sun
- National Centre for Youth Substance Use Research, University of Queensland, St Lucia, Queensland, Australia
| | - Kimberly D'Mello
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Parvati Rose Perman-Howe
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Sheffield Centre for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Eve Taylor
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matilda Nottage
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Leonie Sarah Brose
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Deborah Robson
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ann McNeill
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Le TTH, Le TH, Le MD, Nguyen TT. Exposure to E-Cigarette Advertising and Its Association With E-Cigarette Use Among Youth and Adolescents in Two Largest Cities in Vietnam 2020. Tob Use Insights 2023; 16:1179173X231179676. [PMID: 37255579 PMCID: PMC10226302 DOI: 10.1177/1179173x231179676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/14/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND E-cigarette products have become more popular due to the marketing campaigns on various sources but caused adverse health impacts to users, especially adolescents and youths. This paper aims to describe the situation of exposure to e-cigarette advertisements of youth and adolescents living in two cities of Hanoi and Ho Chi Minh in 2020 and identify the associated factors of e-cigarette marketing with e-cigarettes use in these groups. METHODOLOGY This was a cross-sectional study. The study participants were 1211 youth and adolescents aged 15-24 living in Hanoi and Ho Chi Minh City during the time of data collection (from January 2020 to September 2020). Two primary outcome variables included the ever e-cigarettes use and the intention to use e-cigarettes. Multivariate logistic regression models were used to assess the association between the outcome variables and e-cigarette marketing exposure. RESULTS The proportion of participants who ever use e-cigarettes was 7.4% and a proportion of 4.8% have intention to use e-cigarettes. The most popular source of exposure to e-cigarettes advertisements was social network (Facebook, Twitter, Instagram, Youtube, etc.) and this source had positive association with the odds of e-cigarette smoking among youth and adolescents (OR = 3.38, 95% CI: 1.59-7.14). In addition, referral marketers also contributed to making the participants more likely to smoke e-cigarettes (OR = 2.68, 95% CI: 1.03-6.95). Attractive color and free sample of e-cigarettes were also found to be the motivated factors associated with smoking behaviour among youth and adolescents. CONCLUSIONS New policies should be considered to oppose the impact of youth-oriented e-cigarette advertisements which include regulating and restricting e-cigarette advertisements on social media, as well as through referral marketers.
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Affiliation(s)
| | - Tu Hoang Le
- Hanoi University of Public
Health, Hanoi, Vietnam
| | - Minh Dat Le
- Vietnam Public Health
Association, Hanoi, Vietnam
| | - Tien Thang Nguyen
- Vietnam Public Health
Association, Hanoi, Vietnam
- International Livestock Research
Institute, Hanoi, Vietnam
- Mahidol-Oxford Tropical Medicine
Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Chen H, Chan YL, Thorpe AE, Pollock CA, Saad S, Oliver BG. Inhaled or Ingested, Which Is Worse, E-Vaping or High-Fat Diet? Front Immunol 2022; 13:913044. [PMID: 35784293 PMCID: PMC9240210 DOI: 10.3389/fimmu.2022.913044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/06/2022] [Indexed: 11/13/2022] Open
Abstract
Long term e-cigarette vaping induces inflammation, which is largely nicotine independent. High-fat diet (HFD) consumption is anoter cause of systemic low-grade inflammation. The likelihood of using e-cigarettes as a weight control strategy is concomitant with the increase in obesity. In Australia, only nicotine-free e-fluid is legal for sale. Therefore, this study aimed to investigate how nicotine-free e-cigarette vapour exposure affects inflammatory responses in mice with long term HFD consumption. Mice were fed a HFD for 16 weeks, while in the last 6 weeks, half of the chow and HFD groups were exposed to nicotine-free e-vapour, while the other half to ambient air. Serum, lung, liver and epididymal fat were collected to measure inflammatory markers. While both e-vapour exposure and HFD consumption independently increased serum IFN-γ, CX3CL1, IL-10, CCL20, CCL12, and CCL5 levels, the levels of IFN-γ, CX3CL1, and IL-10 were higher in mice exposed to e-vapour than HFD. The mRNA expression pattern in the epididymal fat mirrors that in the serum, suggesting the circulating inflammatory response to e-vapour is from the fat tissue. Of the upregulated cytokines in serum, none were found to change in the lungs. The anti-inflammatory cytokine IL-10 was increased by combining e-vapour and HFD in the liver. We conclude that short-term nicotine-free e-vapour is more potent than long term HFD consumption in causing systemic inflammation. Future studies will be needed to examine the long-term health impact of nicotine-free e-cigarettes.
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Affiliation(s)
- Hui Chen
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia
| | - Yik Lung Chan
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia
- Respiratory Cellular and Molecular Biology, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Andrew E. Thorpe
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia
| | - Carol A. Pollock
- Kolling Institute of Medical Research, Royal North Shore Hospital, The University of Sydney, Sydney, NSW, Australia
| | - Sonia Saad
- Kolling Institute of Medical Research, Royal North Shore Hospital, The University of Sydney, Sydney, NSW, Australia
| | - Brian G. Oliver
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia
- Respiratory Cellular and Molecular Biology, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- *Correspondence: Brian G. Oliver,
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5
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Notley C, Gentry S, Cox S, Dockrell M, Havill M, Attwood AS, Smith M, Munafò MR. Youth use of e-liquid flavours-a systematic review exploring patterns of use of e-liquid flavours and associations with continued vaping, tobacco smoking uptake or cessation. Addiction 2022; 117:1258-1272. [PMID: 34784651 PMCID: PMC9299186 DOI: 10.1111/add.15723] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 10/01/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS There is concern that young people may be attracted to e-liquid flavours, prompting long-term vaping in naive users and potentially subsequent tobacco smoking. We aimed to review the use of e-liquid flavours by young people and describe associations with uptake or cessation of both regular vaping and tobacco smoking, adverse effects and subjective experiences. DESIGN Systematic review, including interventional, observational and qualitative studies reporting on the use of e-cigarette flavours by young people (aged < 18 years). SETTING Studies published in English language from any country or cultural setting. PARTICIPANTS Young people and their carers (aged < 18 years). MEASUREMENTS A meta-analysis was not possible due to substantial heterogeneity, inconsistency in reporting of flavour categorizations and non-interventional study designs; thus, we narratively report findings. FINDINGS In total, 58 studies were included. The quality of the evidence was extremely low. Most (n = 39) studies were cross-sectional survey designs. In total, 11 longitudinal cohort studies assessed trajectories; eight qualitative studies reported on user experiences. Studies reported views and experiences of a total of 512 874 young people. Both cross-sectional and longitudinal studies suggested that flavours are important for initiation and continuation of vaping. Qualitative evidence shows interest and enjoyment in flavours. There was judged to be insufficient evidence that use of e-liquid flavours specifically is associated with uptake of smoking. No studies found clear associations between flavours and cessation in this population. We found no included reports of adverse effects of flavours. CONCLUSIONS Flavours may be an important motivator for e-cigarette uptake, but the role of flavours in tobacco smoking uptake or cessation is unclear. The quality of the evidence on use of e-cigarette flavours by young people is low overall.
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Affiliation(s)
- Caitlin Notley
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
| | - Sarah Gentry
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
| | - Sharon Cox
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | | | | | - Angela S. Attwood
- School of Psychological ScienceUniversity of BristolBristolUK,MRC Integrative Epidemiology Unit at University of BristolBristolUK
| | - Matthew Smith
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
| | - Marcus R. Munafò
- School of Psychological ScienceUniversity of BristolBristolUK,MRC Integrative Epidemiology Unit at University of BristolBristolUK,NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and School of Psychological ScienceUniversity of BristolBristolUK
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6
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Amin S, Laranjo L, Dunn AG. Social connections influencing e-cigarette use and intentions in Australia: a survey. J Addict Dis 2022; 40:357-365. [PMID: 35049425 DOI: 10.1080/10550887.2021.2003145] [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: 10/19/2022]
Abstract
Social factors play a role in e-cigarette uptake, but Australian evidence is limited. This study evaluated associations between social factors and e-cigarette intention and use. Australian participants surveyed between March 2019 and July 2019 using a cross-sectional survey design, measuring e-cigarette intentions and use, and factors including smoking status and social acceptability. Of 243 respondents, 185 were included in the final analysis, measuring e-cigarette intention and use, and factors including smoking status and social acceptability. Of 185 participants, daily, occasional, and ex-smokers (123 participants) were more likely to have used e-cigarettes (OR = 9.33; 95% CI 4.63-18.80) or intend to use e-cigarettes (OR = 4.86; 95% CI 2.32-10.21), relative to nonsmokers (62 participants). Participants reporting acceptability among people they study or work with (70 participants) were more likely to have used e-cigarettes relative to the reference group (OR = 16.76; 95% CI 3.70-75.83; p = 0.001) and were more likely report intending to use e-cigarettes relative to the reference group (OR = 3.40; 95%CI 1.58-7.30; p = 0.002). With caveats related to the survey participant composition, the results suggest that places of work or study may be an appropriate place to consider interventions aimed at reducing e-cigarette uptake among nonsmokers.
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Affiliation(s)
- Samia Amin
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Liliana Laranjo
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Adam G Dunn
- Discipline of Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Ranjit A, McCutchan G, Brain K, Poole R. "That's the whole thing about vaping, it's custom tasty goodness": a meta-ethnography of young adults' perceptions and experiences of e-cigarette use. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2021; 16:85. [PMID: 34772440 PMCID: PMC8586839 DOI: 10.1186/s13011-021-00416-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 01/04/2023]
Abstract
Background E-cigarettes are increasing in popularity, particularly among young adults. With public health organisations contesting the possible benefits of e-cigarettes, research is required to explore young adults’ use of e-cigarettes as a smoking cessation and recreational tool. This study examined existing qualitative data to understand how transition into adulthood and issues of identity affect young adults’ perceptions and experiences of e-cigarette use. Methods A meta-ethnography was conducted to examine how young adults perceive and use e-cigarettes. Data were synthesised using Noblit and Hare’s (1988) meta-ethnographic approach. Bronfenbrenner’s socio-ecological model (1979) was used to conceptualise themes and map findings. Results A total of 34 studies were included in the review. Young adults viewed e-cigarettes as a safer alternative to traditional cigarette smoking and perceived e-cigarettes as an effective cessation tool. Users were able to personalise their e-cigarette use due to the variety of flavours and devices available. E-cigarettes were found to be a sociable tool as they allowed users to align themselves with their peers who used e-cigarettes and facilitated use within smoke-free environments. Young adults demonstrated high levels of self-efficacy with regards to obtaining e-cigarettes from various retailers and were active consumers of e-cigarette marketing. Conclusion This meta-ethnography provides an in-depth insight into social norms around e-cigarette use and beliefs that e-cigarettes could be a safer alternative to traditional cigarettes. As young adults increasingly engage with e-cigarettes, there is a need for informed policy decisions regarding appropriate use. Engagement with e-cigarettes is often reflected within social media, so this medium could be a key platform for creating tailored interventions which inform young adults about the appropriate use of these products. Supplementary Information The online version contains supplementary material available at 10.1186/s13011-021-00416-4.
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Affiliation(s)
- Ananth Ranjit
- Division of Population Medicine, Cardiff University School of Medicine, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Grace McCutchan
- Division of Population Medicine, Cardiff University School of Medicine, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Katherine Brain
- Division of Population Medicine, Cardiff University School of Medicine, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Ria Poole
- European Centre for Environment & Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall, TR1 3DH, UK.
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Doggett A, Godin KM, Schell O, Wong SL, Jiang Y, Leatherdale ST. Assessing the impact of sports and recreation facility density within school neighbourhoods on Canadian adolescents' substance use behaviours: quasi-experimental evidence from the COMPASS study, 2015-2018. BMJ Open 2021; 11:e046171. [PMID: 34429307 PMCID: PMC8386223 DOI: 10.1136/bmjopen-2020-046171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES There has been relatively little exploration to date of potential protective effects within school neighbourhoods, such as those conferred by facilities that seek to promote health with respect to substance use and related harms. This study examined how the density of sports and recreation facilities in the school neighbourhood is associated with the likelihood of binge drinking, e-cigarette use, cigarette smoking and cannabis use among Canadian secondary school students. DESIGN Longitudinal data from the COMPASS study on Canadian youth health behaviours from 2015/2016 to 2017/2018 was linked with school neighbourhood data capturing the number of sports and recreation facilities within a 1500 m radius of schools. SETTING Secondary schools and school neighbourhoods in Alberta, British Columbia, Ontario and Quebec who participated in the COMPASS study. PARTICIPANTS 16 471 youth who participated in the COMPASS study over three school years (2015/2016-2017/2018). PRIMARY AND SECONDARY OUTCOME MEASURES Binge drinking, e-cigarette use, cigarette use, cannabis use. RESULTS Logistic regression models using generalised estimating equations identified that greater density of sports and recreation facilities within the school neighbourhood was significantly associated with lower likelihood of binge drinking and e-cigarette use but was not associated with cigarette smoking or cannabis use. CONCLUSIONS This research can help to support evidence-informed school community-based efforts to prevent substance-related harms among youth.
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Affiliation(s)
- Amanda Doggett
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Olena Schell
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Suzy L Wong
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Ying Jiang
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Scott T Leatherdale
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Smith H, Lucherini M, Amos A, Hill S. The emerging norms of e-cigarette use among adolescents: A meta-ethnography of qualitative evidence. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 94:103227. [PMID: 33780877 DOI: 10.1016/j.drugpo.2021.103227] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/12/2021] [Accepted: 03/14/2021] [Indexed: 11/22/2022]
Abstract
While qualitative research has indicated that adolescents' motivation for e-cigarette use is different than adults', this body of literature has not yet been brought together and synthesised. We reviewed qualitative evidence on perceptions and uses of e-cigarettes in order to explore the emerging norms of vaping among adolescents. We searched five databases for qualitative research in October 2019 with no restrictions on date of publication or data collection. We identified fifteen papers from thirteen studies. Using a meta-ethnographic approach, we identified a spectrum of descriptive and injunctive norms of vaping across the themes of addiction; perceptions of comparative harm; parental perceptions and peer perceptions. We found addiction and perceptions of comparative harm to reflect descriptive norms, while we found clearer evidence explaining the use and non-use of e-cigarettes through parental and peer approval of vaping. However, these norms were fluid, diverse and sometimes contradictory. This review provides a resource for researchers, policymakers and practitioners to better understand the ways that emerging norms could be influenced through policy and practice.
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Affiliation(s)
- Hannah Smith
- School of Geography, Geology and the Environment, Keele University, Keele, Newcastle ST5 5BG, UK.
| | - Mark Lucherini
- School of Geography, Geology and the Environment, Keele University, Keele, Newcastle ST5 5BG, UK
| | - Amanda Amos
- The Usher Institute, University of Edinburgh, UK
| | - Sarah Hill
- School of Social and Political Science, University of Edinburgh, UK
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10
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Barrett R, Aldamkhi H. An Evaluation of the Knowledge and Perceptions of Pharmacy Staff and Pre-Registration Students of E-Cigarettes Use: A Systematic Review. Tob Use Insights 2021; 14:1179173X211016867. [PMID: 34188579 PMCID: PMC8209790 DOI: 10.1177/1179173x211016867] [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: 11/20/2020] [Accepted: 04/17/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Pharmacy staff are a trusted source of advice on the safe and appropriate use of medicines and devices. Retail pharmacies deliver smoking cessation services and sell e-cigarettes in the UK. This review asks 'what knowledge, experience and ability do staff have to support e-cigarette users to quit smoking'. METHODS A systematic literature search was undertaken drawn on predefined eligibility criteria and a comprehensive search strategy following the PRISMA guideline. Eligible papers reported survey-research published in English from 2015 to 2020. PubMed, Google Scholar, OVID, EMBASE and MEDLINE Databases were searched. No restrictions on study design or language were applied. Two reviewers independently screened for inclusion/exclusion and then extracted the relevant information from the articles for synthesis. RESULTS Of 12 potentially eligible full-text studies, 1 was a duplicate, 7 were excluded as per eligibility criteria. Four papers were finally included in this literature review. Two studies indicated that pharmacy staff are less confident in giving advice on e-cigarette use. Knowledge on the adverse effects of e-cigarettes compared to traditional smoking cessation aids remain unclear. In one study, 42% of community pharmacists did not believe that e-cigarettes could be used for smoking cessation. Three studies identified need for specific regulations and professional support. The overall certainty of the evidence is 'low' or 'very low', with moderate levels of bias. CONCLUSION Pharmacists may be well placed to implement e-cigarette smoking cessation interventions, but most practitioners lacked knowledge and ability to support these customers citing unclear risk of harm. Pharmacists felt secure in recommending traditional cessation tools. Further regulation, guidelines and training is needed. Findings may be less generalizable in countries where e-cigarettes are banned. Their extent of knowledge, experience and ability to support users of e-cigarettes within their community to quit smoking is lacking.
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Affiliation(s)
- Ravina Barrett
- School of Pharmacy and Biomolecular Sciences, Cockcroft Building, University of Brighton, UK
- Visiting Researcher in Pharmacy Practice, School of Pharmacy and Biomedical Sciences, University of Portsmouth, UK
| | - Hajar Aldamkhi
- School of Pharmacy and Biomolecular Sciences, Cockcroft Building, University of Brighton, UK
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11
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Sharma A, McCausland K, Jancey J. Adolescent's Health Perceptions of E-Cigarettes: A Systematic Review. Am J Prev Med 2021; 60:716-725. [PMID: 33775514 DOI: 10.1016/j.amepre.2020.12.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 11/16/2022]
Abstract
CONTEXT E-cigarette use is increasing among adolescents, particularly in high-income countries. This review examines the health perceptions of E-cigarettes among adolescents (aged 12-17 years) residing in the U.S., United Kingdom, Canada, Australia, and New Zealand and their sources of E-cigarette information. EVIDENCE ACQUISITION Peer-reviewed literature published in January 2009-April 2019 in MEDLINE, Embase, and ProQuest were systematically reviewed using identified keywords. The search identified 654 references. Studies (n=99) that met the inclusion criteria were subjected to full-text screening. A total of 27 articles were subjected to quality appraisal using the Joanna Briggs Institute's critical appraisal checklists. EVIDENCE SYNTHESIS A total of 7 qualitative and 18 quantitative studies were included in the review, and the study characteristics, results, and limitations were extracted. A total of 4 main themes emerged from the study findings: (1) perceived relative harm of E-cigarettes versus that of cigarettes, (2) perceived health effects of E-cigarettes, (3) perceived benefits and safety of E-cigarettes, and (4) sources of E-cigarette information and exposure. Most adolescents perceived E-cigarettes to be less harmful than cigarettes; however, often, their health perceptions of E-cigarettes were conflicting. Sources of exposure to E-cigarette information included friends, family, retail point of sale, TV and online advertising, national agencies, healthcare providers, and from direct experience. CONCLUSIONS Findings indicate that adolescents, particularly E-cigarette users, have more favorable perceptions of E-cigarettes than of cigarettes; however, these perceptions are conflicting. Advertising, marketing, and peer and family networks appear to influence adolescents' perceptions. More research is required, particularly in Australia and New Zealand, to better understand adolescents' health perceptions of E-cigarettes and where they source information from so that misperceptions can be addressed through appropriate channels with suitable messaging.
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Affiliation(s)
- Anupriya Sharma
- School of Population Health, Curtin University, Bentley, Australia.
| | - Kahlia McCausland
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley, Australia
| | - Jonine Jancey
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley, Australia
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A review of tobacco abuse and its epidemiological consequences. JOURNAL OF PUBLIC HEALTH-HEIDELBERG 2021; 30:1485-1500. [PMID: 33425659 PMCID: PMC7786188 DOI: 10.1007/s10389-020-01443-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 11/20/2020] [Indexed: 12/12/2022]
Abstract
Aim The economic burden caused by death and disease in the world is credited mainly to tobacco use—currently linked to approximately 8,000,000 deaths per year with approximately 80% of these faralities reported in low and middle income economies. The World Health Organization (WHO) estimates that nearly 7,000,000 deaths are attributed to direct tobacco use, while approximately 1,200,000 non-smokers exposed to second hand cigarette smoke die every year. Accordingly, tobacco use is a major threat to the public health infrastructure; therefore, proper cessation interventions must be put in place to curb tobacco abuse and ease economic and social burdens caused by the tobacco epidemic. Methods A systematic review was conducted to investigate how scientific efforts have been advanced towards harm reduction among smokers and non-smokers. Relevant articles published during the period 2010–2020 in PubMed, Crossref, Google scholar, and Web of Science were used in this study. The articles were selected based on health impacts of cigarette smoking, tobacco cessation and emerging diseases, including Covid−19. Various cessation strategies have been identified although their efficiency is yet to match the desired results. Results A series of carcinogenic chemicals are generated during cigarette smoking resulting in serious health complications such as cancer and mutagenesis. The precursors for tobacco induced diseases are toxic and carcinogenic chemicals of the nitrosamine type, aldehydes, polonium-210 and benzo[a]pyrene, which bio-accumulate in the body system during cigarette smoking to cause disease. Rehabilitation facilities, use of drugs to diminish the desire to smoke, heavy taxation of tobacco products and warning labels on cigarettes are some of the cessation strategies employed towards curbing tobacco abuse. Conclusion The need for further research to develop better methods and research based policies for safe cigarette smoking and workable cessation strategies must be a priority in order to deal with the tobacco epidemic. Campaigns to promote tobacco cessation and abstinence are recommended in this review as a sure measure to mitigate against the deleterious impacts caused by cigarette smoking and tobacco abuse.
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Krüsemann EJZ, van Tiel L, Pennings JLA, Vaessen W, de Graaf K, Talhout R, Boesveldt S. Both Nonsmoking Youth and Smoking Adults Like Sweet and Minty E-liquid Flavors More Than Tobacco Flavor. Chem Senses 2021; 46:bjab009. [PMID: 33687446 PMCID: PMC8130505 DOI: 10.1093/chemse/bjab009] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Smokers may reduce their health risk by switching to electronic cigarette (e-cigarette) use. As e-cigarettes are not harmless, concerns exist about e-cigarette use by nonsmokers and youth. E-liquids are available in many different flavors that increase sensory appeal. Flavor preferences may differ between user groups, which could open doors for product regulation. We investigated which e-liquid flavors are attractive to specific user groups by comparing liking between adolescent nonsmokers (n = 41; mean age 16.9 ± 0.8), young adult nonsmokers (n = 42; mean age 22.7 ± 1.7), and adult smokers (n = 56; mean age 39.7 ± 11.1). Participants smelled tobacco- (n = 6) and nontobacco (n = 24)-flavored e-liquids and rated liking on a 9-point labeled hedonic scale, and familiarity, overall intensity, perceived sweetness, perceived bitterness, and irritation of the odors on a 100-unit Visual Analog Scale. Mean liking ranged from 2.3 (whiskey) to 6.7 (peppermint). Within all groups, the typically sweet and minty flavors (e.g., wine gum, watermelon, peppermint, menthol) were liked significantly more than the tobacco-flavored e-liquids. The set of tobacco-flavored e-liquids was significantly, but slightly, less disliked by adult smokers (3.9 ± 0.2) than adolescent (3.1 ± 0.3) and young adult (3.4 ± 0.3) nonsmokers (P < 0.001). No between-group differences were observed for sweet and minty flavors. Liking correlated significantly positively with odor sweetness (R = 0.49) and familiarity (R = 0.48) and negatively with odor bitterness (R = -0.58), irritation (R = -0.47), and overall intensity (R = -0.27). Thus, sweet- and minty-flavored e-liquids are liked equally by young nonsmokers and adult smokers, and more than tobacco flavors. Banning all flavors except tobacco will likely reduce e-cigarette appeal; potentially more for young nonsmokers than adult smokers.
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Affiliation(s)
- Erna J Z Krüsemann
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, the Netherlands
- Division of Human Nutrition and Health (Bode 62), Wageningen University & Research, P.O. Box 17, 6700 AA Wageningen, the Netherlands
| | - Loes van Tiel
- Essensor BV, Marijkeweg 22a, 6709 PG Wageningen, the Netherlands
| | - Jeroen L A Pennings
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, the Netherlands
| | - Wim Vaessen
- Essensor BV, Marijkeweg 22a, 6709 PG Wageningen, the Netherlands
| | - Kees de Graaf
- Division of Human Nutrition and Health (Bode 62), Wageningen University & Research, P.O. Box 17, 6700 AA Wageningen, the Netherlands
| | - Reinskje Talhout
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, the Netherlands
| | - Sanne Boesveldt
- Division of Human Nutrition and Health (Bode 62), Wageningen University & Research, P.O. Box 17, 6700 AA Wageningen, the Netherlands
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Doggett A, Gohari MR, Godin KM, Ferro MA, Patte KA, Leatherdale ST. Cannabis Use, Screen Time, and Internalizing Symptoms among Canadian Youth: Testing Mediation Pathways. Subst Use Misuse 2021; 56:1232-1240. [PMID: 33975522 DOI: 10.1080/10826084.2021.1922455] [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: 10/21/2022]
Abstract
Background: Existing research suggests positive correlations between screen time sedentary behaviors (STSB) and substance use, including cannabis use, among youth. However, little research has examined what factors mediate these relationships.Methods: This study examined mediating pathways among STSB, internalizing symptoms (IS), and cannabis use in a linked longitudinal sample of 28 269 Canadian youth who participated in the COMPASS study over a two-year period (2017/18 to 2018/19). Structural equation modeling examined two main hypotheses cross-sectionally and over time: 1) if IS mediated associations between STSB and cannabis use frequency, and 2) if STSB mediated associations between IS and cannabis use frequency. Results: Results demonstrated significant partial mediation effects for both hypotheses. For example, indirect effects indicated that IS mediated the association between STSB and cannabis use both cross sectionally (95% CI: 0.021, 0.029) and longitudinally (95% CI: 0.006, 0.010). STSB also mediated associations between IS and cannabis use cross sectionally (95% CI: 0.015, 0.023) and longitudinally (95% CI: 0.010, 0.014). This study demonstrated that the associations between STSB, internalizing symptoms and cannabis use are complex, involving mediation in both directions.Discussion: These findings can be used to inform public health initiatives that aim to take a comprehensive approach to addressing negative health behaviors and outcomes, as it is clear that the multi-directional relationships between STSB and mental health may in-turn impact other health behaviors. Future research should continue to examine mediating factors between STSB and substance use among youth, including exploration of associations with other substances.Supplemental data for this article is available online at https://doi.org/10.1080/10826084.2021.1922455 .
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Affiliation(s)
- Amanda Doggett
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Mahmood R Gohari
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Mark A Ferro
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Karen A Patte
- Faculty of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Scott T Leatherdale
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
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15
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Hewer RMF, Hill S, Amos A, consortium SILNER. Student perceptions of smoke-free school policies in Europe – a critical discourse analysis. CRITICAL PUBLIC HEALTH 2020. [DOI: 10.1080/09581596.2020.1856332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | - Sarah Hill
- Global Health Policy Unit, University of Edinburgh, Edinburgh, UK
| | - Amanda Amos
- Usher Institute, University of Edinburgh, Edinburgh, UK
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16
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Bhatt JM, Ramphul M, Bush A. An update on controversies in e-cigarettes. Paediatr Respir Rev 2020; 36:75-86. [PMID: 33071065 PMCID: PMC7518964 DOI: 10.1016/j.prrv.2020.09.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/17/2020] [Indexed: 12/12/2022]
Abstract
E-cigarettes are electronic nicotine delivery systems (ENDS) which mimic tobacco smoking without the combustion of tobacco. These devices have been misleadingly marketed as "less harmful" alternatives to conventional smoking tobacco products. The e-liquid in e-cigarettes include nicotine, a humectant and other additives including flavourings, colourants, or adulterants such as bacterial and fungal products. In this review, we discuss the contrasting views of the tobacco lobby and most professional societies. We describe the epidemiology of the use of these devices, with a widespread and significant rise in youth e-cigarette use seen in both the USA and Europe. We also describe what is known about the toxicity and mechanisms of EVALI (e-cigarette or vaping associated lung injury). This characterised by respiratory failure with an intense inflammatory response. The presentations are diverse and clinicians should consider vaping as a possible cause of any unusual respiratory illness in patients who have a history of vaping or other use of e-cigarette-related products. Second hand exposure to e-cigarettes is also harmful through respiration and transdermal absorption. E-cigarettes have a worse acute toxicity than tobacco and their long-term toxicity is unknown, and we advocate for the immediate, most vigorous anti-vaping legislation possible.
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Affiliation(s)
- Jayesh Mahendra Bhatt
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, NG7 2UH, United Kingdom.
| | - Manisha Ramphul
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, NG7 2UH, United Kingdom.
| | - Andrew Bush
- Paediatrics and Paediatric Respirology, National Heart and Lung Institute, United Kingdom; Paediatric Chest Physician, Royal Brompton & Harefield NHS Foundation Trust, United Kingdom; Imperial Centre for Paediatrics and Child Health, United Kingdom; Royal Brompton Hospital, Sydney Street, London SW3 6NP, United Kingdom.
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17
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Wang L, Chen J, Ho SY, Leung LT, Wang MP, Lam TH. Exposure to e-cigarette advertising, attitudes, and use susceptibility in adolescents who had never used e-cigarettes or cigarettes. BMC Public Health 2020; 20:1349. [PMID: 32887586 PMCID: PMC7650221 DOI: 10.1186/s12889-020-09422-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 08/23/2020] [Indexed: 12/02/2022] Open
Abstract
Background Tobacco advertisements have been banned in Hong Kong, but low intensity e-cigarette (EC) advertising can still be found in various media outlets. We investigated the associations between exposure to EC advertising and susceptibility to EC use in adolescents who had never used cigarettes or ECs, with potential mediation by attitudes towards ECs and the tobacco industry. Methods The School-based Smoking Survey 2016/17 assessed exposure to EC advertising in the past 30 days, attitudes towards ECs and the tobacco industry, susceptibility to EC use, and other covariates. Generalised linear mixed models and multiple mediation analysis methods were used in data analyses. Results Among 7082 students (mean age 14.9 years), 28.8% reported exposure to EC advertising. Exposure was associated with being uncertain about the harm of EC use, being tolerant towards ECs, believing the tobacco industry is respectable, and being susceptible to EC use; the magnitudes of these associations increased with the number of types of advertising exposed (0, 1, and ≥ 2) (all p-values < 0.01). These attitudinal factors were in turn associated with EC use susceptibility (all p-values < 0.001). The perception that tobacco companies make youth smoke was not associated with the advertising exposure or EC use susceptibility. Of the total effects of EC advertising on use susceptibility, only 16.6% were mediated by attitudinal factors: perceived harm (3.1%), attitudes towards ECs (8.2%), and attitudes towards the tobacco industry (4.9%). Conclusions Even exposure to low intensity EC advertising was associated with susceptibility to EC use in adolescents who had never used cigarettes or ECs. The association was weakly mediated by tolerant attitudes towards ECs and the tobacco industry. The government should reinforce the regulations on EC advertising to protect adolescent health.
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Affiliation(s)
- Lijun Wang
- School of Public Health, University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong, P. R. China
| | - Jianjiu Chen
- School of Public Health, University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong, P. R. China
| | - Sai Yin Ho
- School of Public Health, University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong, P. R. China.
| | - Lok Tung Leung
- School of Public Health, University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong, P. R. China
| | - Man Ping Wang
- School of Nursing, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong, P. R. China
| | - Tai Hing Lam
- School of Public Health, University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong, P. R. China
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18
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Struik LL, Dow-Fleisner S, Belliveau M, Thompson D, Janke R. Tactics for Drawing Youth to Vaping: Content Analysis of Electronic Cigarette Advertisements. J Med Internet Res 2020; 22:e18943. [PMID: 32663163 PMCID: PMC7455879 DOI: 10.2196/18943] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/15/2020] [Accepted: 06/15/2020] [Indexed: 12/13/2022] Open
Abstract
Background The use of electronic cigarettes (e-cigarettes), also known as vaping, has risen exponentially among North American youth in recent years and has become a critical public health concern. The marketing strategies used by e-cigarette companies have been associated with the uptick in use among youth, with video advertisements on television and other electronic platforms being the most pervasive strategy. It is unknown how these advertisements may be tapping into youth needs and preferences. Objective The aim of this 2-phase study was to examine the marketing strategies that underpin e-cigarette advertisements, specifically in the context of television. Methods In phase 1, a scoping review was conducted to identify various influences on e-cigarette uptake among youth. Results of this scoping review informed the development of a coding framework. In phase 2, this framework was used to analyze the content of e-cigarette advertisements as seen on 2 popular television channels (Discovery and AMC). Results In phase 1, a total of 20 articles met the inclusion criteria. The resultant framework consisted of 16 key influences on e-cigarette uptake among youth, which were categorized under 4 headings: personal, relational, environmental, and product-related. In phase 2, 38 e-cigarette advertisements were collected from iSpot.tv and represented 11 popular e-cigarette brands. All of the advertisements tapped into the cited influences of youth e-cigarette uptake, with the most commonly cited influences (product and relational) tapping into the most, at 97% (37/38) and 53% (20/38), respectively. Conclusions The findings highlight the multidimensional influences on youth uptake of e-cigarettes, which has important implications for developing effective antivaping messages, and assist public health professionals in providing more comprehensive prevention and cessation support as it relates to e-cigarette use. The findings also bring forward tangible strategies employed by e-cigarette companies to recruit youth into vaping. Understanding this is vital to the development of cohesive strategies that combat these provaping messages.
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Affiliation(s)
- Laura L Struik
- School of Nursing, Department of Health and Social Development, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Sarah Dow-Fleisner
- School of Social Work, Department of Health and Social Development, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Michelle Belliveau
- School of Social Work, Department of Health and Social Development, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Desiree Thompson
- School of Nursing, Department of Health and Social Development, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Robert Janke
- Library, University of British Columbia Okanagan, Kelowna, BC, Canada
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Green MJ, Gray L, Sweeting H. Youth vaping and smoking and parental vaping: a panel survey. BMC Public Health 2020; 20:1111. [PMID: 32718309 PMCID: PMC7385857 DOI: 10.1186/s12889-020-09228-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 07/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Concerns remain about potential negative impacts of e-cigarettes including possibilities that: youth e-cigarette use (vaping) increases risk of youth smoking; and vaping by parents may have impacts on their children's vaping and smoking behaviour. METHODS With panel data from 3291 youth aged 10-15 years from the 7th wave of the UK Understanding Society Survey (2015-2017), we estimated effects of youth vaping on youth smoking (ever, current and past year initiation), and of parental vaping on youth smoking and vaping, and examined whether the latter differed by parental smoking status. Propensity weighting was used to adjust for measured confounders and estimate average effects of vaping for all youth, and among youth who vaped. E-values were calculated to assess the strength of unmeasured confounding influences needed to negate our estimates. RESULTS Associations between youth vaping and youth smoking were attenuated considerably by adjustment for measured confounders. Estimated average effects of youth vaping on youth smoking were stronger for all youth (e.g. OR for smoking initiation: 32.5; 95% CI: 9.8-107.1) than among youth who vaped (OR: 4.4; 0.6-30.9). Relatively strong unmeasured confounding would be needed to explain these effects. Associations between parental vaping and youth vaping were explained by measured confounders. Estimates indicated effects of parental vaping on youth smoking, especially for youth with ex-smoking parents (e.g. OR for smoking initiation: 11.3; 2.7-46.4) rather than youth with currently smoking parents (OR: 1.0; 0.2-6.4), but these could be explained by relatively weak unmeasured confounding. CONCLUSIONS While measured confounding accounted for much of the associations between youth vaping and youth smoking, indicating support for underlying propensities, our estimates suggested residual effects that could only be explained away by considerable unmeasured confounding or by smoking leading to vaping. Estimated effects of youth vaping on youth smoking were stronger among the general youth population than among the small group of youth who actually vaped. Associations of parental vaping with youth smoking and vaping were either explained by measured confounding or could be relatively easily explained by unmeasured confounding.
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Affiliation(s)
- Michael J Green
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3AX, UK.
| | - Linsay Gray
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3AX, UK
| | - Helen Sweeting
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3AX, UK
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Abstract
Electronic Nicotine Delivery Systems (ENDS) are a new form of tobacco and marijuana administration that obscures the dangers of substance use and can be appealing to adolescents with a multitude of adolescent appeals and the use of electronic technology. As adolescent incidence of ENDS uses increases, health providers stand to lose ground with the past successes of tobacco- and substance-related health promotion as adolescents are initiated with the new technology. These risks identify the need for quality screening or the specific inclusion of ENDS products into our established screening methods. In addition, those who screen positive are provided quality interventions, such as motivational interviewing, that are effective and developmentally appropriate. By increasing our knowledge of ENDS, including them specifically in our regular screenings, and supporting adolescents in positive health choices, successful aversion of lifelong health risks can be overcome.
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Doggett A, Battista K, Leatherdale ST. Modes of cannabis use among Canadian youth in the COMPASS study; using LCA to examine patterns of smoking, vaping, and eating/drinking cannabis. DRUGS-EDUCATION PREVENTION AND POLICY 2020. [DOI: 10.1080/09687637.2020.1769560] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Amanda Doggett
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Kate Battista
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Scott T. Leatherdale
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
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22
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Green MJ, Gray L, Sweeting H, Benzeval M. Socioeconomic patterning of vaping by smoking status among UK adults and youth. BMC Public Health 2020; 20:183. [PMID: 32036787 PMCID: PMC7008571 DOI: 10.1186/s12889-020-8270-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 01/24/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Smoking contributes significantly to socioeconomic health inequalities. Vaping has captured much interest as a less harmful alternative to smoking, but may be harmful relative to non-smoking. Examining inequalities in vaping by smoking status, may offer insights into potential impacts of vaping on socioeconomic inequalities in health. METHODS Data were from 3291 youth (aged 10-15) and 35,367 adults (aged 16+) from wave 7 (2015-17) of the UK Household Longitudinal Study. In order to adjust for biases that could be introduced by stratifying on smoking status, marginal structural models were used to estimate controlled direct effects of an index of socioeconomic disadvantage (incorporating household education, occupation and income) on vaping by smoking status (among adults and youth), adjusting for relevant confounders and for selection into smoking states. We also estimated controlled direct effects of socioeconomic disadvantage on being an ex-smoker by vaping status (among adult ever-smokers; n = 18,128). RESULTS Socioeconomic disadvantage was associated with vaping among never smoking youth (OR for a unit increase in the socioeconomic index: 1.17; 95%: 1.03-1.34), and among ex-smoking adults (OR: 1.17; 95% CI: 1.09-1.26), with little to no association among never smoking (OR: 0.98; 95% CI: 0.91-1.07) and current smoking (OR: 1.00; 95% CI: 0.93-1.07) adults. Socioeconomic disadvantage was also associated with reduced odds of being an ex-smoker among adult ever-smokers, but this association was moderately weaker among those who vaped (OR: 0.88; 95% CI: 0.82-0.95) than those who did not (OR: 0.82; 95% CI: 0.80-0.84; p-value for difference = 0.081). CONCLUSIONS Inequalities in vaping among never smoking youth and adult ex-smokers, suggest potential to widen health inequalities, while weaker inequalities in smoking cessation among adult vapers indicate e-cigarettes could help narrow inequalities. Further research is needed to understand the balance of these opposing potential impacts, and how any benefits can be maximised whilst protecting the vulnerable.
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Affiliation(s)
- Michael J. Green
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3AX UK
| | - Linsay Gray
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3AX UK
| | - Helen Sweeting
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3AX UK
| | - Michaela Benzeval
- Institute for Social and Economic Research, University of Essex, Colchester, CO3 3LG UK
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Amin S, Dunn AG, Laranjo L. Social Influence in the Uptake and Use of Electronic Cigarettes: A Systematic Review. Am J Prev Med 2020; 58:129-141. [PMID: 31761515 DOI: 10.1016/j.amepre.2019.08.023] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/21/2019] [Accepted: 08/22/2019] [Indexed: 12/26/2022]
Abstract
CONTEXT E-cigarettes were introduced to support smoking cessation, but their popularity has increased among nonsmokers, challenging current perspectives on their safety and effectiveness as a public health intervention. The objective of this systematic review was to identify and synthesize current evidence on the influence of social factors on e-cigarette intentions and use. EVIDENCE ACQUISITION MEDLINE, CINAHL, PsycINFO, and Embase were searched for studies of the effects of social factors on e-cigarette intention or use in February 2019. Studies were included if they used experimental, longitudinal, qualitative, or mixed methods designs. Advertising, social interactions, and social norms were considered as social factors; social media was considered a conduit for other social factors. Two reviewers screened all studies; bias risk was evaluated for all RCTs using the Cochrane risk of bias tool. EVIDENCE SYNTHESIS This review included 43 studies: 9 experimental, 11 longitudinal, 22 qualitative, and 1 mixed method. All experimental studies examined advertising and consistently showed that exposure increased intentions to use e-cigarettes. Evidence of the influence of social interactions and social norms came from longitudinal and qualitative studies, suggesting that these factors could increase e-cigarette use. Most participants were nonsmokers (81%; 22,233 of 27,303). Studies rarely considered differences in the effects of social factors on smokers and nonsmokers. CONCLUSIONS Given the increased popularity among nonsmokers and the potential for advertising to increase e-cigarette use, closer public health monitoring of e-cigarette uptake by nonsmokers is warranted. Future primary research should be designed to measure how social factors affect smokers and nonsmokers differently.
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Affiliation(s)
- Samia Amin
- Center for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
| | - Adam G Dunn
- Center for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia; Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts
| | - Liliana Laranjo
- Center for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Brown R, Bauld L, de Lacy E, Hallingberg B, Maynard O, McKell J, Moore L, Moore G. A qualitative study of e-cigarette emergence and the potential for renormalisation of smoking in UK youth. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 75:102598. [PMID: 31785547 PMCID: PMC6983925 DOI: 10.1016/j.drugpo.2019.11.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 10/09/2019] [Accepted: 11/10/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Growth of e-cigarette use among smokers has raised concerns over uptake by non-smokers, particularly young people. Legislative changes aimed in part at reducing youth exposure to e-cigarettes include the EU Tobacco Products Directive (TPD). A core justification for such measures is the belief that e-cigarettes can lead to tobacco smoking through mechanisms of renormalisation including: mimicking and normalizing the act of smoking; increasing product acceptability via marketing; nicotine exposure. These mechanisms are here explored in relation to findings from qualitative research. METHODS This paper reports results from twenty-one group interviews with 14-15 year olds in Wales, England and Scotland, conducted as part of an ongoing evaluation of the impact of the TPD on youth smoking and e-cigarette use. Interviews were conducted around the end of the transitional period for TPD implementation, and explored perceptions of e-cigarettes and tobacco, as well as similarities and differences between them. RESULTS Young people differentiated between tobacco and e-cigarettes, rejecting the term e-cigarette in favour of alternatives such as 'vapes'. Experimental or occasional use was common and generally approved of where occurring within social activity with peers. However, regular use outside of this context was widely disapproved of, unless for the purpose of stopping smoking. Increased prevalence of e-cigarettes did not challenge strongly negative views of smoking or reduce perceived harms caused by it, with disapproval of smoking remaining high. Nicotine use was variable, with flavour a stronger driver for choice of e-liquid, and interest more generally. CONCLUSION The extent to which participants differentiated between vaping and smoking, including styles and reasons for use in adults and young people; absence of marketing awareness; and continued strong disapproval of smoking provides limited support for some of the potential mechanisms through which e-cigarettes may renormalise smoking. However caution over nicotine exposure is still necessary.
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Affiliation(s)
- R Brown
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, Cardiff University, UK.
| | - L Bauld
- Usher Institute of Population Health Sciences & Informatics, University of Edinburgh, UK; Director, SPECTRUM Consortium
| | - E de Lacy
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, Cardiff University, UK
| | - B Hallingberg
- Department of Applied Psychology, Cardiff Metropolitan University
| | - O Maynard
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, Bristol, UK/UK Centre for Tobacco and Alcohol Studies (UKCTAS) and School of Psychological Science, University of Bristol, Bristol, UK
| | - J McKell
- Institute for Social Marketing, University of Stirling and UK Centre for Tobacco and Alcohol Studies, UK
| | - L Moore
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, UK
| | - G Moore
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, Cardiff University, UK; SPECTRUM Consortium
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Bigwanto M, Nurmansyah MI, Orlan E, Farradika Y, Purnama TB. Determinants of e-cigarette use among a sample of high school students in Jakarta, Indonesia. Int J Adolesc Med Health 2019; 34:/j/ijamh.ahead-of-print/ijamh-2019-0172/ijamh-2019-0172.xml. [PMID: 31800392 DOI: 10.1515/ijamh-2019-0172] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 09/26/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The aim of this study was to determine the predisposing, enabling and reinforcing factors associated with electronic cigarette (e-cigarette) use among high school students in Jakarta, Indonesia. METHODS This cross-sectional study took place in eight high schools in Jakarta, Indonesia. A total of 767 students were recruited by multistage cluster random sampling. Bivariate and multivariate statistical analyses were employed to determine the associations between socio-demographic, predisposing, reinforcing and enabling factors and e-cigarette use. RESULTS Respondents were 54.1% male and the mean age was 16 years old [standard deviation (SD): 1.02]. In this sample, 32.2% of students (n = 247) had ever used e-cigarettes and 11.8% of students were e-cigarette users (n = 90). Several measured factors were positively associated with e-cigarette use, including: current smoking of conventional cigarettes [odds ratio (OR): 2.06]; perception that e-cigarettes are less addictive than conventional cigarettes (OR: 1.98); perception that e-cigarettes do not cause cancer (OR: 2.38); parental acceptance of e-cigarette use (OR: 3.80); and having enough money to buy e-cigarettes (OR: 3.24). The only variable found that was negatively associated with e-cigarette use was teacher's use of e-cigarettes (OR: 0.34). CONCLUSIONS This study found that student social influences, perceptions about and accessibility to e-cigarettes were significantly positively associated with e-cigarette use among high school students in Jakarta, Indonesia. This study highlights the importance of educating students, their parents and teachers regarding safety and potential health hazards of using e-cigarettes. Efforts to implement and enforce youth access restrictions on e-cigarettes in Indonesia are crucial to preventing further uptake of these products.
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Affiliation(s)
- Mouhamad Bigwanto
- University of Muhammadiyah Prof. Dr. Hamka, Faculty of Health Sciences, South Jakarta, Indonesia
| | - Mochamad Iqbal Nurmansyah
- Universitas Islam Negeri Syarif Hidayatullah Jakarta, Faculty of Health Science, Kertamukti No. 5 South Tangerang, Banten, 15412, Indonesia
| | - Elizabeth Orlan
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yoli Farradika
- University of Muhammadiyah Prof. Dr. Hamka, Faculty of Health Sciences, South Jakarta, Indonesia
| | - Tri Bayu Purnama
- Faculty of Public Health, Universitas Islam Negeri Sumatera Utara, Medan, Indonesia
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Patiño-Masó J, Font-Mayolas S, Salamó A, Arboix M, Sullman MJ, Gras ME. Predictors of intentions to use cigarettes and electronic-cigarettes among high school students. J Multidiscip Healthc 2019; 12:591-599. [PMID: 31534341 PMCID: PMC6681556 DOI: 10.2147/jmdh.s208031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/19/2019] [Indexed: 12/01/2022] Open
Abstract
Purpose Tobacco is the second most commonly used drug by Spanish high school students and e-cigarette use has increased over the last three years among this population. Students who reported smoking tobacco and/or e-cigarette use often have friends and family that also consume these substances. The aims of the present study were to: determine the prevalence of tobacco and electronic cigarette consumption among young adolescents, the age of initiation and the intention to consume both of these substances in the future; study the relationships between their current tobacco and e-cigarette consumption status, intentions to consume these substances in the future and the consumption of these substances by family members living in their home and friend’s consumption status; investigate the relationship between their current tobacco and e-cigarette consumption status, friends’ consumption status and their intention to consume each substance in the future; analyse the relationship between current consumption status, intentions to consume in the future and perceived risk; identify the main predictors of intentions to use these substances in the future. Methods A cross-sectional survey was conducted in 2017. The sample consisted of 468 school students in the first cycle of secondary education in Catalonia, Spain. The participants who were aged between 11 and 15 years old, with 49.4% being female. Results A stepwise binary logistic regression showed that the best predictors of the intention to smoke tobacco in the future were: having tried tobacco, being a current consumer, having a family member smoking at home and having a low perceived risk of smoking. The best predictors of the intention to use electronic cigarettes in the future were: having tried tobacco, being a current consumer and having friends who smoke or use electronic cigarettes. Conclusion Smoking prevention programs must consider the social network surrounding teenagers, particularly close friends and family. Intervention strategies for delaying the onset of tobacco or e-cigarette consumption are greatly needed.
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Affiliation(s)
- Josefina Patiño-Masó
- Department of Nursing, Institut de Recerca Sobre Qualitat de Vida, Universitat de Girona, Girona, Catalunya, Spain
| | - Sílvia Font-Mayolas
- Department of Psychology, Institut de Recerca Sobre Qualitat de Vida, Universitat de Girona, Girona, Catalunya, Spain
| | - Anna Salamó
- Department of Psychology, Institut de Recerca Sobre Qualitat de Vida, Universitat de Girona, Girona, Catalunya, Spain
| | - Montserrat Arboix
- Department of Health, Escola Municipal del Treball, Granollers, Catalunya, Spain
| | - Mark Jm Sullman
- Department of Social Sciences, School of Humanities and Social Sciences, University of Nicosia, Nicosia, Cyprus
| | - Maria-Eugenia Gras
- Department of Psychology, Institut de Recerca Sobre Qualitat de Vida, Universitat de Girona, Girona, Catalunya, Spain
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Lippert AM, Corsi DJ, Venechuk GE. Schools Influence Adolescent E-Cigarette use, but when? Examining the Interdependent Association between School Context and Teen Vaping over time. J Youth Adolesc 2019; 48:1899-1911. [DOI: 10.1007/s10964-019-01106-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 08/02/2019] [Indexed: 12/31/2022]
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Kirkcaldy A, Fairbrother H, Weiner K, Curtis P. Young people's perspectives of e-cigarette use in the home. Health Place 2019; 57:157-164. [PMID: 31054499 DOI: 10.1016/j.healthplace.2019.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/11/2019] [Accepted: 04/22/2019] [Indexed: 01/03/2023]
Abstract
There is concern that the emergence of e-cigarettes could result in an increase in young people's intake of, and exposure to, nicotine. This UK study used friendship group interviews to elicit the perspectives of young people from socioeconomically contrasting backgrounds regarding e-cigarettes. Young people from both advantaged and disadvantaged backgrounds described similar e-cigarette practices in the home environment, and, for both health and sensory reasons, viewed these as preferable to tobacco smoking. Space-related practices of adult e-cigarette use in the home were revealed to be more malleable than those of tobacco use. Results also highlighted that e-cigarettes offered young people new opportunities for nicotine consumption in the home. Methods of storing e-cigarettes in domestic spaces posed safety risks to younger children and easy access to e-cigarettes for others.
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Affiliation(s)
- Andrew Kirkcaldy
- School of Nursing and Midwifery, University of Sheffield, Barber House Annexe, 3a Clarkehouse Road, Sheffield S10 2LA, UK.
| | - Hannah Fairbrother
- School of Nursing and Midwifery, University of Sheffield, Barber House Annexe, 3a Clarkehouse Road, Sheffield S10 2LA, UK
| | - Kate Weiner
- Department of Sociological Studies, University of Sheffield, Elmfield, Northumberland Road, Sheffield S10 2TU, UK
| | - Penny Curtis
- School of Nursing and Midwifery, University of Sheffield, Barber House Annexe, 3a Clarkehouse Road, Sheffield S10 2LA, UK
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Cavallo DA, Kong G, Ells DM, Camenga DR, Morean ME, Krishnan-Sarin S. Youth generated prevention messages about electronic cigarettes. HEALTH EDUCATION RESEARCH 2019; 34:247-256. [PMID: 30753438 PMCID: PMC6424147 DOI: 10.1093/her/cyz001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 02/01/2019] [Indexed: 05/16/2023]
Abstract
Rates of e-cigarette use are high among youth, and there is little known about the long-term health effects of e-cigarettes. Since peer influence is a powerful determinant of tobacco use, we aimed to identify message themes about e-cigarettes that youth would use to encourage or discourage peers from using e-cigarettes. We conducted 10 focus groups (N = 69) with non-smokers and smokers from one middle school, high school and college in Connecticut. Participants engaged in a discussion about e-cigarettes, and each participant created one written message to encourage e-cigarette use and one to discourage use among peers. We content-analyzed the messages and identified three main themes and 12 encouraging and discouraging sub-themes. Encouraging themes included health benefits of e-cigarettes relative to cigarettes, attractive product characteristics (e.g. flavors) and social advantages (e.g. positive social image) of using e-cigarettes. Discouraging messages included health risks of e-cigarettes relative to cigarettes, unattractive product characteristics (e.g. cost) and social disadvantages (e.g. negative social image of using an e-cigarette). Overall, there were no differences by sex, age group or smoking status in generation of encouraging and discouraging message themes. This study identified youth-generated themes that may aid in e-cigarette prevention among youth.
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Affiliation(s)
- Dana A Cavallo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Grace Kong
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Daniel M Ells
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Deepa R Camenga
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Meghan E Morean
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychology, Oberlin College, Oberlin, OH, USA
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Farber HJ, Neptune E, Ewart G. U.S. Food and Drug Administration Regulation of Tobacco Products. Time for a Course Correction. Ann Am Thorac Soc 2019; 16:44-48. [PMID: 30407839 DOI: 10.1513/annalsats.201809-597ps] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Harold J Farber
- 1 Chair, Tobacco Action Committee, American Thoracic Society
| | - Enid Neptune
- 2 Vice Chair, Tobacco Action Committee, American Thoracic Society; and
| | - Gary Ewart
- 3 Chief, Advocacy & Government Relations, American Thoracic Society
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Curran KA, Burk T, Pitt PD, Middleman AB. Trends and Substance Use Associations With E-Cigarette Use in US Adolescents. Clin Pediatr (Phila) 2018; 57:1191-1198. [PMID: 29652181 DOI: 10.1177/0009922818769405] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Concerns exist that e-cigarette use may introduce adolescents to drugs. This study explores trends and associations of inhaled tobacco use with drug use. We performed a secondary data analysis on the National Youth Risk Behavior Survey examining the inhaled tobacco and drug use patterns among US teens. Adjusted odds ratios were calculated using bivariate and multivariate analyses between inhaled tobacco use with other drug use, adjusting for age, race/ethnicity, and gender. When adjusting for gender, age, and race/ethnicity, teens who use only e-cigarettes had a higher odds than peers who do not use any inhaled tobacco products to have ever tried marijuana or alcohol, currently use marijuana or alcohol, have lifetime drug use, and misused prescription medications. Drug risk behavior appears stratified with type of inhaled tobacco used, with generally exclusive e-cigarette use linked to lowest risk and conventional and e-cigarette use associated with highest risk of drug use.
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Affiliation(s)
- Kelly A Curran
- 1 University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Thad Burk
- 2 Oklahoma State Department of Health, Oklahoma City, OK, USA
| | - Paulette D Pitt
- 1 University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Amy B Middleman
- 1 University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Stroup AM, Branstetter SA. Effect of e-cigarette advertisement exposure on intention to use e-cigarettes in adolescents. Addict Behav 2018; 82:1-6. [PMID: 29471130 DOI: 10.1016/j.addbeh.2018.02.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/26/2018] [Accepted: 02/13/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION With the growth of electronic cigarettes use, curiosity about and experimentation with these products has increased among adolescents. The purpose of the present study was to evaluate the moderating effect of e-cigarette advertisement (ad) exposure on the relation between perceptions of use and intentions to use in youth. METHODS Multiple regression analyses utilizing data from the 2014 National Youth Tobacco Survey (N = 17,286) were used to evaluate the effect of ad exposure, perceived harmfulness, barriers, and benefits of e-cigarette use on intentions to use among youth who had never used e-cigarettes. RESULTS Models for non-smokers accounted for 15.5% of the variance in intention to use (R2 = 0.155, F (15) = 187.0, p < 0.001). Results demonstrate that an increase in the number of exposures to e-cigarette ads was associated with an increase in intent to use (b = 0.039, t = 7.4, p < 0.001). Models also demonstrated significant interactions between ad exposure and perceptions of use on future intention to use. For smokers, models explained 11.1% of the variance in intention to use (R2 = 0.111, F (15) = 3.1, p < 0.001). Ad exposure had a non-significant effect on intention to use e-cigarettes (b = -0.010, t = -0.2, p = 0.859). In smokers, ad exposure did not significantly affect the association between perceptions of use and intention to use. CONCLUSIONS Ads are most effective at attracting non-smoking youth as new users rather than promoting product switching in young cigarette smokers.
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Affiliation(s)
- Andrea M Stroup
- Pennsylvania State University, Department of Biobehavioral Health, 219 Biobehavioral Health Building, University Park, PA 16802, USA.
| | - Steven A Branstetter
- Pennsylvania State University, Department of Biobehavioral Health, 219 Biobehavioral Health Building, University Park, PA 16802, USA.
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Wickramasekara RN, Morrill S, Farhat Y, Smith SJ, Yilmazer-Hanke D. Glutathione and Inter-α-trypsin inhibitor heavy chain 3 (Itih3) mRNA levels in nicotine-treated Cd44 knockout mice. Toxicol Rep 2018; 5:759-764. [PMID: 29984189 PMCID: PMC6031235 DOI: 10.1016/j.toxrep.2018.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 06/07/2018] [Accepted: 06/16/2018] [Indexed: 11/18/2022] Open
Abstract
Chronic nicotine use that replaces tobacco smoking weakens antioxidant defense. Depletion of glutathione by chronic nicotine delivery may compromise liver health. Inter-α-trypsin Inhibitor Heavy Chain 3 (Itih3) mRNA correlates with glutathione. Nicotine and sex interact with Cd44 signaling in regulation of liver glutathione.
Cluster of differentiation 44 (Cd44), a hyaluronan receptor, and the secreted hyaluronan-binding protein Inter-α-trypsin Inhibitor Heavy chain 3 (Itih3) play an important role in cancer and oxidative stress. Smoking of tobacco reduces Itih3 in the plasma and activates hyaluronan signaling through Cd44, but the impact of Cd44 on Itih3 expression is unknown. Here, we studied changes induced by the tobacco component nicotine on the glutathione (GSH) antioxidant system and Itih3 gene expression in Cd44 knockout mice. Cd44 deficiency decreased baseline total GSH and oxidized glutathione (GSSG) levels in the liver compared to wildtype mice. However, contrary to wildtype mice, chronic oral nicotine administration (200 μg/ml) failed to further reduce total GSH and GSSG in Cd44 mice. Sex differences with lowered glutathione levels in females was also detectable only in wildtype but not Cd44 knockout mice. Itih3 mRNA levels in the liver and hypothalamus were not affected by nicotine, Cd44 genotype or sex. Nonetheless, the correlation between Itih3 and total GSH levels in the liver (r = 0.42, p < 0.05) suggested a role of Itih3 in glutathione metabolism in WT mice. Again this effect was diminished in Cd44 knockout mice. The disappearance of nicotine effects, sex differences and correlations between Itih3 and total GSH in Cd44 knockout mice compared to wildtype animals suggests an interaction between nicotine, Cd44 and/or sex-dependent signaling in the regulation of glutathione metabolism.
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Affiliation(s)
| | - Seth Morrill
- Department of Biomedical Sciences, School of Medicine, Creighton University, Omaha, Nebraska, USA
| | - Yasmine Farhat
- Department of Biomedical Sciences, School of Medicine, Creighton University, Omaha, Nebraska, USA
| | - Sarah J Smith
- Department of Biomedical Sciences, School of Medicine, Creighton University, Omaha, Nebraska, USA
| | - Deniz Yilmazer-Hanke
- Department of Biomedical Sciences, School of Medicine, Creighton University, Omaha, Nebraska, USA.,Center for Biomedical Research, School of Medicine, Ulm University, Germany
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Perceptions and Reasons Regarding E-Cigarette Use among Users and Non-Users: A Narrative Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061190. [PMID: 29882828 PMCID: PMC6025300 DOI: 10.3390/ijerph15061190] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 05/30/2018] [Accepted: 05/30/2018] [Indexed: 12/17/2022]
Abstract
This paper aims to provide an in-depth understanding of the attractiveness of e-cigarettes for several different groups. For this purpose, perceptions of and reasons for e-cigarette use were systematically reviewed as reported by e-cigarette users, cigarette smokers, dual users, and non-users, among both adults and youth. MEDLINE® and Scopus were used to search for relevant articles, and references of included studies were also investigated. Two reviewers screened all titles and abstracts independently, blinded to authors and journal titles (Cohen’s Kappa = 0.83), resulting in 72 eligible articles. Risk perceptions, perceived benefits, and reasons for e-cigarette use were categorized in themes and sub-themes. Risk perceptions included harmfulness in general, and specific health risks. Perceived benefits included improved taste and smell, and safety for bystanders. Reasons for use included (health) benefits, curiosity, smoking cessation, and friends using e-cigarettes. The findings highlight that there is a variety of perceptions and reasons mentioned by adult and youth e-cigarette users, cigarette smokers, dual users, and non-users. As such, this overview provides valuable information for scientists, public health professionals, behavior change experts, and regulators to improve future research, risk communication, and possibilities to effectively regulate e-cigarettes.
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Ferkol TW, Farber HJ, La Grutta S, Leone FT, Marshall HM, Neptune E, Pisinger C, Vanker A, Wisotzky M, Zabert GE, Schraufnagel DE. Electronic cigarette use in youths: a position statement of the Forum of International Respiratory Societies. Eur Respir J 2018; 51:13993003.00278-2018. [PMID: 29848575 DOI: 10.1183/13993003.00278-2018] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 04/23/2018] [Indexed: 12/12/2022]
Abstract
Children and adolescents are highly susceptible to nicotine addiction, which affects their brain development, even in those who smoke infrequently. Young people who become addicted to nicotine are at greater risk of becoming lifelong tobacco consumers. The use of nicotine-delivering electronic cigarettes has risen dramatically among youths worldwide. In addition to physical dependence, adolescents are susceptible to social and environmental influences to use electronic cigarettes. The product design, flavours, marketing, and perception of safety and acceptability have increased the appeal of electronic cigarettes to young people, thus leading to new generations addicted to nicotine. Moreover, there is growing evidence that electronic cigarettes in children and adolescents serve as a gateway to cigarette smoking. There can be no argument for harm reduction in children. To protect this vulnerable population from electronic cigarettes and other nicotine delivery devices, we recommend that electronic cigarettes be regulated as tobacco products and included in smoke-free policies. Sale of electronic cigarettes should be barred to youths worldwide. Flavouring should be prohibited in electronic cigarettes, and advertising accessible by youths and young adults be banned. Finally, we recommend greater research on the health effects of electronic cigarettes and surveillance of use across different countries.
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Affiliation(s)
- Thomas W Ferkol
- Depts of Pediatrics, Cell Biology and Physiology, Washington University in St Louis, St Louis, MO, USA
| | - Harold J Farber
- Dept of Pediatrics, Pulmonary Section, Baylor College of Medicine, Houston, TX, USA
| | - Stefania La Grutta
- Institute of Biomedicine and Molecular Immunology, National Research Council of Italy, Palermo, Italy
| | - Frank T Leone
- Dept of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Henry M Marshall
- University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Brisbane, Australia
| | - Enid Neptune
- Dept of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Charlotta Pisinger
- Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Aneesa Vanker
- Dept of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Myra Wisotzky
- International Union Against Tuberculosis and Lung Disease, Federal Way, WA, USA
| | - Gustavo E Zabert
- Dept of Clinical Medicine, FACIMED, Universidad Nacional del Comahue, Neuquen, Argentina
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McKeganey N, Barnard M. Change and Continuity in Vaping and Smoking by Young People: A Qualitative Case Study of A Friendship Group. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15051008. [PMID: 29772812 PMCID: PMC5982047 DOI: 10.3390/ijerph15051008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/11/2018] [Accepted: 05/15/2018] [Indexed: 12/27/2022]
Abstract
This paper reports a qualitative case study of a small friendship group (n = 8) in Glasgow, Scotland. Interviewed twice at six months apart, these 16 to 17 year olds reported a substantial change in their use of and attitudes towards e-cigarettes and tobacco. At time 1, vaping generated much excitement and interest, with six out of eight individuals having their own vape device. At time 2, only two young people still vaped, with the others no longer professing any interest in continued vaping. The two regular smokers, who had been smoking before they first vaped, now only vaped privately and to reduce their tobacco intake. This small case study illustrates plasticity in the use of these devices; just as young people can move into their use, so too can they move away from them. This small study underscores the importance of differentiating between long-term, frequent, consistent use and more episodic, experimental and infrequent use by young people and for undertaking a measurement of actual e-cigarette use at multiple time points in both quantitative and qualitative studies. In addition, the case study illustrates the powerful impact which peers can have on teenagers use of e-cigarettes.
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Affiliation(s)
- Neil McKeganey
- Centre for Substance Use Research, Block 3/2 West of Scotland Science Park, Kelvin Campus, Maryhill Road, Glasgow G20 0SP, UK.
| | - Marina Barnard
- Centre for Substance Use Research, Block 3/2 West of Scotland Science Park, Kelvin Campus, Maryhill Road, Glasgow G20 0SP, UK.
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East K, Hitchman SC, Bakolis I, Williams S, Cheeseman H, Arnott D, McNeill A. The Association Between Smoking and Electronic Cigarette Use in a Cohort of Young People. J Adolesc Health 2018; 62:539-547. [PMID: 29499983 PMCID: PMC5938086 DOI: 10.1016/j.jadohealth.2017.11.301] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 11/28/2017] [Accepted: 11/28/2017] [Indexed: 01/05/2023]
Abstract
PURPOSE Electronic cigarette (e-cigarette) use is associated with smoking initiation among young people; however, it is also possible that smoking is associated with e-cigarette initiation. This study explores these associations among young people in Great Britain. METHODS A longitudinal survey of 1,152 11- to 18-year-olds was conducted with baseline in April 2016 and follow-up between August and October 2016. Logistic regression models and causal mediation analyses assessed whether (1) ever e-cigarette use and escalation were associated with smoking initiation (ever smoking at follow-up) among baseline never smokers (n = 923), and (2) ever smoking and escalation were associated with e-cigarette initiation (ever e-cigarette use at follow-up) among baseline never e-cigarette users (n = 1,020). RESULTS At baseline, 19.8% were ever smokers and 11.4% were ever e-cigarette users. Respondents who were ever e-cigarette users (vs. never users, 53% vs. 8%, odds ratio [OR] = 11.89, 95% confidence interval [CI] = 3.56-39.72) and escalated their e-cigarette use (vs. did not, 41% vs. 8%, OR = 7.89, 95% CI = 3.06-20.38) were more likely to initiate smoking. Respondents who were ever smokers (vs. never smokers, 32% vs. 4%, OR = 3.54, 95% CI = 1.68-7.45) and escalated their smoking (vs. did not, 34% vs. 6%, OR = 5.79, 95% CI = 2.55-13.15) were more likely to initiate e-cigarette use. There was a direct effect of ever e-cigarette use on smoking initiation (OR = 1.34, 95% CI = 1.05-1.72), and ever smoking on e-cigarette initiation (OR = 1.08, 95% CI = 1.01-1.17); e-cigarette and smoking escalation, respectively, did not mediate these effects. CONCLUSIONS Among young people in Great Britain, ever e-cigarette use is associated with smoking initiation, and ever smoking is associated with e-cigarette initiation.
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Affiliation(s)
- Katherine East
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; UK Centre for Tobacco and Alcohol Studies, Clinical Sciences Building, University of Nottingham, Nottingham, UK.
| | - Sara C Hitchman
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; UK Centre for Tobacco and Alcohol Studies, Clinical Sciences Building, University of Nottingham, Nottingham, UK
| | - Ioannis Bakolis
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Centre for Implementation Science, Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sarah Williams
- Public Health England, London, UK; Action on Smoking and Health UK, London, UK
| | | | | | - Ann McNeill
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; UK Centre for Tobacco and Alcohol Studies, Clinical Sciences Building, University of Nottingham, Nottingham, UK
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Laverty AA, Vamos EP, Filippidis F. Uptake of e-cigarettes among a nationally representative cohort of UK children. Tob Prev Cessat 2018; 4:16. [PMID: 32411844 PMCID: PMC7205139 DOI: 10.18332/tpc/89727] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 03/23/2018] [Accepted: 04/03/2018] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Using nationally representative data this study examined experimentation with and regular use of e-cigarettes among children not using tobacco at age 11 years, followed up to age 14 years. METHODS Data come from 10 982 children in the UK Millennium Cohort Study. Logistic regression assessed experimentation with and current use of e-cigarettes by age 14 years. We considered associations of sociodemographics at age 11 years with subsequent e-cigarette use, including data on family income, peer and caregiver smoking. Subsequent models were adjusted for current tobacco use to assess both the strength of the assocations between e-cigarette use and tobacco, and whether sociodemographics were associated with e-cigarettes independently of tobacco. RESULTS Among 10 982 children who reported never smoking at age 11 years, 13.9% (1525) had ever tried an e-cigarette by age 14 years, and of these 18.2% (278) reported being current users. Children in lower income households were more likely to have tried an e-cigarette than those in higher income households (Adjusted Odds Ratio, AOR 1.89, p=0.002). Children who reported friend (AOR 2.28, p<0.001) or caregiver smoking (AOR 1.77, p<0.001) at age 11 years were more likely to have tried an e-cigarette by age 14 years. After adjusting for current tobacco use, there was some attenuation of these associations, although associations of friend and caregiver smoking with e-cigarette use remained statistically significant. CONCLUSIONS Children from lower income families were more likely to experiment with e-cigarettes by age 14 years, although this was heavily mediated by concurrent tobacco use. Caregiver and friend smoking are linked to trying e-cigarettes, although these relationships are less clear for regular e-cigarette use.
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Affiliation(s)
- Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
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Anyanwu PE, Craig P, Katikireddi SV, Green MJ. Impacts of smoke-free public places legislation on inequalities in youth smoking uptake: study protocol for a secondary analysis of UK survey data. BMJ Open 2018; 8:e022490. [PMID: 29593026 PMCID: PMC5875608 DOI: 10.1136/bmjopen-2018-022490] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 02/28/2018] [Accepted: 03/05/2018] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Smoke-free public places legislation has been introduced in many countries to protect the public from the harmful effects of secondhand smoking. While evaluations of smoke-free policies have demonstrated major public health benefits, the impact on youth smoking and inequalities in smoking remains unclear. This project aims to evaluate how smoke-free public places legislation in the UK has impacted on inequalities in youth smoking uptake, and how much of any impact is via changes in parental smoking behaviour. METHODS AND ANALYSIS The study will constitute secondary analyses of UK data (from the British Household Panel Survey and the Understanding Society study). Merging these datasets gives coverage of the period from 1994 to 2016. Missing data will be handled using multiple imputation. The primary outcomes are the rates and inequalities in initiation, experimentation, escalation to daily smoking and quitting among youths aged 11-15 years. Secondary outcomes include the prevalence of smoking among parents of these youths. Discrete-time event history analysis will be conducted to examine whether changes in the probability of youth smoking transitions are associated with the implementation of the smoke-free public places legislation; and whether any observed effects differ by socioeconomic position and parental smoking. A multilevel logistic regression model will be used to investigate whether there is a step change or change in trend for the prevalence of parental smoking after the policy was implemented. The models will be adjusted for relevant factors (including cigarette taxation, the change in the legal age for purchase of cigarettes and e-cigarette prevalence) that may be associated with the implementation of the legislation. ETHICS AND DISSEMINATION This project will use anonymised survey data which have been collected following independent ethical review. The dissemination of the study findings will adopt multiple communication channels targeting both scientific and non-scientific audiences.
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Affiliation(s)
- Philip Emeka Anyanwu
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Well-Being, University of Glasgow, Glasgow, UK
| | - Peter Craig
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Well-Being, University of Glasgow, Glasgow, UK
| | - Srinivasa Vittal Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Well-Being, University of Glasgow, Glasgow, UK
| | - Michael James Green
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Well-Being, University of Glasgow, Glasgow, UK
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Peck MJ, Sanders EB, Scherer G, Lüdicke F, Weitkunat R. Review of biomarkers to assess the effects of switching from cigarettes to modified risk tobacco products. Biomarkers 2018; 23:213-244. [PMID: 29297706 DOI: 10.1080/1354750x.2017.1419284] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Context: One approach to reducing the harm caused by cigarette smoking, at both individual and population level, is to develop, assess and commercialize modified risk alternatives that adult smokers can switch to. Studies to demonstrate the exposure and risk reduction potential of such products generally involve the measuring of biomarkers, of both exposure and effect, sampled in various biological matrices.Objective: In this review, we detail the pros and cons for using several biomarkers as indicators of effects of changing from conventional cigarettes to modified risk products.Materials and methods: English language publications between 2008 and 2017 were retrieved from PubMed using the same search criteria for each of the 25 assessed biomarkers. Nine exclusion criteria were applied to exclude non-relevant publications.Results: A total of 8876 articles were retrieved (of which 7476 were excluded according to the exclusion criteria). The literature indicates that not all assessed biomarkers return to baseline levels following smoking cessation during the study periods but that nine had potential for use in medium to long-term studies.Discussion and conclusion: In clinical studies, it is important to choose biomarkers that show the biological effect of cessation within the duration of the study.
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Affiliation(s)
| | | | | | - Frank Lüdicke
- Research & Development, Philip Morris International, Neuchâtel, Switzerland
| | - Rolf Weitkunat
- Research & Development, Philip Morris International, Neuchâtel, Switzerland
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Abstract
Electronic cigarettes, or e-cigarettes as they are commonly called, have gained wide acceptance among adolescents, especially those with sweet flavors such as bubble gum and cheesecake. Although health effects of e-cigarettes have not been well characterized, their use increases a teen's exposure to nicotine and may serve as a gateway to traditional cigarettes. This article outlines the basics of e-cigarettes and potential health hazards, followed by selected literature on teens' perceptions of e-cigarettes, as well as motivational interviewing strategies that can be used in talking to teens about using electronic cigarettes.
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Affiliation(s)
- Vania Modesto-Lowe
- 1 Connecticut Valley Hospital, Middletown, CT, USA.,2 University of Connecticut School of Medicine, Farmington, CT, USA.,3 Quinnipiac University, Hamden, CT, USA
| | - Camille Alvarado
- 2 University of Connecticut School of Medicine, Farmington, CT, USA
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